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Removal of osseointegrated dental implants: a systematic review of explantation techniques

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Abstract

Objectives

This systematic review aims to evaluate current literature regarding available techniques for removal of osseointegrated implants in terms of explantation’s success, complications, and bone loss.

Material and methods

Two reviewers conducted a systematic literature search through electronic databases (PubMed and EMBASE), complimented by manual and grey literature searches. Successful explantation was defined as the primary outcome. Complications and availability of residual bone for immediate implantation were defined as secondary outcomes.

Results

Eighteen articles, comprising 372 implants and 241 patients, were included. Five techniques were identified: reverse torque, trephines, burs, piezosurgery, and laser-assisted explantation. Peri-implantitis was the most common reason for explantation, followed by crestal bone loss, fracture, and malpositioning. The reverse torque was the most frequently reported technique (284 implants) with 87.7% success rate. Burs were used for explantation of 49 implants with a 100% success rate, while trephines were utilized for removal of 35 implants with 94% success. Piezosurgery (11 implants) and Er.Cr:YSGG laser (1 implant) showed 100% success. One study reported perforation of the sinus floor following trephine explantation, while another reported fracture of 3 implants following reverse torque application. Further analysis was hindered by the quality of the available studies and their lack of data.

Conclusions

Reverse torque seems the most conservative, and in the authors’ opinion, should be the first choice for explantation despite its inferior success rate. Additional studies with randomized controlled designs and larger sample sizes are required.

Clinical relevance

Dental implants have become the leading choice to replace missing teeth with gradually increasing numbers of complications and failures. An effective, conservative, and economic explantation technique is necessary to allow a successive implant placement.

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Authors and Affiliations

  1. Division of Periodontology, University Clinics of Dental Medicine, University of Geneva, 1 Rue Michel-Servet, CH-1211, Geneva 4, Switzerland

    Margaux Roy, Lucie Loutan & Dena Hashim

  2. Geneva, Switzerland

    Giovanni Garavaglia

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  1. Margaux Roy
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  2. Lucie Loutan
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Contributions

M.R. was the first reviewer and she collected and analyzed the data as well as helped the writing of the manuscript. L.L. was the second reviewer and she contributed the materials and methods part of the writing. G.G. conceived the idea. D.H. supervised the review and led the writing as well as the formulation of the explantation guide.

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Correspondence to Margaux Roy.

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Roy, M., Loutan, L., Garavaglia, G. et al. Removal of osseointegrated dental implants: a systematic review of explantation techniques. Clin Oral Invest 24, 47–60 (2020). https://doi.org/10.1007/s00784-019-03127-0

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