A novel technique was developed to remove osseointegrated implants without enlarging the bony socket. Immediate replacement was performed simultaneously using a same-size implant with good primary stability. The prosthesis was delivered after 6 months of healing with good loading function. Good bone stability was found at the 12-month follow-up.
An implant-supported restoration is the conventional treatment for partially or fully edentulous patients. The treatment success rate is high, but implant failures do occur. In situations such as implant fracture, malpositioned implant, or an irretrievable broken screw or abutment, removal of the implant is usually the best option.
There are several methods to remove an osseointegrated implant : (1) implant retrieval kit (e.g. Noble Implant Retrieval Tool; BTI Implant Extraction System); (2) thermal explantation (electrosurgery); (3) thin bur at low speed with irrigation; and (4) trephine out with supporting bone. Methods 2, 3, and 4 will compromise the surrounding bone, and if immediate replacement is desired, a larger implant will be needed.
In the case where immediate replacement is required, the implant retrieval kit is a better way to maintain the original size of the socket. However, if the screw hole of the implant is occupied by an irretrievable screw or abutment, the retrieval kit cannot be used to engage the implant inner wall in order to reverse the fixture.
A novel technique for the removal of an osseointegrated implant without enlarging the socket was developed for this situation. Using this technique, the same size implant can be used for immediate replacement, and the surrounding bone will not be significantly compromised.
A 42-year-old male patient, in good health, attended with a broken 15-degree angulated standard abutment on a B9.5 (4.5 mm × 9.5 mm) ANKYLOS implant at tooth 46, after having been loaded for 13 months. This patient had a betel nut chewing habit which categorized him as a heavy bruxer. In order to achieve a better outcome, the implant had to be removed and replaced with a straight abutment.
The bone covering the implant shoulder was removed using a diamond-coated fissure bur, creating a small gap, 2–3 mm in depth, around the implant shoulder for elevation access ( Fig. 1 ). A carbide surgical round bur (HM1023, ISO 500316 001001023; Hager & Meisinger GmbH) was used to perforate both the buccal and lingual titanium walls in order to split the implant into two pieces.