Explantation (dental implant)

Under explantation ( Lat. Ex "out" plantar "plant") of a dental implant refers to the surgical removal of an implant from the jaw bone .

Fractured, irreparable implant prior to explantation

indication

Implant for orthodontic anchoring on the model

The 5-year survival rate of dental implants since the introduction of titanium implants has been very high at 96.8%. These implants osseointegrate and form an ankylotic connection with the surrounding jawbone. In rare cases, however, the removal of an implant is indicated , for example in the case of advanced peri-implantitis . If the bone loss has only partially occurred, the part that is still osseointegrated must be loosened. If there was a degree of loosening I (just palpable and noticeable, barely visible horizontal mobility of the implant) of a previously osseointegrated implant, the explantation could not be bypassed in a related review. Explantation is also indicated for probing depths greater than 8 mm.

Explantation has to be carried out in some special cases, for example in the case of irritation of a nerve (especially the mandibular nerve ), paresthesia , neuralgia , maxillary sinusitis , implant fractures or an incorrectly placed implant. With implants in the pre-irradiated jaw, the prognosis with a survival rate of 72% after five years is significantly worse than for endosseous implants in healthy bone.

Implants are also used temporarily, for example for the fixation of an orthodontic appliance for tooth regulation or as an auxiliary implant for temporary restoration . Various methods are available for explantation.

Procedure

An implant is usually removed under local anesthesia . Access to the explantation area is created by means of a small gingival incision.

extraction

An implant that has already been loosened can be easily grasped , for example by means of Luer bone forceps or anterior or premolar forceps, and removed by unscrewing it. If the implant is not an osseointegrated titanium implant (for example a steel implant that was previously used), it is usually surrounded by connective tissue and therefore easier to remove.

Unscrew

If a two-part implant is only rudimentarily held in the jawbone, an attempt can be made to unscrew the implant with a force of about 500 Ncm using a small torque wrench that is inserted into the implant .

Milling out

Lindemann milling machine

An osseointegrated, ankylotically healed implant can be exposed by milling around the implant with a Lindemann burr . A disadvantage is the endangerment of neighboring structures and the large, procedural peri-implant bone loss, which is disadvantageous for a later restoration. This can cause a bone defect that is about twice the size of the implant diameter. A delicate long-shaft milling machine is also used.

Trepan milling machine

Face of a trepan cutter

A trephine burr is a cylindrical drill that is hollow on the inside and has sharpened teeth on the face. The trephine burr is adapted to the diameter of the implant. The milling cutter thus drills around the implant, as it were, and is guided downwards along the implant like a pipe. For this purpose, the superstructure (e.g. a tooth crown ) must first be removed in order to be able to insert the trephine drill, which is only slightly larger than the implant. The advantage of this drilling method is that there is far less bone loss than would result from milling with a Lindemann burr. Trephine drills are available in individual widths, depending on the implant diameter. If the trephine burr gets stuck, the contra-angle head may hit or the bearing may break.

Piezo-surgical explantation

In piezo- surgical explantation, the bone is processed by vibrations, similar to the removal of tartar , and thereby removed. This technique was developed by Tomaso Vercellotti. With good cooling with sterile water, the tip of the piezo device is first set to vibrate, which can slide bit by bit deeper to the apex of the implant with light pressure .

Removal by laser

The laser-assisted explantation of a failed dental implant using an erbium-YAG laser is a minimally invasive technique as an alternative to conventional mechanical explantation techniques.

