Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
Home | About JISP | Search | Accepted articles | Online Early | Current Issue | Archives | Instructions | SubmissionSubscribeLogin 
Users Online: 500  Home Print this page Email this page Small font size Default font size Increase font sizeWide layoutNarrow layoutFull screen layout


 
CASE REPORT
Year : 2010  |  Volume : 14  |  Issue : 1  |  Page : 50-52 Table of Contents   

Treatment of protruding osseo integrated dental implant


Department of Dental Specialties, Mayo Clinic, Rochester, Minnesota, USA

Date of Submission05-Dec-2009
Date of Acceptance01-Jan-2010
Date of Web Publication13-Jul-2010

Correspondence Address:
Aravind Buddula
Department of Dental Specialties, Mayo Clinic, Rochester, Minnesota-559 01
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-124X.65440

Rights and Permissions
   Abstract 

Titanium dental implants have been used in the treatment of partial or complete edentulism. The height and width of the residual alveolus and surrounding anatomical structures can determine the proper position and path of insertion of dental implants. The following case report describes the treatment of a malpositioned osseo integrated dental implant with an apex perforating the buccal cortex of alveolar bone. A 61-year-old male was referred by his local dentist for the chief complaint of a swelling at site of tooth 14 where an implant was present. Intraoral clinical examination revealed an implant supported porcelain fused to metal crown replacing the maxillary right first premolar. A peri-apical radiograph of the implant revealed no signs of peri-implant bone loss or radiolucency. Surgical exploration and modification of the protruding implant. The area healed uneventfully without the need of explantation of the implant in site of tooth 14. We felt that the conservative treatment provided was prudent and treatment of choice and anticipate that the implant will most likely continue to function for a lifetime.

Keywords: Dental implant, osseointegration, perforation


How to cite this article:
Buddula A, Sheridan P, Balshe A. Treatment of protruding osseo integrated dental implant. J Indian Soc Periodontol 2010;14:50-2

How to cite this URL:
Buddula A, Sheridan P, Balshe A. Treatment of protruding osseo integrated dental implant. J Indian Soc Periodontol [serial online] 2010 [cited 2020 Sep 25];14:50-2. Available from: http://www.jisponline.com/text.asp?2010/14/1/50/65440


   Introduction Top


For over 30 years, titanium dental implants have been used in the treatment of partial or complete edentulism. [1],[2],[3],[4],[5],[6],[7],[8],[9] Implant stability is attributed to its anchorage in the surrounding alveolar bone, referred to as osseo integration. [10],[11] Proper implant placement in bone is necessary for the success of osseo integration and function. [12] The height and width of the residual alveolus and surrounding anatomical structures can determine the proper position and path of insertion of dental implants. The following case report describes the treatment of a malpositioned osseo integrated dental implant with an apex perforating the buccal cortex of alveolar bone.


   Case Report Top


In February 2007, a 61-year old male was referred by his local dentist for the chief complaint of a swelling at site of tooth 14, where an implant was present. In December 2002, the patient's maxillary right first premolar was extracted. A Nobel Biocare TiUnite dental implant was used to replace the missing tooth in February 2003. Since the time of implant placement, the patient noted swelling in the buccal gingival area where the implant was placed. He could feel it with his tongue and fingers. He had always been slightly uncomfortable with this. He preferred that his gingival tissue be returned to its previous form.

Intraoral clinical examination revealed an implant supported porcelain fused to metal crown replacing the maxillary right first premolar. A peri-apical radiograph of the implant revealed no signs of peri-implant bone loss or radiolucency. Periodontal examination revealed stability of the implant with probing depths ranging from 2-3 mm. There were no clinical signs of peri-implantitis. There was, however, a 5 ΄ 5 mm raised area in the non-keratinized soft tissue facial to the implant [Figure 1]. There were no signs of erythema or infection. Upon digital palpation, there was no soft tissue drainage and the raised area was found to be firm and screw threads could be detected. The patient did not experience any discomfort upon percussion. Hard and soft tissue examination of the rest of the mouth was normal. We recommended surgical exploration and modification of the protruding implant. The patient consented to the treatment plan

The surgery was performed under local anesthesia. Sulcular incisions were made extending from the mesio-buccal of the right maxillary first molar distally to the mesio-labial of the right maxillary canine. A vertical releasing incision was also made at the mesio-labial aspect of the right maxillary canine. A full thickness buccal flap was raised. The area of the implant and surrounding alveolar bone was exposed. It was apparent that the apical portion of the dental implant had perforated cortex of the alveolar bone [Figure 2]. The implant was osseo integrated. There was no necrotic bone surrounding the implant. A high speed bur was used to remove the portion of the implant protruding through the buccal plate of bone. A round diamond bur was used to flatten the implant and try to make it flush with the buccal plate of bone [Figure 3]. Copious irrigation was utilized. The facial flap was then repositioned and secured with 4-0 gut suture [Figure 4]. The patient was seen at four weeks [Figure 5], three months [Figure 6] and six months [Figure 7]. The area healed uneventfully.


