Best Technique for Removing Osseointegrated Implants?

Dr. K asks:

I need to remove several dental implants from the mandibular molar region. They are osseointegrated and stable. There are no other options for this patient. What is the best technique for doing this? What precautions should I take? What complications might I encounter?

42 thoughts on “Best Technique for Removing Osseointegrated Implants?

  1. 1) Why must you remove “severl osseointigrated implants?”

    2) Why are there no other options for this patient?

    3) The implants would need to be trephinated out. But if you haven’t done this before, you probably shouldn’t start on a live patient without proper training/supervision. This is a good case to refer. If you want to learn, ask your specialist to teach you as he does it on the patient. Regardless, this doesn’t sound like something you should be doing by yourself.

    4) Complications encountered can be minor or severe: pain, swelling, bleeding, infection, temporary or permament numbness in the lips/cheek/tongue, fracture of the mandible etc etc…

    cheers!

    Dr. T
    3rd Molar Slayer

  2. i too questioned why solid fixtures need removal, but here goes. previous post discussed use of a trephine bur, a hollow hole cutter which is chosen to just be slightly wider than outside diameter of the fixture. must be done slowly and with lots of irrigation to avoid frying the bone. we also use a reverse threaded tool to allow us to rotate the fixture out ccw. i will proceed as follows. try to reverse torque it out. 40 ncm, no movement, i’ll trephine upper 25% still in bone, try to reverse torque again. no go, another 25%, try to reverse torque again. one needs to be aware if there are apical channels in the fixture, final removal is via fracture unless trephine is carried fully to apex of the implant. must be carefull not to downfracture apical bone into a nerve bundle, take off a tuberosity, ie., try to do no harm. one caveat. many of us have found placing another fixture afterward in the same site immediately is a bad idea. we theorize bone does get cooked to some degree, so recommend waiting 8-10 weeks before implanting larger diameter fixture.

  3. In response to Dr. T (3rd molar slayer)
    I have read many responses by Dr. T (3rd molar slayer) and must confess that invariably, I agree with almost every single point he makes from a clinical standpoint.
    Neverthelss, in addition to his fine clinical judgment, he also invariably makes comments in every post about how various procedures should only be done by specialists and makes assumptions about various skill and knowledge level of practitioners.
    I wish to suggest that this must stop. This forum has a wide variety of practitioners with a wide variation of skill and knowledge level in implantology. Please share your knowledge with us, Dr. T, but refrain from pontificating about who should do what and when, and when to refer, etc. PS: I am an oral surgeon

  4. Jabern is right! No one has a monopoly on learning otherwise we could all belong to various labor Unions with their strict division of labor! I think practitioners on this site come here for opinions, advice and maybe confirmation of some of their own opinions. No one comes here to be told how incompetent they might be. If we wanted to hear that crap we could just talk to the local specialists down the street!

  5. Dear Dr K,
    I find it intriguing that you have to remove fully osseointegrated implants. I for one had to remove 4 osseointegrated implants in the upper incisor area. It was done at my patient’s insistence because after placing them in, he said that he could not stand/countenance them continuing to be present in his jaws. When pressed, he said that he could not give a reason except that he just did not want it in his jaws anymore, period! Flabbergasted and totally nonplussed, it took me some time to digest it. Finally, after several discussions and attempts to persuade the patient to keep them over 2 to 3 visits……after all, they were only one step away from abutment connection and crowns that will replace the removable dentures that he was wearing previously…….I acceded to his request. There was no pain, swelling, infection or whatever that would normally require removal of the implants. They were ideally placed for good aesthetics too. He even agreed to pay separately for its removal. I finally concluded that he must be suffering from some form of phobia…..implantophobia?

    I removed them. Three I trephined out. I only needed to go about one-third down the depth of the implant and I reversed them out.The fourth came out when I applied a reversing torque to it.
    Before I did so, the patient signed a consent form stating exactly as to the circumstances of the need of removal. Primary closure and reissue of his dentures.

    I concluded that every dental implant patient should be assessed psychologically for his/her suitability.

    Just for the sake of knowledge and discussion, is it possible to explain briefly why the osseointegated implants have to be removed in your patient’s case?