Follow-up therapy

After the explantation, depending on the extent of the bone defect, a new implant with a slightly larger diameter can either be placed immediately or a bone augmentation must first be carried out in order to place another implant after the regeneration of the bone.

costs

The removal of an endosseous implant is - as is usually the case with the insertion of an implant - a private dental service. In Germany, it is calculated according to number 3000 of the private fee schedule for dentists (GOZ), which is valued at 70 points (around € 9 if the 2.3-fold rate is applied). In addition, there are the costs of accompanying services, such as examinations, advice, local anesthesia, removing a crown, x-rays, follow-up treatment costs and others.

swell

C. Blum: Implant removal: search for the gentlest method. ZWP, April 15, 2013
W. Bückling: The gentle explantation. ZM, issue 22 (2012)

Individual evidence

^ RE Jung, BE Pjetursson u. a .: A systematic review of the 5-year survival and complication rates of implant-supported single crowns. In: Clinical Oral Implants Research . Volume 19, Number 2, February 2008, pp. 119-130, ISSN 0905-7161 . doi : 10.1111 / j.1600-0501.2007.01453.x . PMID 18067597 . (Review).
↑ AM Roos-Jansåker, S. Renvert, J. Egelberg: Treatment of peri-implant infections: a literature review. In: Journal of Clinical Periodontology . Volume 30, Number 6, June 2003, pp. 467-485, ISSN 0303-6979 . PMID 12795785 . (Review).
^ NP Lang, T. Berglundh u. a .: Consensus statements and recommended clinical procedures regarding implant survival and complications. In: The International journal of oral & maxillofacial implants. Volume 19 Suppl, 2004, pp. 150-154, ISSN 0882-2786 . PMID 15635955 . (Review).
^ KA Grötz, UW Wahlmann u. a .: [Prognosis and prognostic factors of endosseous implants in the irradiated jaw]. In: Oral and maxillofacial surgery: MKG. Volume 3 Suppl 1, May 1999, pp. S117-S124, ISSN 1432-9417 . PMID 10414097 .
↑ T. Vercellotti: Piezo Surgery in Dentistry: Clinical Advantages in Dentistry. Quintessenz Verlag, (July 15, 2011) ISBN 3-86867-042-4
^ LP Smith, T. Rose: Laser explantation of a failing endosseous dental implant. In: Australian dental journal. Volume 55, Number 2, June 2010, pp. 219-222, ISSN 1834-7819 . doi : 10.1111 / j.1834-7819.2010.01225.x . PMID 20604768
↑ Appendix 1 of the schedule of fees for dentists

[1] RE Jung, BE Pjetursson u. a .: A systematic review of the 5-year survival and complication rates of implant-supported single crowns. In: Clinical Oral Implants Research . Volume 19, Number 2, February 2008, pp. 119-130, ISSN 0905-7161 . doi : 10.1111 / j.1600-0501.2007.01453.x . PMID 18067597 . (Review).

[2] AM Roos-Jansåker, S. Renvert, J. Egelberg: Treatment of peri-implant infections: a literature review. In: Journal of Clinical Periodontology . Volume 30, Number 6, June 2003, pp. 467-485, ISSN 0303-6979 . PMID 12795785 . (Review).

[3] NP Lang, T. Berglundh u. a .: Consensus statements and recommended clinical procedures regarding implant survival and complications. In: The International journal of oral & maxillofacial implants. Volume 19 Suppl, 2004, pp. 150-154, ISSN 0882-2786 . PMID 15635955 . (Review).

[4] KA Grötz, UW Wahlmann u. a .: [Prognosis and prognostic factors of endosseous implants in the irradiated jaw]. In: Oral and maxillofacial surgery: MKG. Volume 3 Suppl 1, May 1999, pp. S117-S124, ISSN 1432-9417 . PMID 10414097 .

[5] T. Vercellotti: Piezo Surgery in Dentistry: Clinical Advantages in Dentistry. Quintessenz Verlag, (July 15, 2011) ISBN 3-86867-042-4

[6] LP Smith, T. Rose: Laser explantation of a failing endosseous dental implant. In: Australian dental journal. Volume 55, Number 2, June 2010, pp. 219-222, ISSN 1834-7819 . doi : 10.1111 / j.1834-7819.2010.01225.x . PMID 20604768

[7] Appendix 1 of the schedule of fees for dentists