The document discusses implant failure, its classification, diagnosis, and treatment. It defines the different types of failure as ailing, failing, and failed implants based on clinical and radiographic signs. Risk factors for failure include host factors like smoking, parafunctional habits, and bone quality. Diagnosis involves assessing mobility, peri-implant bone loss, inflammation, and pain. Treatment depends on the type of failure but may include replacing abutments, bone grafting, modifying the prosthesis, or removing the implant. Proper implant placement and occlusal scheme are important to prevent mechanical failures.

1. IMPLANT FAILURE,TREATMENT & MAINTANENCE
Presented by:-
DR. ROHIT PATIL
MDS II

2. • Introduction
• Success criteria for dental implants
• Implant failure classification
• Clinical & radiographic conditions.
• Diagnosis
• Risk factors
• Management of ailing and failing implants
• The treatment options for managing implant failure
• Conclusion
• References
Contents

3. • Implant dentistry has gained popularity because of very high success and survival
rates. However, implant failure and related complications also have been
reported.
• Dental implants demonstrated peri-implant inflammatory reactions which were
associated with crestal bone loss that may eventually lead to the loss of an
implant.
Introduction

4. • It has been shown that the inflammation is more pronounced and the
inflammatory process goes deeper and faster around the dental implant than
around the adjacent natural tooth.
• Not only inflammation various factors like faulty prosthesis, host factors are also
related to implant related complication.

5. (Koth DL, McKinney RV, Steflik DE, Davis QB. Clinical and statistical analyses of human clinical trials with the single crystal aluminum oxide
endosteal dental implant: Five-year results. Journal of Prosthetic Dentistry. 1988 Aug 1;60(2):226-34.)
Success criteria for dental implants
Mckinney, Koth, And Steflik
 Subjective criteria
i. Adequate function.
ii. Absence of discomfort.
iii.Patient belief that esthetics, emotional, and psychological attitude are
improved.

6.  Objective criteria
1. Good occlusal balance and vertical dimension.
2. Bone loss no greater than one third of the vertical height of the
implant.
3. No gingival inflammation.
4. Mobility of less than 1 mm buccolingually, mesiodistally, and vertically.

7. 5. Absence of symptoms and infection associated with the dental implant.
6. Absence of damage to adjacent tooth or teeth and their supporting
structures.
7. Absence of parasthesia or violation of mandibular canal, maxillary sinus, or
floor of nasal passage.
8. Healthy collagenous tissue without polymorphonuclear infiltration.

8.  Revised Criteria For Implant Success Alberktson, Zarb, Washington,
And Erickson –
1. Individual unattached implant that is immobile when tested clinically.
2. Radiograph that does not demonstrate evidence of peri-implant
radiolucency.
3. Bone loss that is less than 0.2 mm annually after the implant's first year
of service.
4. Individual implant performance that is characterized by an absence
of persistent and/or irreversible signs and symptoms of pain,
infections, necropathies, paraesthesia, or violation of the mandibular
canal.
(Smith DE, Zarb GA. Criteria for success of osseointegrated endosseous implants. J Prosthet Dent 1998;62:567-72)

9. HEALTH SCALE FOR DENTAL IMPLANTS
International Congress of Oral Implantologists, Pisa, Italy, Consensus Conference, 2007.
Implant Quality Scale
Group
Clinical Conditions
1 Success (optimum
health)
a)No pain or tenderness upon function
b) No mobility
c)2 mm radiographic bone loss from initial surgery
d)No exudates history
2 Satisfactory survival a)No pain on function
b)No mobility
c)2–4 mm radiographic bone loss
d)No exudates history
(Misch CE, Perel ML, Wang HL, et al. Implant success, survival, and failure: the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference.
Implant Dent 2008;17(1):5-15.)

10. 3 Compromised survival a)May have sensitivity on function
b)No mobility
c)Radiographic bone loss 4 mm (less than1/2 of
implant body)
d)Probing depth 7 mm
e)May have exudates history
4 Failure (clinical or
absolute failure)
Any of following:
a)Pain on function
b)Mobility
c)Radiographic bone loss 1/2 length of implant
d)Uncontrolled exudate
e)No longer in mouth

11. Implant failure classification
Biological Failures
• Early or primary
(Before loading)
Late or
secondary (After
loading)
Mechanical
failures
• Fracture of
implants,
connecting
screws, bridge
framework,
coatings etc
3)Iatrogenic
Failures
• Improper
implant
angulation and
alignment, nerve
damage
Inadequate
Patient adaptation
• Phonetics,
esthetics,
psychological
problems.
• Marco Esposito, Jan Michael Hirsh, Ulf Lekholm et al have classified oral implant failures.