    With respect and regards.
    Kfc

  6. I agree that perhaps I am quck to jump on the “refer” bandwagon (trigger happy). I’ll try to watch what I say in the interest of keeping the discussions on topic.

    But ask yourself this… if this patient were “your mother” and she needed a multitude of osseointegrated implants removed from the POSTERIOR MANDIBLE… would you feel comfortable having someone who appears to have NEVER PEFORMED THIS PROCEDURE BEFORE, peform the surgery on your mother? (Remember the risks… pain, swelling, bleeding, infection, mandible fracture or nerve injury.

    I too am very curious as to why the implants need removal. It be nice if you could post some x-rays and show some models or something in the interest of our academic discussion.

    Anyway, like I said… I’ll try to stay away from the “R” word in the future. Cheers.

  7. There is absolutely nothing wrong with what Dr. T said. As professionals we all have the obligation to do what is best for patients. Performing a high risk procedure when you don’t have the proper training is legally, morally, and ethically wrong.

    Why do people want to be nice at the expense of patients’ welfare?

    Doing nothing and referring are options one could offer the patient, and therefore it is nothing wrong to suggest them to another doctor who is asking for opinions on this forum.

  8. I totally agree with Oral surgeon who recommended referring the patient to an experienced specialist since all the complications he mentioned can happen. Removing these implants with a trphine can lead to a large bone dehiscence on the buccal or lingual of the implant which should be grafted with FDBA bone graft and a membrane. This will help prevent jaw fractures and maintain the alveolar bone so that the patient can wear a denture.
    Since no reason was stated for removal of the implant, I can not for sure recommend removal or keeping them. If the patient still preffer to wear a denture, I would keep these implants as “sleepers”. The patient can still wear his dentures on top of them. This will also help in preserving the alveolar bone under the dentures.

  9. Lets get some perspective on the matter. How many of us have actually taken out fully osseointegrated implants? Such occassions are probably very rare. The very suggestion of it makes us rack our brains for a rational reason for it, indicating that the indication for it is not common and probably very unusual. With that in mind, the basic principles of surgery in this case apply. Any dentist worth his/her salt will know them and the minor oral surgery is not any more difficult than placing an implant or even extracting a tooth. In fact, an apicectomy which any dentist is trained to do demands greater expertise. So, I would suggest that if it has to be done, any dentist who can place an implant can also plan carefully accordingly to the well established surgical principles and proceed. The possible complications are similar to those of removal of a simple impacted wisdom tooth which every dentist is already trained to do.

  10. Dear Dr. T, sir, may I please ask a question? Assume that only one or one and half a millimeter of bone is left at buccal and lingual side of the implant that you have decided to remove. Creating a through and through bone defect is what really happens when you trephine out the implant and its surrounding bone from the jaw. Then, you have to go through repairing or reconstructing the alveolar process.
    Why don’t you once try my technique? It may seem odd to you but it has worked for me along the years and in three cases that I had to remove the osseointegrated implants because the prosthodontist was not very happy with the position or angulation of the implants.
    First, I detach the overlying mucosa or surrounding gingiva from the implant neck and keep them away. Then I attach one pole of the electrocautery to the platform of the implant while the other pole is attached to the leg or the hand of the patient. I put the electrocautery on coagulation mode and keep it for fifteen seconds. This procedure will cauterize and necrotize the layer of bone which is in close proximity, or integrated to the implant. I, then suture the mucosa, prescribe some analgesics and dismiss the patient. After seven days the patient comes back to the office and we unscrew the implant out of the bone very, very, very easily, even without the need for anesthetic injection.
    Cheers.

  11. Dr. Kfc,

    I am a periodontist with experience removing implants. Some of my referring dentists have needed “help” with this due to various issues regarding implants placed either by other dentists or at their practice. Although uncommon, it is occurring more and more. I agree that dentists trained in surgery can do the procedure but I disagree with the idea that a dentist who places implants should be able to remove them. The two procedures require altogether different skill sets and shouldn’t be considered a minor procedure.

    You may be very skilled and capable but I doubt every dentist is already trained to handle impacted wisdom teeth, advanced dental implantology and grafting, apicoectomies, and is polished in surgical principles. I teach at a dental school and it is a rare occasion that a dental student is allowed to perform these procedures. I’m unaware of any dental school that offers such a comprehensive curriculum.

