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Extraction, Implant Removal, & Grafting: Using PRF, Sticky Bone & Waterlase iPlus

Last Updated: Feb 26, 2020

This a 77 year-old patient who was on blood thinners and had to have #6, and #8 removed as they were both unrestorable. We also had to remove the #7 implant as it had a significant amount of bone loss (more than 4.5mm of bone loss on coronal portion and super thin bone on buccal). Implant had to be removed to properly graft the site.

We used our Waterlase iplus to trough around the implant and used 1.0cc of mineralized cortical cancellous bone mixed with iPRF and A-PRF (sticky bone). PRF was created using the Horizontal PRF Centrifuge.

We covered the graft with A-PRF membranes, followed by non-resorbable PTFE membrane (primary closure was going to be difficult in this case). We also did PET (Partial extraction therapy or Socket Shield at site #6, but was not able to do so at Site #8 due to the amount of bone loss on the buccal). We covered the PTFE membrane with another layer of A-PRF. Our plan is to place an implant at site #6 and one at site #8 and do a 3 unit bridge as a final restoration.

Play the video below to watch the case. Additional slides are below.

7 Comments on Extraction, Implant Removal, & Grafting: Using PRF, Sticky Bone & Waterlase iPlus

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Dr Dale Gerke, BDS, BScDe

2/26/2020

A good presentation, well done. A few comments I would make. Firstly, I think this case is an excellent example of why implant crown design and construction is so critical. The lack of emergence profile contour on the initial crown almost certainly created a food trap area and inability to maintain the gingival cuff area. I would guess that it is 99.9% likely that this resulted in crestal bone loss AND extensive caries of the adjacent teeth. The message should be for dentists to direct the laboratory to create a well shaped crown. (I am sure the initial crown was not placed by the presenter.) Secondly, did you consider reverse screwing the implant out? While I am impressed with the surgical removal of bone, it might have been quicker, easier and more conservative to unwind the implant (possibly with a little laser bone removal around the platform area if it did not reverse torque out straight away).

Brian

2/26/2020

Dr Gerke, great point on emergence of the restoration. This pt lost slight amount of bone which was realized at initial uncovery. He was given the option to remove and redo, which he declined and opted for the none ideal restorative option. Additionally, pt was sick and we did not see him for a while. He was leaving lozenges (unfortunately not suger free) every night under his lip which lead to severe decay on his adjacent teeth, which lead to food trap, and further bone loss around the implant. We also gave pt the option to leave implant in place, but he opted to have it removed.

Brian

2/26/2020

Forgot to respond to reverse screwing the implant. We did attempt that with no luck. This was a 14 mm implant and had lost about 4-6 mm of bone.

David Levitt

2/26/2020

Although I applaud the surgical technique, You explanted a repairable implant. If you had cleaned the surface of the implant, removed the crown, placed a healing screw and grafted as you did it would have been fine.

Brian

2/26/2020

Great point. This option was discussed with the patient, but due to the abcess and amount of bone loss on the adjacent teeth (no buccal bone), growing vertical bone to cover exposed threads would have been very unpredictable.

Cliff Leachman

2/26/2020

Great video, laser looked like fun..

Brian

2/26/2020

Thank you! I love using the laser for conservative implant removal and Emax crown debonding in under 1 minute.

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