12. • According to Abdel Salam el Askary, Roland Meffert and terrence griffin
• 1) According to etiology :
A)Failures because of host factors :
o Medical status - Osteoporosis and other bone diseases; uncontrolled
diabetes.
o Habits - smoking, para-functional habits.
o Oral status - poor home care, juvenile, and rapidly progressive
periodontitis, irradiation therapy.
B) Restorative problems :
• Excessive cantilever, pier abutments, no passive fit, improper fit of the abutment, improper
prosthetic design, improper occlusal scheme, bending moments, connecting implants to natural
dentition, premature loading, excessivetorquing.

13. C) Surgical placement:
1. Off axis placement (severe angulation)
2. Lack of initial stabilization
3. Impaired healing and infection because of improper flap design or others.
4. Overheating the bone and exerting too much pressure.
5. Minimal space between implants
6. Placing the implant in immature bone grafted sites.
7. Placement of the implant in an infected socket or a pathologic lesion.
8. Contamination of the implant body before insertion
D) Implant selection :
• Improper implant type in improper bone type.
• Length of the implant (too short, crown-implant ratio unfavourable)
• Diameter of the implant.

14. 2) According to origin of infection :
• Peri-implantitis (infective process, bacterial origin)
• Retrograde peri-implantitis (traumatic occlusion origin, non-infective,
forces off the long axis, premature, or excessive loading).
3) According to timing of failure :
• Before stage II (after surgery)
• At stage II (With healing head and or abutment insertion)
• After restoration.

15. 4) According to condition of failure (clinical and radiographic status)
• Ailing implants
• Failing implants
• Failed implants
• Surviving implants
5) According to responsible personnel
• Dentist (oral surgeon, prosthodontist, periodontist)
• Dental hygienist
• Laboratory technician
• Patient.

16. 6) According to failure mode :
• Lack of osseointegration (usually mobility)
• Unacceptable esthetics
• Functional problems
• Psychological problems.
7) According to supporting tissue type :
• Soft tissue problems (lack of keratinized tissues,
inflammation, etc.)
• Bone loss (Radiographic changes, etc.)
• Both soft tissue and bone loss.

17. Clinical & radiographic conditions
 Ailing Implant-
• The ailing implant expresses radiographic bone loss without inflammation.
A deep pocket around the implant is evident, with absence of bleeding.
 Failing implants-
• The failing implant presents with constant deterioration at follow up and
maintenance appointments.
• Inflammation is present and is evident by signs of edema, redness,
bleeding, and suppuration. The implants are immobile, but radiographic
bone loss is obvious.

18.  Failed implants-
• Failed implants are those with progressive bone loss with clinical mobility
and that are not functioning in the intended sense.
• Failed implants are encapsulated in fibrous capsule.
• A failed implant is one that is fractured, has been totally refractory to all
methods of treatment.

19.  Surviving implants :
Surviving is a term described by Alberktson that applies to implants that are still
in function but have not been tested against success criteria.
 Cluster failures of dental implants :
 multiple implant failures occur in a patient; this is referred to as a “cluster
effect.
 Cluster failures usually occur soon after implant placement.
 Genetic or systemic factors ( Peget’s disease,Osteoporosis,Auto-immune
disorder) that influence the incidence of cluster failures.
 Ekfeldt et al suggested that particular issues need to be considered to prevent
cluster implant losses (such as lack of bone support, heavy smoking habits and
bruxism)
(Ekfeldt A, Christiansson U, Eriksson T,et al. A retrospective analysis of factors associated with multiple implant failures in maxillae. Clin Oral Implants Res 2001;12(5):462-467.)

20.  Bleeding on probing
 Along with BOP modified gingival index can be used to assess marginal
mucosal conditions around oral implants
Apse P, Zarb GA, Schmitt A, Lewis DW. The longitudinal effectiveness of osseointegrated dental implants. The Toronto study: Periimplant mucosal
response. Int J Periodontics Restorative Dent 1991;11:95–111)
Diagnosis

21.  Probing depth and loss of attachment
• Probing should be done in normal probing force .2N- .3N.Probing depth
penetration around teeth has been found to be < 3 mm as opposed to 2 mm
to 4 mm around implants.
 Pus formation
• Pus formation is always a sign of infection with active tissue destructive
processes taking place.