    My personal technique has evolved over time. I use the trephine only when I have adequate thickness B-L. More commonly I use a thin “extraction bur” to create a trough M or D to implant. I then use an elevator and work it out. Each case is different but I found this technique helpful to retain the plates.

  12. May I please ask a question? Assume that only one or one and half a millimeter of bone is left at buccal and lingual side of the implant that you have decided to remove. Creating a through and through bone defect is what really happens when you trephine out the implant and its surrounding bone from the jaw. Then, you have to go through repairing or reconstructing the alveolar process.
    Why don’t you once try my technique? It may seem odd to you but it has worked for me along the years and in three cases that I had to remove the osseointegrated implants because the prosthodontist was not very happy with the position or angulation of the implants.
    First, I detach the overlying mucosa or surrounding gingiva from the implant neck and keep them away. Then I attach one pole of the electrocautery to the platform of the implant while the other pole is attached to the leg or the hand of the patient. I put the electrocautery on coagulation mode and keep it for fifteen seconds. This procedure will cauterize and necrotize the layer of bone which is in close proximity, or integrated to the implant. I, then suture the mucosa, prescribe some analgesics and dismiss the patient. After seven days the patient comes back to the office and we unscrew the implant out of the bone very, very, very easily, even without the need for anesthetic injection.

  13. Dr Jafari,

    That indeed is a very interesting technique. I never would have thought to do that. I have some questions: how thick is the radius of necrotized bone? Any issues with re-grafting? Any complications?

  14. Psychotic patients aside, most dental implants are removed because of progressive bone loss and aesthetic defects. Regardless of whether you are using a trephine or other exotic method (electrocautery), the question that must be asked is, what happens next? Are you going to abandon the site, will you graft and place another implant later, or will you place another implant immediately? Most often, when we remove an implant, we treatment plan its replacement. This makes the choice of instrument more compelling. The problem with trephines is that they heat the bone considerably and, as you get to mid-body, tend to generate titanium filings which contaminate the osteotomy. You end up with, at best, delayed healing or, worse, a foreign body reaction to the Ti remnants. Electrocautery will remove the implant cleanly but you will have a significant zone of necrotic bone. A third method that we have employed for the last 8 years, is the Er,Cr;YSGG 2780nm laser. We use long zirconium tips (20mm) and work our way around the body of the implant. There is NO bone necrosis, NO contamination of the osteotomy with Ti remnants, and you can avoid thin facial plates thereby preserving crucial bone. Additionally, we get bacteriocidal effects and biostimulation, enhancing the healing process. It is now our preferred method of removing ailing/failing implants.

  15. Using trephine burs to remove full intergrated implant is not easy. Try this…..You can advance the implant and wait a few days to reverse the implant out. Good luck…..

  16. Using electrosurge is not smart in this situation…..It may cause too many dead bone…..Multiple implants removal in lower molar area may lead to major osseous problems seems like osseous necrosis often seem in Patient taking Fossamax.

  17. Dear colleagues, thanks for your concern. All my three cases have been single ones. but I think that if you have decided to remove mutiple implants, you can do it one by one or use the electrosurgery in separate sessions.I had never had the chance to measure the width of the electro-necrotized bone, but it can be the purpose of a research project.I have not had any complication in my cases and everything went smoothly, but please do not forget that I had only three cases.At the time of implant removal, all the sockets’ beds were covered by a soft tissue similar to a failed implant.

  18. Dr K:

    I too am interested in why your patient wanted the implants removed.

    Was there major infection [necrosis] in the bone under the implants? Or was it for some other reason?

    I know some patients are a little paranoid and might seek removal of full yintegrated implants, but the average patient is not a *head case*, so there must be other concerns in their minds.

    Anyone else have any ideas what could seek one to get a fully integrated implant yanked out?

