Dental implants are highly successful and predictable when performed by skilled oral surgeons, properly positioned, and appropriately selected and restored. Failures, although rare, are often attributed to poor positioning, which can result from improper planning or unskilled dentists. In addition, failures may also be due to bone loss from gum disease or infection. In such cases, the dental implant must be removed, the site repaired, and then a new dental implant must be placed. Removal of failed dental implants can be a difficult procedure. This is because the implants are often integrated and fused to the surrounding bone. This bond must be disrupted in order to remove the implants.
There are two techniques for removal of failed dental implants. The first approach involves using a special type of cutting instrument, known as a trough bur, to cut the bone around the healed implant. In this procedure, 0.5-1 mm of bone is cut around the implant allowing it to be gradually loosened and removed. Once the implant is removed, the area is thoroughly cleaned and evaluated for possible bone grafting to restore any bony defects. While the implant can be readily removed with this technique, it does require removal of healthy bone and is considered to be a relatively traumatic procedure. The cutting procedure can produce excessive heat, affecting the bone vitality. It also removes vital bone and creates a potentially larger defect requiring bone grafting.
A newer and less invasive technique utilizes special instruments to gently torque the implant out of the bone. With this approach, an adapter is attached to the implant. Next, a high-torque instrument is engaged to the adapter and, with a high-reverse torque, the implant is gently de-bonded and removed from the bone. With very dense bone or extremely tight implants, a few millimeters of bone at the top may need to be cut to aid in implant removal. Using this special high-torque instrument, the implant can be removed without eliminating any vital bone, thereby preserving it for future implant placement use.
We see many patients with unfortunate failed dental implants that could have easily been prevented. Using this special high-torque implant removal instruments, we can remove the implants in a fashion that is more conservative, less invasive, less traumatic, and less painful. This technique also helps to preserve the existing bone for implant replacement later. If you have a failing dental implant that must be removed, ask your surgeon about this approach.