22.  Radiographic features of failed implants-
o There can be two well-distinct radiographic pictures: a thin peri-fixtural radiolucency
surrounding the entire implant, suggesting the absence of a direct bone-implant contact
and possibly a loss of stability, and an increased marginal bone loss.(>7 mm).
o When an implant fails because of a reason other than infection (such as surgical or
prosthetic trauma), it usually has mobility and peri-implant radiolucency, and there may
be an absence of inflammation.

23.  Pain or sensitivity
• Pain or discomfort is often associated with mobility and could be one of the first
signs which indicate an implant failure.
 Dull sound at percussion
• It has been suggested that a subdued sound upon percussion against the implant
carrier is indicative of soft tissue encapsulation, whereas a clear crystallization
sound indicates successful osseointegration.
 Mobility-
o Clinically discernible mobility can be present without distinct radiographic bone
changes. Therefore, mobility is the cardinal sign of implant failure.
• Several different types of mobility can be seen
• Rotation mobility, Lateral or horizontal mobility, Axial or vertical mobility.

24.  Assessment of implant stability-
o Reverse torque test-
 Implants that rotate under the applied torque are considered failures and
are then removed.
o Periotest-
 It is a device which is an electrically driven and electronically monitored tapping
head that percusses the implant a total of 16 times. The entire measuring
procedure takes about 4 s.

25. Esthetic evaluation
Mesiodistal dimension
of the crown
5-point rating scale
Grossly undercontoured, slightly undercontoured, no
deviation, slightly overcontoured, grossly overcontoured
Position of the incisal edge
of the crown
5-point rating scale
Grossly undercontoured, slightly undercontoured, no
deviation, slightly overcontoured, grossly overcontoured
Implant crown esthetic index was developed by Henry JA et al as an objective
tool in rating esthetics of implant-supported single crowns and adjacent soft tissues.

26. Labial convexity of the
crown
5-point rating scale grossly undercontoured, slightly
undercontoured, no deviation, slightly
overcontoured, grossly overcontoured
Color and translucency of
the crown
3-point rating scale gross mismatch, slight mismatch,
no mismatch
Surface of the crown 3-point ratingscale deviation of 1.5 mm or more,
deviation less than 1.5 mm, no deviation
Position of mucosa in the
approximal embrasures
3-point rating scale deviation of 1.5 mm or
more, deviation less than 1.5 mm, no deviation)
Contour of the labial
surface of the mucosa
5-point rating scale grossly undercontoured, slightly
undercontoured, no deviation, slightly
overcontoured, grossly overcontoured)

27.  Host factors
 Systemic diseases-
• Osteoporosis, osteomalacia, fibrous dysplasia, diabetes mellitus, thyroid
disorders responsible for poor wound healing and poor osseintegration
which causes early failure of implants.
Risk factors

28. • HABITS
1. Smoking:
 Significance
•Causes alveolar vasoconstriction and decreased blood flow
 In case of poor oral hygiene, smokers have 3 times more marginal bone loss
Recommendations:
• 1.Obtain a smoking history
• 2.Advice on risks of periodontal breakdown
• 3.Advice on the prognosis
• 4.Smoking cessation

29. 2. Parafunctional habits-
• Most common cause of implant bone loss or lack of rigid fixation
During the first year after implant insertion. Commonly manifests as
connecting screw loosening because of overload.
• Fracture of porcelain , progressive bone lose can also be seen
• Failures are higher in maxilla because of decrease in bone density.

30. • Increased number of implants to be placed
• Avoid cantilevers and occlusal contacts in lateral excursions
• Use of wide diameter implant to provide greater surface area. Progressive bone
loading and prosthetic design that improves the distribution of stresses
throughout the implant system.
• The anterior teeth may be modified to recreate the proper incisal
guidance and posterior interference during excursion.
• For maxillary implant restoration hollow night guard is used and in case of
mandibular implant supported prosthesis the occluding surface of maxillary
night guard are relieved over the implant crown.