  19. Using the microtip of a laser beam to remove an implant is a very good idea and I am sure that many people have thought about it before. Laser is a highly sophisticated technology, but it needs much pomp and several circumstances like special training, special settings, special safety regulations, well trained auxiliary staff etc… It is a very costly treatment modality as well. Where I live, not every patient can afford it. If the charges are to be paid by an insurance company, they’ll do their best to shun their responsibility. Its availability is also limited to university clinics, major treatment facilities and highly expensive private dental clinics. On the contrary, the electrosurgical devices are easily found at any dental premise.
    Using a laser from the Erbium-Yag family is also a very wise choice. Their target is a water molecule, which is very similar to a CO2 laser mode of action, but with much a better effect on calcified tissue. Multiple studies have shown that using Erbium family lasers even when they are accompanied by water spray, may have a damaging effect on the lased tissue which does not make it a suitable bed for simultaneous grafting by biomaterials or even viable autogenous bone. This is also applicable to electrocauterized bone, because in both cases, the microvasculature of the bony bed is coagulated, though the depth of the necrotic layer may not be the same.

  20. Well said, Dr. Mehdi Jafari. We should use optimal technology suitable to the economy and context of our peculiar practice location. Lasers are very expensive and can do wonderful things but in this case may be technological and economic overkill. Especially, if other methods that are effective are readily available. Your use of electrocautery in removing osseointegrated implants is a stroke of genius. If you do it for 5 seconds instead of 15 seconds, will it be adequate? If possible, it will mean that there will be a narrower margin of bone necrosis and therefore faster healing time and earlier implant placement if necessary.

  21. On the contrary, the erbium based lasers have the least damaging effect on both soft and hard tissue. Published studies indicate a zone of thermal interaction of only 8-15 microns! The supression of the inflammatory response and concommittant biostimulation creates the ideal environment post-surgically. In a contest of cold surgical steel vs. erbium lasers, there is no contest. Electrocautery, on the other hand may have an interaction in the millimeter range and there is no biostimulation. If I were to suggest that clinicians buy lasers just to cut bone, I would be guilty of hyperbole. However, the list of FDA approved procedures for oral and implant surgery is extensive. Oh, did I mention implant repair? Also 8 years of treating the ailing/failing implant with the ER,Cr;YSGG laser (published). So before you denigrate this instrument as an expensive toy, READ THE LITERATURE. I think you will come away with an entirely different perspective. And in a few years when most of you are using at least one laser wavelength (diode or erbium), think back to this blog and smile. RJM

  22. We won’t wait a few years to smile because we READ THE LITERATURE.While using Er: YAG laser, the operator must be aware of the possible risks involved and caution must be exercised to minimize these risks. Use of inappropriate power settings, especially high energy, for irradiation of calcified tissues is a major risk. During laser irradiation, the power settings play a significant role and must be regulated appropriately in order to avoid detrimental effects to the irradiated tissue [Ishikawa I \. Re: Er: YAG laser scaling of diseased root surfaces. Frentzen M, Braun A, Aniol D (2002; 73:524–530) . J Periodontol 2002; 73: 1227] .The power energy output at the tip must not be high, preferably not more than 60 mJ, to avoid such undesirable effects. Also, water irrigation is essential to eliminate thermal side-effects on the calcified surface. An in vitro study showed that surfaces treated with Er:YAG laser at 100 mJ/pulse exhibited delayed growth and adhesion of gingival cells than surfaces treated with 60 mJ/pulse [Feist IS, De Micheli G, Carneiro SR, Eduardo CP, Miyagi S, Marques MM . Adhesion and growth of cultured human gingival fibroblasts on periodontally involved root surfaces treated by Er: YAG laser. J Periodontol 2003; 74: 1368– 1375]. Furthermore, another factor limiting the rate of laser ablation of dental hard tissue is the risk of excessive heat accumulation within the tooth. Excessive heat may result in undesirable damage to the pulp and the root surface [Glockner K, Rumpler J, Ebeleseder K, Stadtler P. Intrapulpal temperature during preparation with the Er: YAG laser compared to the conventional burr: an in vitro study. J Clin Laser Med Surg 1998; 16: 153– 157] . Some degree of heat generation is inevitable during laser scaling using the Er: YAG laser. Thermal alteration of the root surface after laser irradiation has been reported by some researchers. However, most recent reports propose the use of water as a coolant during Er: YAG laser irradiation to avoid any harmful effects to the irradiated tissues.have a nice day.

