Fracture line in osstem implant: thoughts?

I had placed an Osstem 4x11mm implant in 36 region 3 years ago.  I used a rigid abutment. It is a non-hexed screwable type one piece abutment for cement retained crowns.  It is meant to cold weld to the implant fixture once placed under required torque.  For some reason screw loosening happened 2 times and I placed the same abutment back again.  Eventually the screw broke. I retrieved it.  The implant also shows a crack line on the labial surface and around 3 mm of bone loss labially.  The patient is asymptomatic.  Can I place a hexed 2 piece abutment, which would not put an expansion pressure on the implant and aggravate the crack line, and use it in a bridge with another implant?  Or should I not take this risk and try and remove the implant?  What would be the prognosis if I were to load this implant with a technically more sound hexed abutment?  The patient had gotten other fixed prosthesis work done with another dentist when she was away. I will be working on the current occlusion she has.

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15 thoughts on “Fracture line in osstem implant: thoughts?

  1. Seeing the occlusion , I see an impending failure of fixture or abutment and it’s allied parts. Long term survival won’t be great. See the upper molar, it’s totally flat. Need to do some force assessment and inform patient of realistic consequences than to suffer at a later stage with a bigger procedure

  2. I’ve had a similar problem with an osstem/Hiossen implant. I retrieved the implant, grafted the site and placed a new implant 4 months later. Likely there was excessive occlusal load or off-axis forces on the implant. Placing a two-piece abutment will not solve the problem.

  3. Removing the fixture is not a pleasant experience; you’ll lose more bone, delay treatment and a patient that is very disappointed. I would:
    1. Ease the occlusal load
    2. Change to different abutment
    3. Use specifically formulated abutment ‘micro gap’ sealer.
    Hope this help

    1. Sounds good. I hv never removed a fixture before. Will work on the maxillary occlusion. Maybe place one more implant distal to it and club the two or more. Thank u so much. Will try to post further rx pics.

  4. I had similar experience and had to remove implant with vertical crack. I am not sure whether I can provide illustrations of the case that may be helpful. If not a photograph is displayed in my website designated to complications in implant dentistry.

    Best of luck

  5. If these films are recent and show the existing condition of the remaining teeth then there are other problems that need attention. The occlusal plain appears to be potentially destructive and needs to be corrected and some teeth need repair. The replacement of this implant will not be the solution to fixing the problem. If the implant is cracked it should be removed and replaced, but before restoring the new implant the other problems need to be addressed. Contact the other dentist and try to coordinate treatment so that the different treatment plans do not conflict.

  6. To remove the fixture cut away implant with a #330 burr as far apically you can reach. Then luxate the fixture and attach a fixture mount and reverse turn with a ratchet to completely remove.
    Dennis Flanagan DDS MSc

  7. With regard to the technique for implant removal, this abstract may be helpful

    Removal of dental implants: review of five different techniques.

    Stajčić Z1, Stojčev Stajčić LJ2, Kalanović M2, Đinić A2, Divekar N3, Rodić M3.

    Int J Oral Maxillofac Surg. 2016 May;45(5):641-8. doi: 10.1016/j.ijom.2015.11.003. Epub 2015 Dec 10.

    The aims of this study were to review five different explantation techniques for the removal of failing implants and to propose a practical clinical protocol. During a 10-year period, 95 implants were explanted from 81 patients. Explantation techniques used were the bur-forceps (BF), neo bur-elevator-forceps (ηBEF), trephine drill (TD), high torque wrench (HTW), and scalpel-forceps (SF) techniques. The following parameters were analyzed: indications for explanation, site of implantation, and the type, diameter, and length of the implant removed. The most frequent indications for implant removal were peri-implantitis (n=37) and crestal bone loss (n=48). The posterior maxilla was the most frequent site of implant removal (n=48). The longer implants were more frequently removed (n=78). The majority of implants were removed after 1 year in function (n=69). The BF/ηBEF and SF techniques were found to be the most efficient. Explantation techniques appeared to be successful for the removal of failing implants. The BF/ηBEF and SF techniques demonstrated 100% success. The ηBEF technique enabled safe insertion of a new implant in the same explantation site. The HTW technique appeared to be the most elegant technique with the highest predictability for insertion of another implant. An explantation protocol is proposed.

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