Reversal of Osseointegration as a Novel Perspective for the Removal of Failed Dental Implants: A Review of Five Patented Methods

Osseointegration is the basis of successful dental implantology and the foundation of cementless arthroplasty and the osseointegrated percutaneous prosthetic system. Osseointegration has been considered irreversible thus far. However, controlled heating or cooling of dental implants could selectively damage the bone at the bone–implant interface, causing the reversal of osseointegration or “osseodisintegration”. This review compares five methods for implant removal, published as patent documents between 2010 and 2018, which have not yet been discussed in the scientific literature. We describe these methods and evaluate their potential for reversing osseointegration. The five methods have several technical and methodological similarities: all methods include a handpiece, a connecting device for coronal access, and a controlling device, as well as the application of mechanical and/or thermal energy. The proposed method of quantifying the temperature with a sensor as the sole means for regulating the process seems inadequate. A database used in one of the methods, however, allows a more precise correlation between a selected implant and the energy needed for its removal, thus avoiding unnecessary trauma to the patient. A flapless, microinvasive, and bone-conserving approach for removing failed dental implants, facilitating successful reimplantation, would benefit dental implantology. These methods could be adapted to cementless medical implants and osseointegrated percutaneous prosthetics. However, for some of the methods discussed herein, further research may be necessary.

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Transient Heat Transfer in Dental Implants for Thermal Necrosis-Aided Implant Removal: A 3D Finite Element Analysis

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-18-00210 ◽

2019 ◽

Vol 45 (3) ◽

pp. 196-201

Author(s):

Mustafa Gungormus ◽

Guzin Neda Hasanoglu Erbasar

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Dental Implants ◽

Temperature Increase ◽

Implant Removal ◽

Analysis Method ◽

Thermal Necrosis ◽

Element Analysis ◽

Bone Implant ◽

Invasive Method

Removal of osseointegrated but otherwise failed (mechanical failure, mispositioning, esthetics, etc) dental implants is a traumatic process resulting in loss of healthy bone and complicating the treatment process. The traumatic effects of implant removal can be reduced by weakening the implant-bone attachment. Thermal necrosis-aided implant removal has been proposed as a minimally invasive method toward this end. In this method, an electrocautery tip is contacted to the implant to increase the temperature to 47°C and generate a limited and controlled thermal necrosis at the bone-implant interface. So far, no controlled studies have been performed to investigate the optimal clinical parameters for this method. In this study, we aimed to investigate, using finite element analysis method, the optimal settings to achieve intentional thermal necrosis on 3 implant systems, at 5 W and 40 W device power and with different size tips. The temperature increase of the implants at 40 W power was very sudden (< 0.5 seconds) and as the bone reached 47°C, the implants were at unacceptable temperatures. At 5 W power, temperature increase of the implants happened at manageable durations (< 1 second). Moreover, the temperature increase was even slower with larger implants and larger tip sizes. Therefore, low power settings must be used for thermal necrosis-aided implant removal. Also, the size of the implant and the tip must be taken into consideration in deciding the duration of contact with the electrocautery tip and the implant.

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Macrophagic Inflammatory Response Next to Dental Implants with Different Macro- and Micro-Structure: An In Vitro Study

Applied Sciences ◽

10.3390/app11125324 ◽

2021 ◽

Vol 11 (12) ◽

pp. 5324

Author(s):

Maria Menini ◽

Francesca Delucchi ◽

Domenico Baldi ◽

Francesco Pera ◽

Francesco Bagnasco ◽

...