  23. I don’t doubt your veracity, however I do doubt your authenticity. You will note that my comment was using the Er,Cr;YSGG laser, NOT the Er;YAG laser. In any modality, including electrocautery, innappropriate settings can result in less than desireable results (In fact, we were taught NEVER to use radiosurgery around implants because it will cause deintegration!). That is why we get training before using any surgical instrument. The erbium based lasers are noted as “cool lasers” because of the LACK of thermal degradation. I also note that your bibliography is rather dated and does not reflect the updated technology available today in the next generation machines. Water is not used as a coolant, but rather to acheive a hydrophotonic effect on the tissue. Excitation of water containing tissue, ablation of targeted tissue, and biostimulation is unique to lasers. The second highest absorption spectrum is hydroxyapatite, making it an ideal modality for bone surgery. Concommittantly, it has virtually no absorption in titanium, so that it can be used near or on the surface of the implant without damaging it. I have heard all of these negative comments about lasers for years. Some of the most vocal proponents are those who denigrated this technology just a few years earlier. I stand by my comments and look forward to giving my patients the best care possible, not getting mired down in parochial arguements because that’s what we learned in our dental school training. Virtually every dental school in this country now uses either diode, Nd;YAG, or erbium based lasers in their curriculum. So I again admonish you to read the literature in this discipline (see the cover story in this months JADA on lasers in endodontics), especially the Society for Oral Laser Applications (SOLA). The future for minimally invasive dentistry and re-engineering the wound response is incredibly bright, and will have, at it’s center, a laser.

  24. First, Kimura and associates have proven that the laser/tissue interaction of Er-Yag and Er,Cr;YSGG lasers are exactly the same.[ Kimura et.al.:effects of Er,Cr;YSGG laser irradiation on root surface, morphological and anatomic analytical studies. J Clin Laser Med Surg 19(2):69-72 2001.
    Second, talking about ESOLA, I would like to refer you to the following book that has been actually endorsed by ESOLA, and its president has written a foreword to that.[ Moritz,A. Oral Laser Applications, Quintessenz publisher/Berlin:2006 p.(355-362).This time it is a very recent and up to date refernce which is confirming what I have written before. I hope it convinces you that our knowledge is not that obsolete and makes you think about looking at the other people from above.
    Third, since you are such a kind and decent person, will you please find us a way to prove our AUTHENTICITY.Have a nice day.

  25. First, the Er;YAG (2940nm) and ER,CR:YSGG (2780nm)are not the same. There is a 300% difference in absorption in water containing tissue between the two. As a result, the Er;YAG must be used in contact mode. This raises the possibility of thermal interaction of this laser. The Er,Cr;YSGG can be used several mm from the targeted tissue, ensuring the hydrophotonic effect. I have had the opportunity to lecture internationally with Dr. Moritz and will be contributing to the second edition of his textbook, writing the section on lasers in Oral Implantology. In fact, at the University of Vienna where he teaches, they have embraced the 2780nm wavelength as being the most efficacious for surgery/implants. I am also the incoming president of ASOLA, the US affiliate of SOLA. So I stand with my observations. Have a nice day.

  26. Hibst and Keller and then Sasaki et al. have explained the theory of ‘micro-explosions’ regarding the mechanism for hard tissue ablation. According to this theory, the energy is selectively absorbed in water and other hydrous organic contents. Some vapor turned into steam, builds up internal pressure until explosive destruction of inorganic substance occurs, even before the melting point is reached. Therefore, the effects of Er: YAG and Er: Cr YSGG lasers are probably not only explained by their thermal effects, but by the micro-explosions associated with water vaporization within the hard tissue. Laser ablation of bone with erbium laser wavelengths proceeds in a similar fashion. The higher water content and lower density of bone allows faster cutting, through dislocation of hydroxyapatite and cleavage of the collagen matrix. This ease of cutting places the use of Er: YAG and Er, Cr: YSGG laser wavelengths as the preferred choice for laser bone ablation when compared to other wavelengths, although there may be higher heating effects with Er: YSGG (Jahn R. et al. Thermal side effects after use of the pulsed IR laser on meniscus and bone tissue. Unfallchirurgie 1994; 20: 1-10). It has been shown that a single course of non-surgical treatment of peri-implantitis using Erbium lasers group may not be sufficient for the maintenance of failing implants (Schwarz F. et al. Clinical and histological healing pattern of peri-implantitis lesions following non-surgical treatment with an Er: YAG laser, Lasers Surg Med. 2006 Aug; 38(7):663-71). Peri-implantitis is a rapidly progressive failure of osseo-integration, in which the production of bacterial toxins precipitates inflammatory changes and bone loss. Mechanical debridement together with chemical decontamination of the exposed implant surface, with or without local application of antibiotics, has proved somewhat effective. The possibility to remove bacterial colonization with an appropriate laser wavelength might be an added benefit, but as far as the independent investigators have proven, it is the one and the only. We should never forget that there are potential risks inherent in using a micro-second pulsed laser. The ability of laser energy in bacterial decontamination appears to place its use above that of other modalities, but, there is less evidence of beneficial use where the implant is coated with a ceramic or hydroxyapatite; this may be mostly due to the micro-complex surface irregularities, which have been shown to harbor bacteria and malicious chemicals in a failing situation (Ichikawa T. et al. In vitro adherence of Streptococcus constellatus to dense hydroxyapatite and titanium. J Oral Rehabil 1998; 25: 125–127).