31.  Quality & quantity of bone-
• Patients with low quantity and low density of bone were at highest risk for
implant loss.
• In type IV bone due to its thin cortex, poor medullary strength, and low
trabecular density implant failure is more.
• In division C & D bone chances of failure of implants is more due to less
bone support.

32. • Osteoplasty (C–w)
• Root form implants (C–h)
• Subperiosteal implant (C–h, C–a
partial, or completely edentulous
mandible).
• Disk design implants (posterior
mandible, anterior maxilla)
• Ramus frame implant (C–h
completely edentulous mandible)
• Autogenous iliac crest bone grafts to
improve the anterior division D are
strongly recommended.
• Endosteal implants of adequate height
can rarely be positioned in the
posterior maxilla with division D bone
without a sinus graft.
• After 6 months post sinus graft, the
division D posterior maxilla is restored
to division A or C–h, and root form
implants may be inserted for posterior
prosthodontic support.

33. Malpositioning of Implants
 Classification
• Proximity of implants to each other
• Proximity of implants to adjacent
teeth
• Abnormal angulation of the implant
• Malposition of implant in relation to
position of the missing tooth it
replaces
 C/F & Diagnosis-
• Fracture of prosthesis.
• Fracture of abutment &
abutment screw.
• Bone loss.
• Peri-implantatis.
• Implant mobility.
 IOPA
 CBCT

34. • Mechanical debridement of the affected implant should be done followed by
antiseptic treatment.
• Bone grafting is necessary to provide the added bone support.
• Implant abutment can be replaced by angled abutment and custom made
abutment.
• If it is determined that the implant cannot be functionally or esthetically
restored in its existing location, the implant can be left unexposed beneath
the soft tissue and not uncovered, or it can be uncovered but not placed into
function.

35. Improper occlusal scheme
 Articulating paper is used (30 μm) for the initial implant occlusion adjustment in
centric occlusion under light tapping forces.
 The implant prosthesis should barely make contact.
 Any mobile teeth opposite to the implant prosthesis should be extracted.
 Fixed arch Prosthesis-Group function occlusion or mutually protected occlusion with
shallow anterior guidance when opposing natural dentition & No working and
balancing contact on cantilever.
 For the occlusion on overdentures, it has been suggested to use bilateral balanced
occlusion & monoplane occlusion in resorbed ridge can be used.
 C/F & Diagnosis-
• Bone loss.
• Screw loosening, screw fracture.
• Fracture of the prosthesis.

36. • Reduction in cusp inclination can decrease the resultant bending moment with a
lever-arm reduction and improvement of the axial loading force. Reduced cusp
inclination, shallow occlusal anatomy, and wide grooves and fossae may be
beneficial when constructing implanted prostheses.
• Typically, a 30%-40% reduction in the occlusal table in a molar region has been
suggested because any dimension larger than the implant diameter can cause
cantilever effects.
• Cusp inclination has been found to produce a high level of For every 10° increase
in cusp inclination, there is an approximately 30% increase in torque.

37.  Cantilevers are class-1 levers, which increase the amount of stress on
implants.
 According to Glantz ; D = F x L / E x W x H , D is the amount of deformation, F is
the force of occlusion, L, W,and H are the length, width, and height of the
cantilever, respectively, and E is the modulus of elasticity of the material .
 The length of the cantilever should be minimized while maximizing the
height and width of the cantilever.
 Cantilever length is influenced by type of arch, no of implants , A-P spread,
type of prostheses to be used.
Improper cantilever

38. • At each increment of 5 mm in cantilever length, stress increased by
approximately 30% to 37% on the cortical bone around implant.
• According to McAlarney and Stavropoulos ratio of cantilever length and A- P
spread should be between 2-1.5.
• Recommended cantilever lengths to be 1.5 times the A/P spread, but
shorter in poor quality bone.

39.  C/F & Diagnosis-
• Progressive bone lose.
• Fracture of the framework.
• Prosthesis Fracture.
• Screw loosening.
• Fracture of implant abutment
junction.
After regenerative treatment in ailing/ failing implants additional implants can be
placed to reduce to cantilever length.