Keyword(s):

Inflammatory Response ◽

Dental Implants ◽

In Vitro Study ◽

Titanium Implants ◽

Implant Surface ◽

Bone Implant ◽

Optimal Outcomes ◽

Negative Controls ◽

Inflammatory Effect

(1) Background: Intrinsic characteristics of the implant surface and the possible presence of endotoxins may affect the bone–implant interface and cause an inflammatory response. This study aims to evaluate the possible inflammatory response induced in vitro in macrophages in contact with five different commercially available dental implants. (2) Methods: one zirconia implant NobelPearl® (Nobel Biocare) and four titanium implants, Syra® (Sweden & Martina), Prama® (Sweden & Martina), 3iT3® (Biomet 3i) and Shard® (Mech & Human), were evaluated. After 4 h of contact of murine macrophage cells J774a.1 with the implants, the total RNA was extracted, transcribed to cDNA and the gene expression of the macrophages was evaluated by quantitative PCR (qPCR) in relation to the following genes: GAPDH, YWHAZ, IL1β, IL6, TNFα, NOS2, MMP-9, MMP-8 and TIMP3. The results were statistically analyzed and compared with negative controls. (3) Results: No implant triggered a significant inflammatory response in macrophages, although 3iT3 exhibited a slight pro-inflammatory effect compared to other samples. (4) Conclusions: All the samples showed optimal outcomes without any inflammatory stimulus on the examined macrophagic cells.

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Effect of Osteoporosis on Well-Integrated Bone Implants

Applied Sciences ◽

10.3390/app11020723 ◽

2021 ◽

Vol 11 (2) ◽

pp. 723

Author(s):

Amani M. Basudan ◽

Marwa Y. Shaheen ◽

Abdurahman A. Niazy ◽

Jeroen J.J.P. van den Beucken ◽

John A. Jansen ◽

...

Keyword(s):

Dental Implants ◽

Femoral Condyle ◽

Bone Implants ◽

Bone Implant ◽

Ovx Rats ◽

Bone Response ◽

Significant Difference ◽

Female Wistar Rats ◽

Edentulous Patients

The installation of dental implants has become a common treatment for edentulous patients. However, concern exists about the influence of osteoporosis on the final implant success. This study evaluated whether an ovariectomy (OVX)-induced osteoporotic condition, induced eight weeks postimplantation in a rat femoral condyle, influences the bone response to already-integrated implants. The implants were inserted in the femoral condyle of 16 female Wistar rats. Eight weeks postimplantation, rats were randomly ovariectomized (OVX) or sham-operated (SHAM). Fourteen weeks later, animals were sacrificed, and implants were used for histological and histomorphometric analyses. A significant reduction in the quantity and quality of trabecular bone around dental implants existed in OVX rats in comparison to the SHAM group. For histomorphometric analysis, the bone area (BA%) showed a significant difference between OVX (34.2 ± 4.3) and SHAM (52.6 ± 12.7) groups (p < 0.05). Bone–implant contact (BIC%) revealed significantly lower values for all implants in OVX (42.5 ± 20.4) versus SHAM (59.0 ± 19.0) rats. Therefore, induction of an osteoporotic condition eight weeks postimplantation in a rat model negatively affects the amount of bone present in close vicinity to bone implants.

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Possible Causes in Breaking of Dental Implants Research

Materials Science Forum ◽

10.4028/www.scientific.net/msf.907.104 ◽

2017 ◽

Vol 907 ◽

pp. 104-118

Author(s):

Maria Stoicănescu ◽

Eliza Buzamet ◽

Dragos Vladimir Budei ◽

Valentin Craciun ◽

Roxana Budei ◽

...

Keyword(s):

