DR. KONSTANTINOS NIKOLOPOULOS
BDS, FFD (SA) MFOS, South Africa; Oral & Maxillofacial Surgeon – Dubai, UAE
Management of Failed Implant Cases
Reported dental implant success rates are high resulting in an ever-increasing number of patients being treated with implants. Nevertheless, implant failures due to peri-implantitis & bone loss do occur. The most predictable management of these cases appears to be implant removal & replacement. The aim of this lecture is to describe an atraumatic method & treatment modality in dealing with these dental implant cases. Over time the percentage of dental implants that fail increases because of biological and technical issues. Inevitably clinicians will have to dedicate more time to dealing with ailing and failing dental implants. The clinical presentation of ailing and failing implants is peri-implantitis. This is an inflammatory disease of bacterial origin with bone loss. The prevalence of peri-implantitis varies between studies from 6 % to 36%. The decision to treat or remove (explant) a failing implant is a judgment that needs to be made by the treating clinician and needs to be based both on clinical and radiographic evaluation. Dental implant removal may be indicated in cases of advanced bone loss around implants. If a non-mobile infected implant is deemed hopeless and needs to be explanted usually it no longer needs to be removed by the traditional destructive “trephine” technique. Implant removal devices are now available that facilitate removal of failed implants with a predictable technique that permits conservative implant extraction and the same time preserving most of the viable soft and hard tissue.
This clinical protocol aims to:
- Explant the infected implant.
- Decrease the bacterial load by curettage and decontamination of the implant socket.
- Maintain the regenerative capacity of the surrounding alveolar walls.
- Achieve primary stability for the immediate replacement implant either in the same or adjacent site.
- Immediately load the replacement implants.
- Identify failed implants requiring removal & replacement.
- Identify an atraumatic method of removing failed implants.
- Become familiar with the concept of immediate replacement of failed implants in the same or adjacent site
- Become familiar with the protocol of immediate loading replaced implants.
- Identify cases where immediate replacement is not possible, and a delayed protocol is indicated.