40. • C/F-
• Torque loss.
• Progressive bone loss due to
inflammation.
• Peri-implantitis.
• Screw loosening.
• Regenerative treatment should be done to
reduce the inflammation & to increase to bone
level.
• Use proper abutment with platform-switching
concept.
• CAD/CAM abutment can be used .
Implant Abutment misfit

41. Surgical Error
Excessive Pressure Heat generation Oversized osteotomy
Bone cell damage
The critical
temperature above
which bone necrosis
occurs is 47°C for 1
minute.
Lack of initial stability.
Mobility of implant
No regeneration of the peri-implant bone.
Presence of an inflammatory infiltrate in the gap between bone and implant
No .organization of the peri-implant bone clot

42. • Speed must not be above 1200 RPM.
• Proper coolant should be used while perform osteotomy.
• In case of over sized osteotomy larger diameter implant can be used &
loading can be delayed
Injury to the vital structures
Injury of inferior
alveolar nerve
Maxillary sinus
perforation
soft tissue injury
Paresthesia of lip
Nasal bleeding
Maxillary sinusitis
Flap dehiscence.
Presence of large edema
or hematomas.
Exposure of implant site.

43. • Proper flap design to prevent soft tissue injury .
• Large dehiscence can be treated by removal of granulation tissue and
resuturing.
• if sinus perforation occurs loading should be delayed by 6 months.
• Transantral endoscopic surgery can be done in case of maxillary sinusitis
or losing implant in maxillary sinus.
• Detailed initial treatment planning and careful surgery to unroof the canal
and move the neurovascular bundle inferiorly prior to fixture installation
can be done to prevent inferior alveolar nerve injury.

44. Management of ailing and failing implants
• Identification of the cause.
 Peri-implantitis
• Prophylactic procedures
• The patient should be motivated to perform an adequate level of
plaque control on a regular basis.
• Overcontoured and sub-gingivally placed prosthesis, particularly in the
proximal region, will prevent the patient from attaining optimal oral
hygiene, thereby jeopardizing the health of abutment teeth and their
surrounding tissues.

45.  Therapeutic strategies
• Cumulative interceptive supportive therapy (CIST)
• This protocol is cumulative in nature and includes four steps which should
not be used as single procedures, but rather as a sequence of therapeutic
procedures with increasing antibacterial potential, depending on the
severity and extent of the lesion.
• In 2004 it was modified and called AKUT-concept by Lang et al.
(Smeets R, Henningsen A, Jung O, Heiland M, Hammächer C, Stein JM, et al. Definition, etiology, prevention and treatment of peri-
implantitis – A review. Head Face Med 2014;10:34)

46. (Lang NP, Lindhe J. Maintenance of the implant patient. In: Lang NP, Lindhe J, eds. Clinical periodontology and implant dentistry. Vol. 2: Clinical concepts,
5th edn. Oxford: WileyBlackwell, 2008: Chapter 60.)

47. Maintenance of implants

48. A. Mechanical debridement (supportive therapy protocol A)
• Oral implants with evident plaque or calculus deposits adjacent to only
slightly inflamed peri-implant tissues), but lacking suppuration and having
a probing depth not exceeding 3 mm.
• While calculus may be chipped off using carbon-fiber curettes, plastic hand
instruments or ultrasonic instruments with a plastic tip.
• The use of a high pressure air powder abrasive (mixture of sodium
bicarbonate and sterile water), has been advocated, as this removes the
microbial deposits, does not alter the surface topography and has no
adverse effect on cell adhesion.

49. • CO2, Diode-, Er:YAG- and Er,Cr:YSGG- lasers are used in the treatment of
peri-implant diseases with increasing frequency
• Most of these lasers, function through vaporization mode. High temperatures
could alter or damage the implant surface making them inappropriate for use
in treating the implant defect. They could also result in charring or coagulation
of tissue, delaying the reparative cascade.
• The Er, Cr: YSGG laser, operating at 2780 nm, blates tissue by a hydrokinetic
process that prevents temperature rise.
(El-Askary AS, Meffert RM, Griffin T. Why do implants fail? Part II. Implant Dentistry. 1999; 8:265– 276.)

50. B. Antiseptic treatment (supportive therapy protocol B)
• The type of implant surface will determine the method of
decontamination.
1. Critic acid (40% concentration; pH 1)
2. Chlorhexidine gluconate (.1%)
3. Stannous fluoride
4. Tetracycline
• contact with a supersaturated solution of antimicrobials and/or antibiotics,
for 30-60 seconds have been used for the preparation of the implant
surfaces, as they have the highest potential for the removal of endotoxins
from both the hydroxyapatite and the titanium implant surfaces.
• In general, 3–4 weeks of regular administration are necessary to achieve
positive treatment results.

