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Dental implants are successfully used to replace the missing teeth. Despite the predictability of success of dental implants.

Dental implants have a high success rate, but some people experience dental implant failure. It’s estimated that about 5 to 10 percent of dental implants fail, either shortly after a procedure or months or years later.

Video: Full (Edited) Surgical Protocol  Including Preparation, Explantation, GBR & Closing Suturing 

Numerous factors can affect the success of a dental implant. These include gums disease, smoking, insufficient jaw bone, medical conditions like uncontrolled diabetes and rheumatoid arthritis, poor dental maintenance, poor oral hygiene, an inexperienced surgeon, type of implants, the precision of surgical technique and misplaced implants.

Examples of misplaced implants:

  1. Placing the implants too buccal which can cause a fracture in the buccal bone
  2. Placing the implants too close to a tooth or to a tooth root – which can lead to bone deficiency around the implant and hence less blood supply.

The patient presented in this case was referred by her prosthodontic, after she complained for the past 2 weeks of pain, swelling and pus formation that came from the implants , implanted by her MFS. The patient is 69 years old and healthy.

Based on chronological criteria, the biological failures can be classified a “early failures” (due to unsuccessful osseointegration, indicating impaired bone healing) and “late failures” (due to loss of osseointegration).

Several factors may be associated with early implant failure such as smoking, implant characteristics, infection, and insufficient bone quality/quantity. Recognition of risk factors can reduce the failure rate and increase the predictability of dental implant treatment.

After an implant is removed, the patient is left with a difficult decision regarding replacement options. A removable prosthesis may be a possibility, but it is often not the first choice of therapy. A fixed partial denture on adjacent natural teeth can also be a treatment option if there is a single implant site failure. This option is predicated, however, upon the patient agreeing to preparation of the natural teeth as well as the abutment teeth having enough periodontal support to withstand the forces of a bridge. Most of the time, the patient will choose to replace the failed dental implant with placement of another implant.

Replacement of a failed dental implant with a second implant has varying survival rates in the literature and have been reported to be in the range of 69% to 91%.

In addition to having lower success rates than the initial implants, replacement implants often require additional soft- and/or hard-tissue grafts, longer time to heal, new abutments/crowns, and possible additional financial costs for the patient.

Prior to re-implantation, ascertaining the etiology of the initial implant failure is certainly warranted. In addition, methods to improve osseointegration of the replacement implant should be employed.

In this case, the etiology of implant 24 failure could be the misplacement of the implants, thus, sequentially buccal plate and blood supply was destroyed. Vascularity to the hard and soft tissue surrounding a dental implant is vital to its osseointegration. (see XR before explantation)

Implant 25 was lost due to fibrous downgrowth. (See XR explantation)

XR Showing Misplaced Implants

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Fracture in Palatal Buccal Plate

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After consulting with the patient prosthodontist, the following steps were taken:

  1. Explantation of implants 24 and 25 were done and followed by a meticulously remove all soft tissue, remove of some amalgam remnants, disinfection of the residual implant socket and surrounding tissue with sterile saline solution and last but not least increasing angiogenesis to the hard and soft tissue by decortication.
  2. In order to restore the loss of bone and to correct the fracture on the buccal plate a GBR was done with allograft bone and collagen membrane. (see XR after GBR)
  3. Ensuring complete closure by suturing with resorbable and nylon sutures.

New implant will be placed 6 months after GBR.

XR After Explantation

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