point of view , assessing implant mobility is of no value since it reflects irreparable damage . If there is residual osseointegration and the implant is not mobile , one can use special instruments to unscrew the implant with or without raising a flap . And if the situation requires it , one can raise a flap and remove as little bone as necessary to unscrew the implant .
“ The wide range of reported prevalence of peri-implantitis in the literature reflects the high heterogeneity of clinical and radiographic thresholds adopted for disease definition .”
Can the use of biomaterials help following explantation ?
First , patients should be informed about the indications , origin and scientific documentation of the biomaterials used following explantation . As illustrated in the clinical case ( Fig . 1 ), following explantation it may be necessary to use biomaterials as adjuncts to the reconstruction of the alveolar crest with an autologous bone block . This may be accomplished by using a deproteinized bovine bone material ( Geistlich Bio- Oss ® or Geistlich Bio-Oss Collagen ® ) covered with layers of a resorbable collagen barrier membrane ( Geistlich Bio-Gide ® ). In cases of augmentation of the peri-implant soft tissue volume , the use of a collagen matrix ( Geistlich Fibro-Gide ® ) may be considered .
How do you prepare patients for implant complications , including implant loss ?
Sometimes patients are not sufficiently informed about long-term technical and biological implant complications . Signs of early complications , such as soft tissue inflammation and initial bone loss , are not accompanied by symptoms detectable by the patient , such as pain and implant mobility . Therefore , early diagnosis by dental professionals ¹ ⁴ and therapy of initial complications⁹ , ¹¹ are highly recommended to prevent greater damage or even implant loss .
When was the last time you had to explant an implant ?
An explantation should not be the first choice when complications occur . Very recently , however , I had an explantation that was unavoidable after a large-diameter implant had been placed in the esthetic area immediately following tooth extraction , without respecting a correct prosthetic positioning , and restored with a single-unit crown that was not accessible for plaque control .
Are implants placed after explantation still predictable ?
Following explantation , a reevaluation of the clinical and radiographic situation is indicated . Depending on the chief complaint of the patient and the residual risks , several options for the new prosthetic rehabilitation should be considered . These may involve removable as well as fixed tooth- or implant-supported reconstructions . Despite the lower survival rate of implants placed in sites of previous explantation ¹³, a new treatment plan , including the use of new implants , may be considered .
References 1 Esposito M , et al .: Eur J Oral Sci . 1998 ; 106 ( 1 ): 527-51 . ( systematic review ) 2 Berglundh T , et al .: J Periodontol . 2018 ; 89 Suppl 1 : S313-S318 . ( consensus report ) 3 Derks J , Tomasi C .: J Clin Periodontol . 2015 ; 42 Suppl 16 : S158-71 . ( clinical study ) 4 Ferreira SD , et al .: J Clin Periodontol . 2006 ; 33 ( 12 ): 929-35 . ( clinical study ) 5 Heitz-Mayfield LJ , Huynh-Ba G .: Int J Oral Maxillofac Implants . 2009 ; 24 Suppl : 39-68 ; 33 ( 12 ): 929-35 .
( clinical study ) 6 Sgolastra F , et al : Clin Oral Implants Res . 2015 ; 26 ( 4 ): e8-e16 . ( meta-analysis ) 7 Serino G , Ström C .: Clin Oral Implants Res . 2009 ; 20 ( 2 ): 169-74 . ( clinical study ) 8 Wilson TG Jr .: J Periodontol . 2009 ; 80 ( 9 ): 1388-92 . ( clinical study ) 9 Roccuzzo M , et al .: Clin Oral Implants Res . 2014 ; 25 ( 10 ): 1105-12 . ( clinical study ) 10 Monje A , et al .: J Periodontol . 2017 ; 88 ( 10 ): 1030-1041 . ( clinical study ) 11 Costa FO , et al .: J Clin Periodontol . 2012 ; 39 ( 2 ): 173-81 . ( clinical study ) 12 Heitz-Mayfield LJA , et al .: Clin Oral Implants Res . 2018 ; 29 ( 1 ): 1-6 . ( clinical study ) 13 Machtei EE , et al .: Clin Oral Implants Res . 2008 ; 19 ( 3 ): 259-64 . ( clinical study ) 14 Salvi GE , Zitzmann NU .: Int J Oral Maxillofac Implants . 2014 ; 29 Suppl : 292-307 . ( systematic review )
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