Explant Implant and Vertical GBR?

I plan to explant the implant as seen in the image below. I had a few questions regarding the case, any advice and guidance would be appreciated.

  1. Does anyone have experience with the neodent implant removal tool and if so any advice on how to use it, otherwise I will just trephine the implant.

  2. There are interdental peaks therefore I plan to carry out vertical GBR. Any advice on which non resorbable PTFE membrane to use and which grafting material is most suitable here for a good outcome ?

  3. With regards to the nasopalatine bundle and it’s exit from the incisive foramen, palatally I plan to carry out an intrsucular incision and raise a full thickness flap, I assume I will then be able to isolate the neurovascular bundle. Do I just work around the bundle or do I dissect it ?

  1. I have experience with Explanting a Neodent implant with implant removal tool, it works great. Just place it in until it engages and then you can rotate the implant out.
    DON’T traphine and waste all that good bone. Just remove the implant and curette the crap out of all the granulamatous tissue. Make sure you have clean, clear bleeding bone before bone grafting. Try really hard to preserve any interproximal bone left there.

  2. I have had good results with Cytoplast Ti enforced PTFE. Can throw in Gem21 to add some biologics or PRF.

No opinion on Nurovascular removal, some surgeons do and others don’t.

Thanks for posting/sharing this case. My opinion is to leave the implant and attempt to graft the exposed threads using detoxification and grafting protocols, of which there are many described.The implant doesn’t appear to be too far facial, and should be amenable to a GBR reconstruction. I think the risk in the maxillary anterior of bone loss and gingival recession following explantation is high, and could require a number of challenging procedures to reconstruct the hard and soft tissue to ideal dimensions (if at all). Good luck with this case. Michael Pollak FICOI

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I always either torque the integrated implant out, which can be hard on instruments or I cut very narrow slots with a diamond saw, on either side of the implant and remove much of the buccal plate. Certainly this saves ALOT of bone over trephine. This images show a horizontal defect and that the vertical will follow suit with simple GBR.

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Totally agree with this approach!!

Could you please clarify why you would elect to explant this fixture?
Is it mobile? Is it causing pain?
It doesn’t appear to be too far off and once it is removed the residual defect will likely create a more significant compromise…

Thanks for the amazing advice !

Hi Scotty,

I would always prefer to try to save an implant but although there are interdental peaks present there is loss of palatal and buccal bone upto 50% with probing depths greater 8-9mm profuse bleeding and suppuration.

If I was to carry out GBR with the implant in place, in my opinion I would need to provide a palatal and buccal barrier to contain the graft I have found mainly my resective approaches for failing implants to be more predictable, with this amount of bone loss would chemical and mechanical debridement with grafting be conducive to reintegration ?

I did also nsider this as one of my options as well but was reluctant in case of failure. I have actually informed patient explantation and Maryland bridge. Vertical GBR if successful would be an option for potential implant placement in future.

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My experience has been, which is why I am not a fan of overdiagnosis via CBCT, is that a large percentage of anterior fixtures have no buccal bone yet they are fine. When interdental peaks are present to preserve the volume then a connective tissue graft to augment the soft tissue will do wonders. I would have a really difficult time defending the decision to explant this fixture… often times the enemy of good is better

I was on the IADS (International Association of Dental Specialists) forum earlier this week and a well respected contributor on the forum suggested that we should place a connective tissue graft for every anterior implant. While this is a bit aggressive I will agree that the vast majority of anterior implants would at least benefit from such and a lot of esthetic failures could be avoided. It is a simple procedure, though rarely taught, that almost always improves the outcome of any restorative procedure and I firmly believe that implant dentistry is a restorative profession that can be supplemented with surgery.

Have to say with all due respect disagree with the notion not being able to justify explanting this implant; infact trying to salvage it may have more repurcussions. You have lost bone through and through you have no contained walls and up to 70% bone loss, the only thing keeping the soft tissue coronal are the interdental peaks that remain. Connective tissue grafting is for improving the soft tissue contour and bulking it out and to improve a thin phenotype with possibly with a few coronal threads being exposed. Carrying out CTG will achieve nothing in this case your best bet is explantation and alternative treatment options and or vertical GBR.

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The bottom half of the screen shot of the CBCT would suggest to me that it is certainly a well contained defect. Could you please explain the notion that it is through and through???