  27. Dear Dr: Just get a couple of transfer coping´s, screw on the implants you want to remove and then, unscrew your implants! that´s it, plz don´t use a trephine!!!!

  28. I refer you to my paper “Treatment of the Contaminated Implant Surface Using the Er,Cr;YSGG Laser” Implant Dentistry, 2004;4(165-170). Of all of the treatment modalities for debriding the implant surface, the Erbium based family is vastly superior. There are dozens of recent articles covering the whole spectrum of laser wavelengths, indications/contraindications, and comparisons to traditional techniques. If you are going to quote papers, kindly quote more recent studies from major universities with impeccable credentials. I can assure you that the “micro-explosions” you quote from the literature are far kinder to tissue than the contact of scalers and high speed handpieces. And, unlike “cold surgical steel”, we have the additional benefits of bacteriocidal properties and photobiomodulation which enhances the wound response.

  29. Gentlemen,

    Can we return to the central issue.
    I find the “mine is bigger than yours arguments a bit tedious”.
    Can we have some other practitioners comment on their experience with he electrosurg idea – as this seems a most interesting approach.
    Actual complications experienced ? Number of cases ? Can shorter / lower power settings also work ? Any literature ? Anybody working on this idea at any particular university ?
    Your input on this very valuable topic would be appreciated.
    The need for implant removal will become more common place as sytems (parts) become redundant, patient’s dental / health status change with time, treatment plans evolve (ie. now we like adult ortho), and a wider base of dental practitioners pace more implants. Even a compounding complication rate of ‘say’ 0.1 % will build to a substantial expanding group of “problem” implants.

  30. I have a question to all oral surgeons and periodontist out there. I had two mini implants placed in my upper jaw tooth # 14. The general dentist placed two Intra-lock Mini implants side by side then connected it permanently to a root canal treated tooth # 15. One big crown covered both sites. I was not aware at the time that it would be impossible for me to clean between the screws; I started to have bone loss in the area. I have had the crown cut in half and removed from the implants (this was not done by the original dentist who did the work). Now I would like the implants removed because they simply do not serve a purpose in my mouth. I did research on the brand of implants and learned these types of implants are really meant for folks who wear dentures. I was told that the screws could not be made into “sleepers” because it is one piece. I cannot crown it again because it would be ridiculous to put myself back into a situation where I can’t clean it again. I was told about the option of capping the screws individually, so basically what use to be one tooth would become two little teeth, but I would be able to clean them. I really don’t know why they can’t be removed. The screws did bond with my bone but if they were screwed in can’t they be screwed out? any advice would be great! nene

  31. Nene, ask your dentist to keep the adjacent mucosa away from the implants and then have each of your implants cauterized for five seconds .They will be easily screwed out after a week or ten days.

  32. My husband believes two crowned implants (back molars) are causing nerve pain (pressure that is unending) and wants the implants removed. The implants have been in for about a year. What will the removal entail and what are the risks? How do we find a skilled surgeon? Your input is very much appreciated.

