Implant Removal

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Does anybody have any ideas on ways to remove implants atraumatically? This implant needs to be removed as it is too large and placed out of position. I don’t really want to trephine it because of the risk of damaging tooth #28. I have heard of people touching the implant with an electrosurge unit to necrose the adjacent bone. Any thoughts?

Thanks,

Tony

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Section it from the inside to minimize the effect on the adjacent bone.
Use a microscope if you have one. And be very patient.
There is no atraumatic solution, sparks will fly.
The electrocution of an implant is not predictable. Does Minnesota allow the death penalty by electrocution?

You may just luck out and be able to unscrew it. Believe it or not that happened and it made my day taking out #8 and 9 implants one day. Let’s all say a prayer for Tony.

All the best,

John

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Hi Tony,
Removing an implant of that size is a “bear”. If you are absolutely certain it must be removed then I might consider using a Piezo extraction tip along the interproximal surface, a little at a time until I could get a purchase with a periotome ( preferably from H and H manufacturer) and luxate. Alternating between the Piezo and the periotome being careful to not overheat the bone with the Piezo. With patience, I’m sure it will move enough to back out. Internal sectioning of the implant may prove very messy. It’s not easy to cut through the implant internally the entire length of that beast. I suspect post implant removal bone grafting will be necessary.
Good Luck . Love to see post op photos!

Ed

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I agree. I have used the pieazo peristome tip. Take a little away and then try to reverse torque the implant with a placement driver from whatever kind it is. If t does not torque the takes little more bone away with he pieazo. Take it slowly. I have done this many times with much success

James

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Thanks for your input. This patient was referred to me to finish the implant care in the lower right. The current implant was already placed (and unfortunately integrated) prior to me getting involved. The implant is a 6mm diameter Zimmer. It is placed too far distal and too shallow. The patient has high esthetic demands which cannot be met given the current implant position. It was placed by another periodontist in the area. I am assuming it was placed immediately and the surgeon used a wide implant to attain primary stability via the lateral walls of the socket. The implant is healthy, just positioned poorly. I have tried to convince the patient to restore it even though it is not ideal, but she wants something that will look better.

Thank you to all who have chimed in. I truly appreciate your thoughts and prayers!

Tony

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I remove implants the same as Ed with the addition of after using the piezo ext tip circumferentially, and a luxator, I engage the implant with the ratchet and insertion tool and attempt to back it out.

Mark

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Dear Tony,
I had not seen the xray of the implant when I posted a few minutes ago. Now that I have viewed the reality of your dilemma, punt.

Mark

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Hi Tony,

Be prepared to buy all new piezo inserts when trying to remove the implant that way. You’ll still remove plenty of bone around the fixture. Bone that you cannot afford to remove looking at the radiograph. Good luck!

All the best,

John

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Hi Tony,

The way I like to handle implant removal cases in general and especially posterior mandible is to use Piezo for outlining a buccal plate osteotomy and removing the implant from the buccal. Although this sacrifices the plate it is straightforward to graft and obtain adequate bone volume for optimal implant placement. I have found this approach to be much better and more straightforward than most any other way for this location for sure. Hope this helps.

All the best,

Michael

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Hi Michael,
Your approach looks to be very practicle. What would you do to repair the remaining 4 wall defect? Infuse?
I have not yet read your paper but I look forward to the gems I am sure are there.
Happy Easter to you and all that will be celebrating. And an enjoyable Passover Ceder for most of the rest of us.

Mark

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Hi Mark,

The remaining 4 wall defect can be grafted in several ways. I have used Infuse with mineralized allograft (MinerOss) I have also used recombinant PDGF(Gem 21) with MinerOss. Both approaches have worked well, the later of course being less expensive. I typically wait 6 months prior to reentry. As far as membranes are concerned I use the buccal PTFE reinforced membrane (Osteogenics) and secure it with the Profix screws (these are 3 mm length screws that are self-threading).

I found this approach for the mandibular cases to be very predictable and yes, practical. Hope this helps. Wishing you a blessed Passover Ceder.

All the best,

Michael

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Thanks, Michael,

I would not have used a barrier with the Infuse and particulate. Is this a mistake?
I would have with the PDGF.
Thanks,

Mark

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Hi Tony,

I think if you platform switch using a narrower custom abutment & place a nice temporary, your pt. may be satisfied, considering that the gingival margin of a lower premolar isn’t seen by anyone except her when she pulls her cheek out. Nothing much to lose vs. a very destructive surgery, ridge reconstruction & new implant whose bill she will tell you to send to her previous therapist. Been there. Good luck.

Ted

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Great idea, Mike.

A couple of questions. What do you place coronally over the defect/graft? Or are you going for primary closure, depending on the location of the foraman. As far as progenitor cell recruitment goes, do you feel you get enough from the other “walls” of the defect so don’t worry about what may be coming from the periosteum?

Bob

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After reading your note, I called Zimmer and found that they sell an implant retrieval tool kit that will dislodge the implant from the site. You should speak with them because they sell various types of retrieval tools.

Good luck with the case,

Jay

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Hi Mark,

I have had equal success using barriers with Infuse and particulate. It is definitely not a mistake to not use a barrier. For sure with particulate PDGF it is in order. Hope this helps.

Mike

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Thanks Michael.

You have been teaching me for almost 20 years. I hope I have been learning from you for equally as long.

Mark

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