Dental Implants ◽

Dental Implant ◽

Scientific Literature ◽

Surface Characteristics ◽

Raw Material ◽

New Materials ◽

Materials Used ◽

Type Of Failure ◽

First Time ◽

Consequent Increase

Dental implants are becoming increasingly used in current dental practice. This increased demand has motivated manufacturers to develop varieties of product through design, but also looking for new materials used to improve surface characteristics in order to obtain a better osseointegration. But the increase in the use of implants goes to a consequent increase in the number of failures. These failures are caused either by treatment complications (peri-implantitis), by fatigue breakage under mechanical over-stress, by defective raw material, or due to errors during the insertion procedures. Although they are rare, these complications are serious in dentistry. Before to market a dental implant to clinical practitioners, the product is validated among other determinations in number of biocompatibility research. Raw material issues, details about its structure and properties are less published by the scientific literature, but all this are subject of a carefully analysis of the producers. Breaking of dental implants during surgical procedures, during the prosthetic procedures or during use (chewing, bruxism, accidents, etc.), is the second most common cause of loss of an implant after consecutive peri-implantitis rejection. Although the frequency of this type of failure for a dental implant is much smaller than those caused by the peri-implantitis, a detailed study of broken implants can explain possible causes. The use of scanning electron microscopy (SEM) in the study of the cleave areas explain the production mechanism of cleavages, starting from micro-fissures in the alloy used for the production of dental implants. These micro-fissures in weak areas of the implant (anti-rotational corners of the polygons, etc.) could generate a serious risk of cleavage first time when a higher force is applied.

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Tantalum as a Novel Biomaterial for Bone Implant: A Literature Review

Journal of Biomimetics Biomaterials and Biomedical Engineering ◽

10.4028/www.scientific.net/jbbbe.52.55 ◽

2021 ◽

Vol 52 ◽

pp. 55-65

Author(s):

Ivan Putrantyo ◽

Nikhit Anilbhai ◽

Revati Vanjani ◽

Brigita De Vega

Keyword(s):

Mechanical Properties ◽

Additive Manufacturing ◽

Dental Implants ◽

Bulk Material ◽

High Melting Point ◽

Design Modification ◽

Bone Implant ◽

Specific Strength ◽

Metallic Implants ◽

Tantalum Coatings

Titanium (Ti) has been used in metallic implants since the 1950s due to various biocompatible and mechanical properties. However, due to its high Young’s modulus, it has been modified over the years in order to produce a better biomaterial. Tantalum (Ta) has recently emerged as a new potential biomaterial for bone and dental implants. It has been reported to have better corrosion resistance and osteo-regenerative properties as compared to Ti alloys which are most widely used in the bone-implant industry. Currently, Tantalum cannot be widely used yet due to its limited availability, high melting point, and high-cost production. This review paper discusses various manufacturing methods of Tantalum alloys, including conventional and additive manufacturing and also discusses their drawbacks and shortcomings. Recent research includes surface modification of various metals using Tantalum coatings in order to combine bulk material properties of different materials and the porous surface properties of Tantalum. Design modification also plays a crucial role in controlling bulk properties. The porous design does provide a lower density, wider surface area, and more immense specific strength. In addition to improved mechanical properties, a porous design could also escalate the material's biological and permeability properties. With current advancement in additive manufacturing technology, difficulties in processing Tantalum could be resolved. Therefore, Tantalum should be considered as a serious candidate material for future bone and dental implants.

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The Role of Occlusion in the Dental Implant and Peri-implant Condition: A Review

The Open Dentistry Journal ◽

10.2174/1874210601610010594 ◽

2016 ◽

Vol 10 (1) ◽

pp. 594-601 ◽

Cited By ~ 6

Author(s):

Carmen V. Graves ◽

Steve K. Harrel ◽

Jeffrey A. Rossmann ◽

David Kerns ◽

Jorge A. Gonzalez ◽

...

Keyword(s):

Dental Implants ◽

Dental Implant ◽

Scientific Literature ◽

Dental Treatment ◽

Treatment Approach ◽

Human Studies ◽

Study Designs

Dental implants have become a widely used dental treatment approach. It is important to identify factors that can be detrimental to dental implants and the peri-implant complex. There is controversy regarding whether occlusion plays a role in the implant and peri-implant condition. The present study aims to review the scientific literature regarding this topic. Animal and human studies, and previous reviews on the topic are included and presented. There is a wide heterogeneity among study designs. Several articles demonstrated that occlusion and occlusion overload could detrimentally affect the peri-implant condition, while other articles did not support these results. More studies are needed to help understand the mechanisms by which occlusion might play a role in the peri-implant condition.

