PMC5516738_01
Preoperative radiographic view (panoramic X-ray image). Implant of #37 area shows the broken abutment screw off the implant fixture inside.
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A 70-year-old male requested Department of Periodontology to remove the implant fixture at second molar region of left mandible (Figure 1).
Conventional removal method applied on #37 region. (a) Preoperative state showing a gingival defect. (b) Implant removal using a trephine bur (external diameter: 6 mm, internal diameter: 5 mm; Biomet, Warsaw, IN, USA), elevator (Hu-Friedy, Chicago, IL, USA), and root forceps (Hu-Friedy, Chicago, IL, USA). (c) The implant and the surrounding alveolar bone removal. ((d) and (e)) Immediate bone grafting [Osteon II 0.5 g (particle size 0.5~1.0 mm) and collagen membrane 15 x 20 mm; Genoss, Suwon, Korea] on the implant removal socket. (f) Suture for a primary wound closure.
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fig2
After placing buccal and lingual flap properly, interrupted suture was given on the spot for primary closure (Figure 2).
Postoperative radiographic view (periapical X-ray image). (a) Implant fixture with a fractured abutment screw. (b) Implant removal site filled with a bone grafting material.
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Periapical X-ray image verified the complete implant removal after the surgery (Figure 3).
Postoperative radiographic view (panoramic X-ray image). Implant reinstallation on #37 region four months after the implant removal.
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Two months after the surgery, completely cured soft tissues of the surgical site were verified; thus reinstallation of an implant was planned and carried out four months later (Figure 4).
PMC5516738_02
Preoperative radiographic view (panoramic X-ray image). Implants of right maxilla area show a severe alveolar bone loss lesion.
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A 66-year-old female who had discomfort on implants of first premolar, second premolar, and first molar region of right maxilla came to Department of Periodontology (Figure 5).
Advanced and mixed removal methods applied on #14, #15, and #16 regions. (a) Supragingival eruption state of an implant fixture. (b) Implant prosthodontics removal state showing a lack of keratinized gingiva and peri-implant tissue impairment. (c) Exposure of upper portion of the implant fixture and severe surrounding alveolar bone loss. (d) Implant removal using the Neo FR Kit (NeoBiotech, Seoul, Korea) on #14 and #16 regions and using the trephine bur (external diameter: 5 mm, internal diameter: 4 mm) on #15 region and the surrounding alveolar bone. (e) Implant removal socket showing a perforation of the sinus inferior wall and maintenance of the internal schneiderian membrane. (f) Tension-free suture for a natural healing progress.
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Immediate implant reinstallation was impossible on the same site because of the alveolar bone loss and a need for inflammation treatment (Figure 6).
Vertical augmentation of alveolar ridge applied on the implant removal site. (a) Severe vertical resorption state four months after the implant removal. (b) Narrow alveolar ridge. (c) Insertion of a tenting screw (Dentium, Seoul, Korea) and application of a GORE-TEX membrane TR6Y (W. L. Gore & Associates Inc., Flagstaff, Arizona, USA). ((d) and (e)) Bone grafting using a Bio-Oss 1.0 g (Geistlich Pharma AG, Wolhusen, Switzerland), and GORE-TEX membrane covering the site and supported by the tenting screw. (f) Suture for a primary wound closure.
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fig7
These sites were supported by tenting screws (Dentium, Seoul, Korea) to secure vertical height (Figures 7 and 8(c)).
Postoperative radiographic view (periapical X-ray image). (a) Implant fixture with severe surrounding alveolar bone loss. (b) Implant removal site. (c) Vertical augmentation of an alveolar ridge.
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fig8
Panoramic X-ray image verified successful implants removal (Figures 8(a) and 8(b)). These sites were supported by tenting screws (Dentium, Seoul, Korea) to secure vertical height (Figures 7 and 8(c)).
Postoperative radiographic view (panoramic X-ray image). Implant reinstallation on #14 and #16 regions four months after the implant removal.
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fig9
Four months after this treatment, two implants were reinstalled at first premolar and first molar regions (Figure 9).