Dental İmplantların Çıkarılma Sebepleri ve Klinik Yönetimi
Özet
Dental implantlar, diş eksikliklerinin rehabilitasyonunda yüksek başarı ve sağkalım oranları sunan güvenilir tedavi seçenekleri arasında yer almaktadır. Bununla birlikte, biyolojik, mekanik, cerrahi ve hasta kaynaklı çeşitli faktörlere bağlı olarak implant başarısızlıkları ortaya çıkabilmekte ve bazı durumlarda implantın cerrahi olarak çıkarılması gerekebilmektedir. İmplant eksplantasyonunun en yaygın nedenleri arasında periimplantitis kaynaklı ilerleyici kemik kaybı, implant kırıkları, hatalı implant konumlandırılması, protetik komplikasyonlar ve estetik sorunlar yer almaktadır. Bu durumların doğru şekilde değerlendirilmesi, uygun tedavi planlaması ve çevre dokuların korunması açısından büyük önem taşımaktadır. İmplant çıkarımında temel hedef; çevre alveolar kemik ve yumuşak dokuların mümkün olduğunca korunması, postoperatif morbiditenin azaltılması ve ileride uygulanabilecek restoratif tedaviler için uygun bir biyolojik zemin oluşturulmasıdır. Bu doğrultuda, ters tork ve ters vida teknikleri gibi minimal invaziv yöntemler öncelikli olarak tercih edilmekte; gerekli durumlarda piezocerrahi, trefan frez veya konvansiyonel cerrahi yaklaşımlar uygulanabilmektedir. Eksplantasyon sonrasında yeniden implant yerleştirilmesi veya alternatif rehabilitasyon seçenekleri, defekt morfolojisi, kemik hacmi, estetik gereksinimler ve biyomekanik koşullar dikkate alınarak bireysel olarak planlanmalıdır. Bu nedenle implant eksplantasyonu, multidisipliner değerlendirme ve dikkatli cerrahi planlama gerektiren önemli bir klinik süreçtir.
Dental implants are among the reliable treatment options offering high success and survival rates in the rehabilitation of tooth loss. However, implant failures can occur due to various biological, mechanical, surgical and patient-related factors, and in some cases, surgical removal of the implant may be necessary. The most common causes of implant removal include progressive bone loss due to peri-implantitis, implant fractures, incorrect implant positioning, prosthetic complications and aesthetic issues. The correct assessment of these conditions is of great importance in terms of appropriate treatment planning and the preservation of surrounding tissues. The primary objective of implant removal is to preserve the surrounding alveolar bone and soft tissues as much as possible, minimise postoperative morbidity, and create a suitable biological foundation for future restorative treatments. Accordingly, minimally invasive techniques such as reverse torque and reverse screw techniques are prioritised; where necessary, piezo surgery, trephine drills or conventional surgical approaches may be employed. Re-implantation following explantation or alternative rehabilitation options should be planned on an individual basis, taking into account defect morphology, bone volume, aesthetic requirements and biomechanical conditions. For this reason, implant explantation is a significant clinical procedure that requires a multidisciplinary assessment and careful surgical planning.
Referanslar
Kim YK, Park JY, Kim SG, Lee HJ. Prognosis of the implants replaced after removal of failed dental implants. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2010 Sep;110(3):281–6.
Solderer A, Al‐Jazrawi A, Sahrmann P, Jung R, Attin T, Schmidlin PR. Removal of failed dental implants revisited: Questions and answers. Clin Exp Dent Res. 2019 Dec 21;5(6):712–24.
Misch CE, Perel ML, Wang HL, Sammartino G, Galindo-Moreno P, Trisi P, et al. Implant Success, Survival, and Failure: The International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. Implant Dent. 2008 Mar;17(1):5–15.
Montes CC, Pereira FA, Thomé G, Alves EDM, Acedo RV, de Souza JR, et al. Failing Factors Associated With Osseointegrated Dental Implant Loss. Implant Dent. 2007 Dec;16(4):404–12.
Bowkett A, Laverty D, Patel A, Addy L. Removal techniques for failed implants. Br Dent J. 2016 Feb 12;220(3):109–14.
Froum S, Yamanaka T, Cho SC, Kelly R, St James S, Elian N. Techniques to remove a failed integrated implant. Compend Contin Educ Dent. 2011 Sep;32(7):22–6, 28–30; quiz 31–2.
Stajčić Z, Stojčev Stajčić LJ, Kalanović M, Đinić A, Divekar N, Rodić M. Removal of dental implants: review of five different techniques. Int J Oral Maxillofac Surg. 2016 May;45(5):641–8.