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Development of Antiresorptive Agent-Related Osteonecrosis of the Jaw After Dental Implant Removal: A Case Report

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-18-00032 ◽

2018 ◽

Vol 44 (5) ◽

pp. 359-364

Author(s):

Shinsuke Yamamoto ◽

Keigo Maeda ◽

Izumi Kouchi ◽

Yuzo Hirai ◽

Naoki Taniike ◽

...

Keyword(s):

Dental Implants ◽

Dental Implant ◽

Osteonecrosis Of The Jaw ◽

Japanese Woman ◽

Implant Removal ◽

Antiresorptive Agent ◽

Oral Bisphosphonate ◽

Antiresorptive Agents ◽

The Right ◽

Implant Treatment

Dental implant treatment is a highly predictable therapy, but when potentially lethal symptoms or complications occur, dentists must remove the implant fixture. Recently, reports on antiresorptive agent-related osteonecrosis of the jaw have increased in the field of dental implants, although the relationship between dental implant treatment and antiresorptive agents remains unclear. Here, we report a case of antiresorptive agent-related osteonecrosis of the jaw that developed after dental implant removal. A 67-year-old Japanese woman with a medical history of osteoporosis and 7 years of oral bisphosphonate treatment was referred to our hospital with a chief complaint of painful right mandibular bone exposure. A family dentist removed the dental implants from the right mandible using a trephine drill without flap elevation in August 2016. However, the healing was impaired; she was referred to our hospital 3 months after the procedure. We performed a sequestrectomy of the mandible under general anesthesia. In conclusion, this patient's course has two important implications: First, the removal of dental implants from patients who are prescribed oral bisphosphonates for long durations can cause antiresorptive agent-related osteonecrosis of the jaw. Second, meticulous procedures are required to prevent and treat the development of antiresorptive agent-related osteonecrosis of the jaw after dental implant removal.

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Healing Pattern Analysis for Dental Implants Using the Mechano-Regulatory Tissue Differentiation Model

International Journal of Molecular Sciences ◽

10.3390/ijms21239205 ◽

2020 ◽

Vol 21 (23) ◽

pp. 9205

Author(s):

Ming-Jun Li ◽

Pei-Ching Kung ◽

Yuan-Wei Chang ◽

Nien-Ti Tsou

Keyword(s):

Dental Implants ◽

Soft Tissues ◽

Bone Ingrowth ◽

Element Model ◽

Design Guidelines ◽

Tissue Differentiation ◽

Bone Implant ◽

Crestal Bone Loss ◽

History Of ◽

Good Agreement

(1) Background: Our aim is to reveal the influence of the geometry designs on biophysical stimuli and healing patterns. The design guidelines for dental implants can then be provided. (2) Methods: A two-dimensional axisymmetric finite element model was developed based on mechano-regulatory algorithm. The history of tissue differentiation around eight selected implants can be predicted. The performance of the implants was evaluated by bone area (BA), bone-implant contact (BIC); (3) Results: The predicted healing patterns have very good agreement with the experimental observation. Many features observed in literature, such as soft tissues covering on the bone-implant interface; crestal bone loss; the location of bone resorption bumps, were reproduced by the model and explained by analyzing the solid and fluid biophysical stimuli and (4) Conclusions: The results suggested the suitable depth, the steeper slope of the upper flanks, and flat roots of healing chambers can improve the bone ingrowth and osseointegration. The mechanism related to solid and fluid biophysical stimuli were revealed. In addition, the model developed here is efficient, accurate and ready to extend to any geometry of dental implants. It has potential to be used as a clinical application for instant prediction/evaluation of the performance of dental implants.

