Successful reimplantation of Osstem TSIII implant system after removal of failed implant: a case report
By: Heon-Young Kim, Jin-Woo Kim, Sun-Jong Kim
As utilization of implant treatment for loss of teeth increases, the occurrence of complications increases as well. Failure of dental implants is due not only to biological factures such as unsuccessful osseointegration or peri-implantitis but also as a results from mechanical complications involving implant body/fixture fracture, abutment screw fracture, abutment fracture, fractured prosthesis, etc. The failure of an implant may be classified as early or late. Early failures occur shortly after surgery and are characterized by the lack of osseointegration. In contrast, late failures occur after prosthetic restoration. and post successful osseointegration.
The aim of this case report is to describe a case of an explanted fractured fixture (OSSTEM GSII) followed by a reimplantation of an SLA-surfaced implant (OSSTEM TSIII) in the mandibular posterior area.
Age/Sex : 50 / F
Chief complaint : Discomfort in the left mandibular posterior area
1) Intra-oral examination : loosened crown #37
2) Radiographic examination : Fracture of the fixture on #37 (Fig 1)
Implant fixture (Osstem GSII) installed in June, 2009 (Fig 2).
1) To evaluate the osseointegration, periodic follow-up was done for 2 months and healing was uneventful. Final prosthesis was delivered at 2 months post-operatively (Fig 3-4).
2) After 5 years, the patient visited with discomfort in the left mandibular posterior area.
Fig. 2. Pre op and Post op on #37. A : Pre op panoramic view B : Post op panoramic view
Fig. 3. (POD 2months) Final prosthesis was delivered Fig. 4. (POD 2years) Follow-up Stable marginal bone levels around fixture was observed
1) Implant fixture was removed in December, 2014 (Fig 5).
Fig. 5. Fractured fixture, retrieved from mandibular posterior area.
Fig. 6. GBR was performed with autograft and allograft material
3) After 5 months, staged implant re-insertion on #37 was performed with TSIII CA implant May, 2015 (Fig 7).
Fig. 7. (#37i) OSSTEM GS II Ø4x13 OSSTEM TS III CA Ø5x11.5
Although the initial success rate of the dental implant is very high, the fracture and failure of implant often occurs during prosthetic loading. The reimplanted fixture was osseointegrated successfully and stable marginal bone levels around fixture was observed.
There are two main causes of implant fracture:
(i) Mechanical overloading leads to metal fatigue. Overload can also be a consequence of the patient’s physiological alterations.
(ii) Peri-implant vertical bone loss is attributable to both chronic peri-implant inflammation and occlusal trauma.
In this case, the diameter of the fixture was not sufficient to withstand the load, resulting to the eventual fracture of the fixture. Hence, it is of paramount importance to consider the occlusal force and oral habits of patient (e.g., bruxism or clenching) in the planning of the implant fixture and the design of prosthesis.
Even if implant surgical site and procedure is good and initial fixation, stable, post-operative instruction and periodic check-up should still be emphasized.