  33. i am here for thanking my dear colleague,kate.i used her thechnique for removing two fully integrated implant.i did this very easily &2 mm of bone was left at buccal site. then i filled 4 walled socket with bio-oss.what is the most proper healing time for inserting new implants?

  34. If I may say so, while it may not be a good idea to assume the level of experience of a practitioner, it is certainly valid and valuable to outline the degree of complexity and risk in a procedure, so questioners can judge whether or not something falls within the bounds of their skill, training and experience. No matter how much we know, we still have a lot to learn. Personally, I never carry out a new or unusual procedure until I’ve gone through it with someone who already had that experience. It’s just common sense.

  35. I have tried this electrosurgical technique for removing dental implants twice with no success
    There seems to be no definitive answer to how many secs to use?
    I have tried up to 10s with no effect
    Any thoughts

  36. Nick:
    I found this

    European Cells and Materials Vol. 7. Suppl. 2, 2004 (page 48) ISSN 1473-2262
    Thermo-explantation. A novel approach to remove osseointegrated implants
    G. Massei 1, S. Szmukler-Moncler 2
    1 Private Practice in Torino, Italy, 2Consulting in Implantology, Basel, Switzerland.

  37. Some time before, I really needed to buy a building for my organization but I didn’t earn enough cash and couldn’t buy anything. Thank heaven my friend suggested to try to get the loans at creditors. Thus, I acted so and used to be satisfied with my sba loan.

  38. A client has come to me regarding removal of fully osseointegrated titanium implants. She now has 7 scattered throughout her mouth, 2 of which were placed within the last year in an area where there was a sinus lift and she developed tinnitus on that side when she was healing but caught an upper respiratory infection that was treated with antibiotics. The general problem aside from what was described above is that she is losing the teeth either next to or opposite from where an implant is placed. Her perio just replaced the lost teeth with implants scattered throughout her mouth and now as she loses more teeth always next to or above or below the implant she cannot satisfactorily have them restored without placement of more implants individually and she is at the point of looking at implant to implant bridges but that cannot be accomplished because she has live teeth out from her implants or 2 implants next to each other. This woman had a beautiful smile, was born with basically perfect teeth but over time she had fillings that were replaced with onlays progressing to crowns, etc. She is only 54, has already spent a small fortune, (One hygensist actually referred to her as mercedes mouth)and she is so distraught because of the progressive tooth loss without significant perio disease and she is generally in good health but her nutrition has suffered over a period of years because she cannot eat normally. Then there is the tinnitus.

    Please offer some suggestins as to what to do with this situation. She has gone to three dentists who recommend just keeping the implants and continue restoring them but that still leaves her with missing alternate molars upper and lower jaw with the suggestion being more implants.

    So if you want to know why someone would want to remove 7 osseointegrated implants: 1. progressive tooth loss next to and above or below placed implants, 2. multipl bone grafts from different sources when she doesn’t have serious bone loss; 3. tinnitus developed around 2 placed implants and sinus lift; 4. cannot restore dentition with implants as they are because of placement of previous implants, 5. aesthetic loss of beautiful teeth and smile, 6. subsequent poor nurtrition due to limited food choices or must develop balanced reciipes then puree.

    She spent a lot ot time and money saving her smile only end up like this. Please let me offer her some advice before she chooses to litigate.

  39. Litigate? Do you or anyone know those tooth loss are as result of implants next to those? Or is that just periodontitis spreading.
    Why do people think about suing first when things don’t turn out the way they wanted to?
    Can you post xray of the current condition? I dealt with law suit involving implants as a third party and lots of them in my opinion, are pissed off people who didn’t get what they wanted even though it wasn’t directly the dentist’s fault. I mean, come on people!!

  40. A small correction:
    Tinnitus is the perception of sound within the human ear in the absence of corresponding external sound. Could be caused by natural hearing impairement.
    And regarding the situation with the “mercedes mouth”, I think that by not properly ajusting the occlusion for those implant crowns you end up having problems in the opposing dentition. And FREMITUS is very indicative of a poorly adjusted occlusion on those implnats!!!!!! She desperately needs somebody proficient in occlusion adjustments to check her for premature contacts and interferences. Otherwise the only good “teeth in her mouth” could become the implant restored teeth. A perio consult is also necessary.

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