Malpositioned Implant Fixtures: Any Experience with Using an Electrosurge Unit to Pulse Generate Heat to the Implant/Bone Interface?

Last Updated February 28, 2011

Dr. A. asks:

I am a general dentist and I am very experienced in the surgical placement of implants. I have been referred a patient who has SteriOss implants placed in the #8 and10 sites[maxillary right central incisor, maxillary left lateral incisor; 11, 22]. These implants were placed 7 months prior and are integrated. They have not been loaded. The implant fixtures are malpositioned and malaligned and they cannot be restored. My usual protocol in cases like this is to remove the implants with reverse torque and spin them out. However, with SteriOss implants, the crest module is so weak that these crest module usually break and flower.

My alternative is to core out the implants with a trephine bur. However, in this case the buccal plate is very thin and the implant in #10 site is 0.5 mm from #11 [maxillary left canine; 23]. So if I core out the implant in this site, I will destroy the periosteum of the adjacent canine. My other alternative is to use a Piezo surgical tip to remove the mesial and distal bone and then attempt to spin out the implants. This is often successful, but sometimes not, in which case, I sometimes have to remove the buccal plate and perform a GBR procedure.

My question revolves around the consideration of using electrosurgery to pulse generate heat to the implant/bone interface. If I could weaken the integration enough to have woven bone instead of lamellar bone surround the implant, I would have a more predictable way of spinning out the implant. Has anyone had experience with this in a predictable way without jeopardizing the patient and the surrounding bone?

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