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Surgical Treatment of Chronic Rhinosinusitis after Sinus lift

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2017.31.4451 ◽

2017 ◽

Vol 31 (4) ◽

pp. 271-275 ◽

Cited By ~ 16

Author(s):

Nicole Tin-Lok Jiam ◽

Andrew N. Goldberg ◽

Andrew H. Murr ◽

Steven D. Pletcher

Keyword(s):

Dental Implants ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Implant Removal ◽

Sinus Surgery ◽

Sinus Lift ◽

Presenting Symptoms ◽

Dental Implantation ◽

Imaging Results

Background The sinus lift (or sinus augmentation) is a common procedure to improve maxillary bone stock before dental implantation. Chronic rhinosinusitis (CRS) is a potential complication of this procedure and may be refractory to medical treatment. Functional endoscopic sinus surgery has previously been used to address CRS, however, results of previous studies indicated that implant removal is required. There are limited follow-up data available. Objective The purpose of this study was to characterize the long-term outcomes and efficacy of endoscopic sinus surgery for refractory CRS after sinus lift, including the ability to salvage dental implants. Methods This was a retrospective case series that described nine patients who, between June 2011 and September 2016, underwent endoscopic sinus surgery for CRS after a sinus lift procedure. The presenting symptoms of the patients, medical management, imaging results, operative procedures, and outcomes were reviewed. Results The majority of patients developed symptoms (mucopurulent nasal drainage, facial pain and/or pressure, nasal congestion, and foul smell) within 3 months of implant placement and were treated with at least three courses of antibiotics before referral to an otolaryngologist. All the patients underwent wide endoscopic maxillary antrostomy, with no surgical complications or postoperative reports of infection. There was a statistically significant improvement in 22-item Sino-Nasal Outcome Test scores (t(8) = -2.908; p = 0.02) and discharge, inflammation, and polyps/edema endoscopic scores ([z = -2.539; p = 0.011) between pre- and postsurgical treatment. Four patients had their dental implants removed before presentation. Among the five patients who presented with intact dental implants, none required removal before or after functional endoscopic sinus surgery. Conclusion Functional endoscopic sinus surgery was a reasonable and efficacious treatment option for patients who presented with paranasal sinus disease after a sinus lift. Dental implant removal may not be a requirement for successful treatment of CRS associated with sinus lift procedures.

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Bone-Implant Contact around Crestal and Subcrestal Dental Implants Submitted to Immediate and Conventional Loading

The Scientific World JOURNAL ◽

10.1155/2014/606947 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Ana Emília Farias Pontes ◽

Fernando Salimon Ribeiro ◽

Giovanna Iezzi ◽

Juliana Rico Pires ◽

Elizangela Partata Zuza ◽

...

Keyword(s):

Dental Implants ◽

Bone Implant ◽

Anova Test ◽

Edentulous Mandible ◽

Bone Implant Contact ◽

Bone Level

The present study aims to evaluate the influence of apicocoronal position and immediate and conventional loading in the percentage of bone-implant contact (BIC). Thus, 36 implants were inserted in the edentulous mandible from six dogs. Three implants were installed in each hemimandible, in different positions in relation to the ridge: Bone Level (at crestal bone level), Minus 1 (one millimeter apical to crestal bone), and Minus 2 (two millimeters apical to crestal bone). In addition, each hemimandible was submitted to a loading protocol: immediate (prosthesis installed 24 hours after implantation) or conventional (prosthesis installed 120 days after implantation). Ninety days after, animals were killed, and implant and adjacent tissues were prepared for histometric analysis. BIC values from immediate loaded implants were 58.7%, 57.7%, and 51.1%, respectively, while conventional loaded implants were 61.8%, 53.8%, and 68.4%. Differences statistically significant were not observed among groups (P=0.10, ANOVA test). These findings suggest that different apicocoronal positioning and loading protocols evaluated did not interfere in the percentage of bone-implant contact, suggesting that these procedures did not jeopardize osseointegration.

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