   Discussion Top


The authors felt that this case report provided the opportunity to briefly discuss two issues: 1) the appropriate placement of dental implants and 2) treatment options for the malpositioned and symptomatic implants. Recently, there has been much discussion on image-guided implant placement and "flapless" surgery. In this instance, the authors suspected that the clinician placing the implant used "flapless" surgery for the simple flap utilized to treat the problem if used at implant placement would have avoided the problem. Image-guided implant placement is a valuable tool, but most likely not necessary in the majority of cases of implant placement. In the case of implant placement at this No. 14 site, a simple flap would have revealed the concavity in the facial aspect of the alveolus and allowed implant placement while saving the patient lot of expenditure and unnecessary radiation exposure associated with CT scans and image-guided implant placement.


   Conclusion Top


The options considered in treatment of the malpositioned implant were removal of the implant or reduction and reshaping of the protruding portion of the implant. The trauma, cost, and time involved in implant removal and replacement could not be justified. We felt that the conservative treatment provided was prudent and treatment of choice and anticipate that the implant is most likely continue to function for a lifetime.

 
   References Top

1.Brεnemark PI, Adell R, Breine U, Hansson BO, Lindstrφm J, Ohlsson A. Intra-osseous anchorage of dental prostheses: I: Experimental studies. Scand J Plast Reconstr Surg 1969;3:81-100.  Back to cited text no. 1      
2.Brεnemark PI. Osseointegrated implants in the treatment of the edentulous jaw: Experience from a 10-year period. Scand J Plast Reconstr Surg 1977;16:1-132.  Back to cited text no. 2      
3.Albrektsson T, Brεnemark PI, Hansson HA, Lindstrφm J. Osseointegrated titanium implants: Requirements for ensuring a long-lasting, direct bone-to-implant anchorage in man. Acta Orthop Scand 1981;52:155-70.  Back to cited text no. 3      
4.Adell R, Lekholm U, Rockler B, Brεnemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;10:387-416.  Back to cited text no. 4      
5.Albrektsson T. A multicenter report on osseointegrated oral implants. J Prosthet Dent 1988;60:75-84.   Back to cited text no. 5      
6.Albrektsson T, Dahl E, Enbom L, Engevall S, Engquist B, Eriksson AR, et al. Osseointegrated oral implants: A Swedish multicenter study of 8139 consecutively inserted Nobelpharma implants. J Periodontol 1988;59:287-96.  Back to cited text no. 6      
7.Van Steenberghe D. A retrospective multicenter evaluation of the survival rate of osseointegrated fixtures supporting fixed partial prostheses in the treatment of partial edentulism. J Prosthet Dent 1989;61:217-23.  Back to cited text no. 7      
8.Adell R, Eriksson B, Lekholm U, Brεnemark PI, Jemt T. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants 1990;5:347-59.  Back to cited text no. 8      
9.Zarb GA, Schmitt A. The longitudinal clinical effectiveness of osseointegrated dental implants: the Toronto study, Part I: Surgical results. J Prosthet Dent 1990;63:451-7.  Back to cited text no. 9      
10.Zarb GA, Schmitt A. The longitudinal clinical effectiveness of osseointegrated dental implants: the Toronto Study, Part II: The prosthetic results. J Prosthet Dent 1990;64:53-61.  Back to cited text no. 10      
11.Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: A review and proposed criteria of success. Int J Oral Maxillofac Implants 1986;1:11-25.  Back to cited text no. 11      
12.Smith D, Zarb G. Criteria for success of osseointegrated endosseous implants. J Prosthet Dent 1989;62:567-72.  Back to cited text no. 12      


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]


This article has been cited by
1 Successful Dental Implant Placement Surgeries With Buccal Bone Fenestrations
Liviu Steier,Gabriela Steier
Journal of Oral Implantology. 2015; 41(1): 112
[Pubmed] | [DOI]
2 Electrodeposition of pronectin for titanium to augment gingival epithelium adhesion
Shingo Kawabata,Kazunari Asano,Atsuko Miyazawa,Tazuko Satoh,Yasuhiko Tabata
Journal of Tissue Engineering and Regenerative Medicine. 2013; 7(5): 348
[Pubmed] | [DOI]



 

Top
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    Introduction
    Case Report
    Discussion
    Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed2790    
    Printed140    
    Emailed1    
    PDF Downloaded353    
    Comments [Add]    
    Cited by others 2    

Recommend this journal