51. • Machined titanium surfaces are the easiest to decontaminate.
• Tetracycline stimulates fibroblast growth in the affected area.
• Prolonged application time of citric acid solution are not recommended for use on
HA surfaces, since this would alter the quality and impair its ability to bond to
the titanium body of the implant.
• If the HA is already damaged due to the virulence of the infection surrounding
the implant. It is eliminated completely by drilling and then proceed to apply
air abrasion or ultrasound and subsequently decontaminate the area with
anticeptics.
(Buser D, Merickske-Stern R, Dula K, et al. Clinical experience with one-stage, non-submerged dental implants. Advances Dental Res. 1999; 13:153–161.)

52. C.Antibiotic treatment (supportive therapy protocol C)
• Before starting the antibiotic treatment the mechanical (A) and the antiseptic
(B) treatment protocols have to be applied.
• During the last 10 days of of the antiseptic treatment antibiotic treatment
should be used.
(El-Askary AS, Meffert RM, Griffin T. Why do implants fail? Part I. Implant Dentistry. 1999; 8:173–183.)
(Mombelli A, Van Oosten MAC, Schürch E, Lang NP. The microbiota associated with successful or failing osseointegrated titanium implants. Oral Microbiol Immunol
1987; 2: 145–51.)

53. D.Regenerative and resective therapy (supportive therapy protocol D)
• Only if infection is controlled successfully, as evidenced by an absence of
suppuration and reduced edema, further treatment to restore the bony support
of the implant by means of regenerative techniques or to reshape the peri-
implant soft tissues and/or bony architecture should be done.
• It is recommended to remove the prosthesis 8 weeks prior to surgical
treatment in order to ensure optimal results of oral hygiene practices and
allow the soft tissue to heal and collapse around the implant sites.
• The first step in surgical therapy is to degranulate the defect. It is followed by
exposing and treating the bacterially contaminated implant surface.

54. • If the surface is clean and detoxified, with all exposed areas of the implant
visualized and instrumented, it is possible to graft with an allograft material such
as DFDBA to achieve biologic healing.
• If the implant surface cannot be cleaned and detoxified due to vents, holes in
the implant fixture, it is advisable to graft with an alloplast material such as
HA or Bioactive Glass.
• The resective osseous surgery is indicated to reduce pockets and bone
recontouring to correct negative architecture of bone . This include Resection
techniques including ostectomy, with the raising of an apical repositioning flap,
and implantoplasty.

55.  A 44-year-old woman with failing endodontically
treated maxillary central incisors presented for
treatment and after extraction of two incisors two
implants were placed.
 After 4 months of healing,
1 implant was placed in site #11. Site #21 had poor
bone quality for initial stabilization, therefore, the
osteotomy was compressed with an osteotome and a
larger implant was installed.
CALCIUM HYDROXIDE PASTE AS A SURFACE DETOXIFYING AGENT FOR INFECTED
DENTAL IMPLANTS: CASE REPORT
Dennis Flanagan.
Journal of Oral Implantology, 2009.

56.  At the eighth postoperative week, the patient presented with a small facial
swelling at site #21.
 The source of the infection was the mid body of implant 21. The area was
debrided with a periodontal curet, treated with calcium hydroxide paste (Pulpdent
Corp, Watertown, Mass) for less than 30 seconds, and rinsed with sterile saline
 An allograft material was then placed in the defect , and a barrier membrane was
placed (Biomend) and was primarily closed.
 The site healed uneventfully and 2 porcelain fused to metal crowns were
subsequently made to complete the treatment

57.  Removal of failed implant:
 The techniques of removal of failed implants include use of a counter- torque
ratchet, Piezo tips, high-speed burs, elevators, forceps, reverse screw and
trephine burs and combinations of these tools.
 Use of the counter-torque ratchet is the least invasive technique for
removing an implant. It is screwed into a failed implant and reverse
torqued. It works well in the maxilla.
 In the mandible, where the bone is denser, it is advisable to use a bur 360 degrees
around an implant to remove bone at least one-half its length before counter
torquing.
THE TREATMENT OPTIONS FOR MANAGING IMPLANT FAILURE

58. Hopeless implant
Fracture
Screw not
engageable
Screw
engageable
Bone
removal
techniques
Reverse
screw
technique
No fracture
With internal
connection
No internal
connection
Screw not
engageable
Screw
engageable
Bone
removal
techniques
Ratchet
engageable
Ratchet not
engageable
Counter torque
ratchet technique
Bone removal
techniques
METHODS OF IMPLANT REMOVAL
(Mantena SR, Gottumukkala SNVS, Sajjan S, Rama
Raju A, Rao B, Iyer M. Implant Failures—
Diagnosis and Management. Int J Clin Implant Dent
2015;
1(2):51-59.)

