Clinical Case Study: Extraction of Malpositioned Implant and Placement of New Implants
Case By: Gail G. Childers, DMD
Patient History
The patient is a 44-year old male with no significant health issues, past history of smoking. Patient presented with history of trauma to the mandibular anterior teeth and had avulsed tooth #24 and a dental implant placed by a previous surgeon 3 years prior to being referred to the practice. It was noted from the radiograph that the dental implant is malpositioned and a history of internal root resorption is evident on #25 with severe bone loss noted and greater than 60% bone loss noted on the mesial aspect of #23 (Fig 1).
Case Summary
In the clinical presentation of #23, #24 and #25, it was agreed to extract teeth #23 and #25, as well as the dental implant. The alveolar ridge would then be augmented for placement of new dental implants. The surgical site was exposed, tooth #23 and #25 were extracted as shown in Fig. 2. Upon Piezosurgical extraction of the malpositioned dental implant #24, Regenaform® RT allograft paste was implanted into the sites with placement of a MatrixDerm® Membrane to contain the bone graft material and provide a barrier to soft tissue down growth into the bone defect (Fig. 3). A radiograph was taken immediately post-operatively (Fig. 4). Patient was treated for one week post-op with 500 mg Amoxicillin and 800 mg Motrin.
At 2 ½ months post-op, the patient was evaluated for healing and bone regeneration. Fig. 5 shows the appearance of the defect at the 2 ½ month follow-up time point. The MatrixDerm® Membrane supported soft tissue healing and the augmentation of the ridge was adequate for the second surgical procedure.
In the second surgical procedure the treated region of the alveolar ridge was exposed (Fig. 6). Extraction of tooth #26 was indicated to allow placement of two dental implants to support the restoration (Fig. 7). Two Straumann dental implants were placed at sites #23 and #26. Because the implant in #26 was placed immediately after extraction, the gap around the implant required grafting to facilitate implant stabilization. The gap was treated with Collatene„ and SynOss„ Putty (Fig. 8). Collatene„ was used to aid in hemostasis and wound healing. SynOss„ Putty was used to augment the residual ridge and to fill the defect. MatrixDerm® Membrane was place over the bone graft material and around the dental implants (Fig. 9). Implant healing screws were secured over the membrane (Fig. 10). The wound was closed with Cytoplast„ PTFE 4.0 sutures with slight exposure of the membrane at the midline region (Fig. 11).
At 4 months post implant placement, a radiograph was taken, which shows implant in place with bone growth (Fig. 12). The final restoration performed by Dr. William Stiles, Medford, New Jersey, is a 4-tooth implant-supported bridge over the dental implants and abutments. There was 6 mm keratinized tissue at Implant #26. (Fig. 13). At 20-month post-implant, the implants and restoration continue to function and remain stable as seen in the 20-month post-implant radiograph (Fig.14).
Fig. 5 2 ½ month post-op follow up photograph at re-entry
Fig. 7 Extraction of #26. Straumann tissue level implants inserted at sites #23 and #26 “ note gap at site #26
