A dental implant is a permanent fixture, typically made of titanium, designed to replace a missing tooth root. It integrates with the jawbone to provide a stable base for an artificial tooth. While implants are a highly successful, long-term solution, complications can arise that necessitate their removal, a procedure known as explantation. Understanding the reasons and methods for removal is the first step in managing this situation.
Causes of Dental Implant Failure
Implant failure is classified as early (before bone fusion) or late (months or years after integration). Late-stage failure is most commonly caused by peri-implantitis, an inflammatory disease affecting the surrounding soft tissue and bone. This condition results from bacterial plaque buildup, leading to progressive bone loss and eventual loosening.
Early failure is typically due to a lack of osseointegration, the process where the implant bonds with the jawbone. Instability results from poor bone quality, insufficient bone volume, or early infection. Other factors include poor initial placement, such as an incorrect angle or proximity to vital structures. Mechanical complications, like a fracture or prosthetic component failure due to excessive force, can also require removal.
Methods Used to Remove a Failing Implant
The technique used depends on the degree of integration between the implant and the jawbone. If the implant is loose or has minimal osseointegration, a non-surgical approach is preferred. This involves using specialized tools, such as a detorque wrench, to apply a controlled counter-clockwise force. This reverse torque technique is the least invasive because it unscrews the implant without removing surrounding bone tissue.
If the implant is fully integrated, surgical removal is necessary, requiring the removal of a small amount of bone to free the implant. The most common surgical method uses a trephine bur, a hollow, cylindrical drill that cuts a ring of bone around the implant body. The trephine diameter is selected to be slightly larger than the implant, allowing it to be lifted out while minimizing bone loss.
Another surgical method is piezosurgery, which uses high-frequency ultrasonic vibrations to precisely cut the bone surrounding the implant. The reverse torque technique is the most conservative option. If this approach fails, the clinician must switch to a surgical technique to complete the explantation. While the trephine bur is often the fastest method, it results in the highest volume of bone loss.
Site Management Immediately Following Removal
Immediate management of the resulting bone defect is necessary to prepare the site for future restoration. The empty socket must be treated to prevent ridge resorption, the process where the jawbone collapses inward. A bone grafting procedure is almost always performed immediately after explantation to counteract this structural loss.
The surgeon fills the void with bone graft material, which can be synthetic or derived from a donor source, to preserve the volume and height of the jawbone. This material acts as a scaffold, encouraging the patient’s own bone cells to grow into the area. The soft tissue is then secured with sutures to achieve primary closure, protecting the graft and promoting healing.
Recovery Time and Replacement Options
Initial recovery involves managing post-operative symptoms, such as swelling and mild to moderate pain, which usually peak within two to three days. Patients should use ice packs and take prescribed pain medication. Soft foods must be consumed for the first few days, and vigorous rinsing or physical activity should be avoided to protect the surgical site and the bone graft.
Longer-term recovery focuses on the maturation of the bone graft, which takes approximately three to six months for the new bone to become dense enough to support a new implant. After this period, replacement options are explored based on the healed bone quality. The most common option is placing a new dental implant, often repositioned slightly. If bone quality remains insufficient, alternatives include a fixed dental bridge or a removable partial denture.