Removal of failed dental implants revisited: Questions and answers

Abstract

Objectives: This narrative review is aiming on showing reasons for implant failure, removal techniques, and respective clinical considerations; further, the survival rate of implants in previous failed sites is examined.

Materials and methods: Questions have been formulated, answered, and discussed through a literature search including studies assessing implant failure and removal up to 2018.

Results: Studies describing reasons for implant failure, implant removal techniques, and the reinsertion of implants in a previous failed site (n = 12) were included. To date, peri-implantitis is the main reason for late implant failure (81.9%). Trephine burs seem to be the best-known method for implant removal. Nevertheless, the counter-torque-ratchet-technique, because of the low invasiveness, should be the first choice for the clinician. Regarding zirconia implant removal, only scarce data are available. Implantation in previously failed sites irrespective of an early or late failure results in 71% to 100% survival over 5 years.

Conclusion: If removal is required, interventions should be based on considerations regarding minimally invasive access and management as well as predictable healing. (Post)Operative considerations should primarily depend on the defect type and the consecutive implantation plans.

Keywords: dental implants; explantation; failing implant; implant removal.

Figure 1

Classification of etiologic reasons for an implant failure (11)

Figure 2

Illustration showing the reverse screw technique. (a) Preoperative X‐ray showing advanced peri‐implantitis in Region 38. (b) Removal of the temporary cemented three‐piece bridge. (c) Disconnection of the abutment. (d) (I) If needed, a trephine bur is used to remove the first 2 cm of bone‐to‐implant contact (in this case not needed); (II) the screw is applied and cut counterclockwise into the implant; (III) counterclockwise torque is applied until the implant becomes loose and is unwinded. (e) Removed implant from Region 38. (f) Post‐operation site. (g) (IV) The socket has been kept in good condition and ready for regeneration and/or for a new implant (V) (as described by Anitua and Orive, 2012)

Figure 3

Clinical case with a combined approach using a forceps (d) (minute residual bone) and the reverse screw technique (e). (a,b) Preoperative clinical situation. (c) X‐ray. Arrows showing the bone defect depth (d). Removal of the implant (c,f) with a forceps by counterclockwise rotation. (e) Implant removal (c,g) with the reverse screw technique. Arrows showing height of previous bone level. (f,g) Showing both implants after removal. Arrows showing height of previous bone level

Figure 4

Clinical recommendations