Dr. A. asks:
Does anyone have experience with treating an implant fixture that fractured under occlusal loading? Recently I had a patient where I had placed 2 Neos implants in the lateral incisor position to support a 4-unit fixed partial denture replacing the maxillary incisors.
The only treatment that I know of is to trephine out the implant fixture, graft the site and place another implant fixture after the graft osseointegrates. Because of the emergence profile considerations I cannot place a wider diameter implant. In the mean time I have placed implant fixtures in the maxillary central incisor sites and have inserted a provisional fixed partial denture. The only other thing I can think of is to leave the fractured implant as is in the lateral incisor position and to just cover the site with a cantilevered pontic and use the other 3 implant fixtures for retention of the fixed partial denture.
Any advice or thoughts?
My advice is to get the fractured implants out and graft. Piezosurgery is a better way to remove implants than trephining, it will save more of your buccal anatomy then a trephine will. Why did the implants fracture?
Well me too agree with the Dr.sb well Trepinating the bone for the implant removal will lead to the compromised esthstic,functional efficacy of the next implant which will be placed will also be compromised.
By the way lets come to the basics you have not mentioned the diameter and the length of the implant placed and one thing i,ll like to ask you is,is that implant was placed too buccally as the long axis as long axis principal if not followed also must have transmitted the force of mastigation to different direction.But irrespective of it Q,s is how did the implant fractured.
If you don’t have access to piezo for removal, try an 859L-010 diamond (we recently used a Meisinger on 3 broken CoreVents) with care. The “L” makes it 12 or 14mm long. (ISO 806-314)
Was it actually the implant that fractured or the abutment? It sounds like pretty extreme forces in the anterior region. Bruxism? Accident?
I’m not familiar with Neo, but if you need a larger diameter implant, you may need to augment or expand the ridge.
I almost forgot: USE LOTS OF IRRIGATION! Avoid damaging the adjacent bone (but you already knew that…I said use ‘Care’.)
Good luck. A cantilever might be OK (4 on 3) in the anterior, except for this history: already lost 4 natural teeth and broke an implant.
As always, we can never have too much information. You may want to consult with experienced local surgeons or DDSs to convey the entire picture.
That implant will fracture. Treat the implant as a fractured tooth. Remove it and regenerate the bone and place a different and larger implant implant. Check the bite.
I think all the advise above is good. I would add that sometimes you can make a small trough mesial or distal to the implant and push it loose with an elevator. It can save the buccal bone. Ultimately, the best thing is to start over by removing the implants, augmenting, and placing new implants like you mentioned.
Good Luck.
I thnink the fractured implant should be removed for all future legal issue also,with malpractice attorney on the chase these days, they will twist and turn the case against you.
Using piezo is the way but as said tons of irrigation.
Grafting with membrane over the top….cytoplast and someone is going to yell at me but if you do not have it, you need something that will not reabsorb or pick up bacteria, teflon tape or the sticky part of a bandaid.
Sometimes you need to think out of the box
Remove the implant and graft as said before. Piezo is best. This was not one of those 5mm Bicon implants was it?
dear doctor
all above is a good advices but really we need to know a more history about fractured part ? pt. habits
I agree to remove the implant as a treatment of brocken abutment. I made a case like that. Take the implant out with long surgical bur as prescribed by Mike Stanly. No need for graft or membrane, it will heal alone. 3 month healing in the mandible is enough. Put new implant even the same diameter. Remove the cause. Have a good luck
i dont understand , how u gonna take out an implant then, no graft ?? unless
1- plannig to graft later,
2- planning to graftr later
3- u dont know how to do it
4- send it to specialist