59. o DENTAL IMPLANT REIMPLANTATIONS
 Delayed Reimplantation after loss of an implant.
• When an implant is lost, a flap should primarily cover the entrance to the site
and after 9-12 months, a new implant can be replaced at that site.
• New implants are larger in length and diameter than the implants placed first.
 Immediate Reimplantation after loss of an implant
• Failure rates after implant removal were not significantly different between
delayed and immediate reimplantations.
• If there is adequate bone to achieve primary stability, delayed placement does
not appear to provide any advantages.

60. Removed failed dental implant
Re-evaluate original treatment plan
Implant not critical for
restoration
Proceed to final
restoration
Critical for
restoration
Consider redoing the implant
Place new implant in
an adjacent site
Perform new implant at
same site
Revise treatment
plan to hybrid
implant tooth
FPD/T
ooth supported
FPD/RPD
Unsuccessful successful
Consider second
re-do
or

61. Treatment of peri-implantitis using an Er:YAG laser or an
air-abrasive device: a randomized clinical trial.
Renvert S, Lindahl C, Roos Jansa˚ker A-M, Persson GR J Clin Periodontol 2011; 38: 65–73.
 The aim of the present study was to assess the clinical outcomes following
treatment with either a non-surgical debridement using an air- abrasive
device or an Er:YAG laser in subjects with implants and a diagnosis of
periimplantitis.
 Results-
• No baseline subject characteristic differences were found. Bleeding on
probing and suppuration decreased in both the groups.
• The average change in the bone level was a loss of 0.3 mm for the laser
group and a loss of 0.1 mm bone height for the air-abrasive group.
 Conclusion- Air- abrasive group shows better clinical out come than laser
group.

62. Prognosis of the implants replaced after removal of failed dental
implants.
Young-Kyun Kim, Jin-Young Park, Su-Gwan Kim Int J Oral Maxillofac Implants ;2016
 This study was carried out to evaluate the survival rate and condition of tissue
surrounding the replaced implants after removal of failed implants.
• The most frequent site of implant failure was the maxillary first molar area.
• The average healing time for patients undergoing delayed replacement was
2-3months.
• No significant difference in the failure rate of the second implant was
observed between the immediate and delayed replacement groups.

63. Background: The aim of this study was to assess the clinical effectiveness of single
dental implants placed in sites of previously failed implants.
Methods: The study consisted of a consecutive cohort of 1,215 patients who
received 1,387 single implants for single-tooth replacement during a 6-year period
(1999 to 2005). Inclusion criteria were a single implant replacing a previously failed
implant and follow-up data ≥6 months.

64. Results: A total of 75 patients experienced the failure of 96 implants. Of those, 31
implants in 28 patients were replaced by a similar implant placed in the same location.
Nine of the replacement implants failed, resulting in an overall survival rate of 71%.
Follow-up ranged from 6 to 46 months.
Replacement of maxillary and mandibular failed implants was similar.
All failures occurred during the first year after implant replacement. On average,
implant replacement occurred 5.8 ± 5.2 months after original implant removal; three
implants were placed immediately after implant removal.
A third attempt for single implant replacement was made in two patients. However,
one failed.

65. Conclusions:
Replacement of a failed implant presents a challenge to achieve
osseointegration in a healed bone site and may result in a decline in the
survival rates.
Patients and clinicians should be aware of these results before a
replacement attempt is considered. The success of replacement may be
increased by the use of wider implants or with improved surfaces.

66. Conclusion
• Failure of implant can be multi-factorial.
• Often many factors come together to cause the ultimate failure of the
implant.
• One needs to identify the cause not just to treat the present condition
but also as a learning experience for future treatments.
• Proper data collection, patient feedback, and accurate diagnostic tool will
help point out the reason for failure.
• An early intervention is always possible if regular check-up are
undertaken.

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68. Thank you…