Failed Dental Implant
Removing a Failed Dental Implant is a Safe and Relatively Easy Process
What is the best approach for removing a failed dental implant? Dental implants are becoming more and more widely accepted in the world of restorative dentistry. However, there is a growing problem emerging with dental implants and in some cases the issues that arise require there removal. In most instances, removing a failed dental implant is a safe and relatively easy process. But it depends on the case because some implants that are fully integrated with the bone, may cause severe bone loss and trauma and thus require a very conservative approach. At Westcoast International Dental clinics throughout Vietnam, we’re well experienced with the latest implantology techniques and procedures.
Why dental implants fail?
To understand dental implant failure, we have to first understand the types of failure that can occur. In general, there are two classes of implant failures that are based on timing. We have "early failures" that occur within the first few months of when the implant is surgically placed. In these cases, the bone has not formed rigidly around the implant and the implants are usually very easy to remove. In many early failures, the implant is quite loose. This is often due to poor healing ability of the patient, infection, lack of stability when it was placed (not firm enough in the bone) or most likely micro motion (too much movement of the implant during the healing process).
This article doesn’t really focus on the way to remove early failures because these implants are already very loose and easy to "unwind and remove".
"Late failures" can be considered occurring after a year after the tooth has been in function. In these cases, it is possible that the implant was firm and then gets loose. This may be due to infection or too much force on the implant. This occurs often with premature overloading of an implant where it spontaneously is rejected. This type of late failure is easy to remove much like the early failure.
In most other late failure cases, the implant is rigid but X-rays show a pattern of implant disease called "perio-implantitis", where bacteria has developed and is destroying the bone around the neck of the implant. Perio-implantitis is a growing concern with dentists and patients because it represents an active infection with a dental implant. This infection manifests as sometimes with pain, plus, abscess and bad odor. Measures are required to stop this disease. Unfortunately in many cases, the implant should be removed to prevent spreading pain, infection and further bone loss.
Recent studies from Sweden have been showing that 26% of implants placed 5-10 years ago show signs of perio-implantitis!
Finally, another reason your implant might need to be removed, if it’s in the wrong position? When it’s in the wrong position, it’s considered a failure because there is trouble restoring the implant into proper function or esthetics. This is highly preventable with proper treatment and planning.
Are some dental implants easier to remove than others?
If you have an failed dental implant that needs removing, then the adherence depends on your bone quality. In general, implants in the lower jaw are more difficult to remove than the upper jaw. But implants in the upper jaw may also be very firm. Duration is a factor too. Over 24 months is a significant period in which the bone and implant firmly set together.
We even see that implants with only 2-3 mm of bone still around the implant, the implant fixture is very firm. This is because bone forms a very strong chemical bond to the implant surface.
Another consideration is the width, length and connection of the implant. Wider and longer implants are obviously more difficult because there is more bonding to bone. Narrow implants can be more difficult because the implant top may fracture under high stress during removal. Strange and unusual external connections are present with more than 1000 brands of implants, which can make it difficult for some removal tools to fit into the existing connections. Essentially limiting the easy facilitation of the extraction!
Finally, some implants are near structures such a lower nerve or upper sinus. Great care is needed to prevent damage to adjacent teeth and sensitive structures.
Can another dental implant be placed after the failed one is removed?
In some cases, a new implant can be immediately placed in the site along with a bone grafting procedure to support the new implant. This immediate implant replacement option will save you time and prevent the need for a follow up surgery, which would also save you money.
Sometimes a failed dental implant can’t be replaced quickly because of the size of destruction. Removals that end up creating a much bigger hole than the implant fixture make it harder or impossible to replace the implant. Therefore, it is very important to attempt to remove implants in a gentle way, and be prepared to include a bone grafting procedure in the area for reducing the loss of healthy bone. The bone grafting procedure is aimed at creating a healthier bone site for the placement of a future implant.
My Dentist says we may be able to save my implant with bone grafting. Is it worth a try or should it be removed?
This is one of the critical discussions going on in implant dentistry these days. There are samples of success stories of failing or ailing implants that receive a second chance to integrate with a surge of new bone growth.
However, the chance of re-growing bone successfully over a challenged implant is under 8-25%. The risk of contamination is ever present and there is also a high probability that perio-implantitis will emerge again. On a positive note, studies do illustrate if there is good tissue growth on the sides of the implant and you keep the implant very clean, it may last longer. Currently the research is very mixed in terms of the approaches to use to save ailing implants in terms of antibiotics, techniques for surface decontamination and techniques and materials for bone regeneration. Each dental implant is different in its surface features and therefore it requires significant consideration to decide what techniques might work best for each type of dental implant surface.
Also, there are many factors to consider when performing this salvage procedure. Including what kind of defect or failure occurred and the amount of bone loss you’ve sustained. The design of your implant, oral hygiene level and access for cleaning, whether you’re a smoker or not and your general medical condition all important elements in this process.
Common implant removal methods - techniques
The key is to preserve as much healthy bone as possible in the removal process. Essentially the best tools used to remove an implant would be ones that have enough force to remove an implant without causing significant damage. It is possible to remove an implant in some cases with almost no bone removal. This is the ideal goal and highest-best approach.
In order to remove a failed dental implant there are two approaches that are generally used. One method involves the use of a cutting device, called a trough bur. This tool is designed to cut a small portion of your bone (0.5 – 1.0 mm) safely and accurately along the implant edge, which will release the tension on the implant and expedite its removal. At Westcoast we prefer using an instrument called a piezo-electric device with a special micro tip. Piezo tomes use an ultrasonic type of energy to gently remove bone around an implant.
Again the key is to minimize the removal of tiny amounts of bone from each side of the implant which will facilitate its removal. It’s usually best to keep as much bone around the front and back walls of the implant area as possible when engaged because the other areas can often regenerate spontaneously.
Finally, new technological breakthroughs in removal systems are coming. They are not perfect and the skill and experience of your dentist is important in knowing how to use the tools. These removal systems use high reverse torque and may remove your failed dental implant in a few minutes. Often, these high-torque tools are connected or hooked to the adapter and a high amount of reverse torque is applied, efficiently removing the implant from the bone.
There are 3 brands currently on the market. This combined with other techniques and a careful plan is the best way to remove a failed dental implant.
At Westcoast we have and use all three of the devices in our state of the art practices. This makes it possible for us to safely and easily remove just about any implant currently being sold. The key element to remember when an implant fail’s, is to make sure that it’s extracted without disrupting or removing any more of the adjoining bone than is necessary.
If you are tourist traveling in Vietnam or are full time resident and find yourself needing a competent specialist to remove one or more of your implants or have other related issues? Feel free to contact us, as we’d be glad to assist you. At Westcoast our dental teams are constantly seeking to improve their knowledge and skills and are committed to offering patients cutting edge treatment technologies, using the most effective, safest, procedures and products available.