Schwarz F, Derks J, Monje A, Wang H. Peri‐implantitis. J Clin Periodontol. 2018 Jun 20;45(S20).
Anitua E, Piñas L, Begoña L, Alkhraisat M. Prognosis of Dental Implants Immediately Placed in Sockets Affected by Peri-implantitis: A Retrospective Pilot Study. Int J Periodontics Restorative Dent. 2017 Sep;37(5):713–9.
Chee W, Jivraj S. Failures in implant dentistry. Br Dent J. 2007 Feb 10;202(3):123–9.
Dental endosseous implants. The Journal of the American Dental Association. 2004 Jan;135(1):92–7.
Porter JA, von Fraunhofer JA. Success or failure of dental implants? A literature review with treatment considerations. Gen Dent. 2005;53(6):423–32; quiz 433, 446.
Lee JH, Frias V, Lee KW, Wright RF. Effect of implant size and shape on implant success rates: A literature review. J Prosthet Dent. 2005 Oct;94(4):377–81.
Sanivarapu S, Moogla S, Kuntcham R, Kolaparthy L. Implant fractures: Rare but not exceptional. J Indian Soc Periodontol. 2016;20(1):6.
el Askary AS, Meffert RM, Griffin T. Why do dental implants fail? Part I. Implant Dent. 1999;8(2):173–85.
Chee W, Jivraj S. Failures in implant dentistry. Br Dent J. 2007 Feb 10;202(3):123–9.
Becktor JP, Isaksson S, Sennerby L. Survival analysis of endosseous implants in grafted and nongrafted edentulous maxillae. Int J Oral Maxillofac Implants. 2004;19(1):107–15.
Sendyk D, Chrcanovic B, Albrektsson T, Wennerberg A, Zindel Deboni M. Does Surgical Experience Influence Implant Survival Rate? A Systematic Review and Meta-Analysis. Int J Prosthodont. 2017 Jul;30(4):341–7.
Lindquist LW, Carlsson GE, Jemt T. Association between Marginal Bone Loss around Osseointegrated Mandibular Implants and Smoking Habits: A 10-year Follow-up Study. J Dent Res. 1997 Oct 1;76(10):1667–74.
SCHOU S. Implant treatment in periodontitis‐susceptible patients: a systematic review. J Oral Rehabil. 2008 Jan 20;35(s1):9–22.
Balshi TJ, Wolfinger GJ. Dental Implants in the Diabetic Patient. Implant Dent. 1999;8(4):355–9.
Farzad P, Andersson L, Nyberg J. Dental Implant Treatment in Diabetic Patients. Implant Dent. 2002 Sep;11(3):262–7.
Froum S, Yamanaka T, Cho SC, Kelly R, St James S, Elian N. Techniques to remove a failed integrated implant. Compend Contin Educ Dent. 2011 Sep;32(7):22–6, 28–30; quiz 31–2.
Vercellotti T. Piezoelectric surgery in implantology: a case report--a new piezoelectric ridge expansion technique. Int J Periodontics Restorative Dent. 2000 Aug;20(4):358–65.
Tonetti MS. Risk factors for osseodisintegration. Periodontol 2000. 1998 Jun 23;17(1):55–62.
Smith L, Rose T. Laser explantation of a failing endosseous dental implant. Aust Dent J. 2010 Jun 21;55(2):219–22.
Monje A, Nart J. Management and sequelae of dental implant removal. Periodontol 2000. 2022 Feb;88(1):182–200.
Iezzi G, Piattelli A, Mangano C, Degidi M, Testori T, Vantaggiato G, et al. Periimplant Bone Response in Human-Retrieved, Clinically Stable, Successful, and Functioning Dental Implants After a Long-Term Loading Period. Implant Dent. 2016 Jun;25(3):380–6.
Kolonidis SG, Renvert S, Hämmerle CHF, Lang NP, Harris D, Claffey N. Osseointegration on implant surfaces previously contaminated with plaque. Clin Oral Implants Res. 2003 Aug 17;14(4):373–80.
Berglundh T, Persson L, Klinge B. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. J Clin Periodontol. 2002 Dec 15;29(s3):197–212.
Chrcanovic BR, Kisch J, Albrektsson T, Wennerberg A. Factors influencing the fracture of dental implants. Clin Implant Dent Relat Res. 2018 Feb 6;20(1):58–67.
Referanslar
Kim YK, Park JY, Kim SG, Lee HJ. Prognosis of the implants replaced after removal of failed dental implants. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2010 Sep;110(3):281–6.
Solderer A, Al‐Jazrawi A, Sahrmann P, Jung R, Attin T, Schmidlin PR. Removal of failed dental implants revisited: Questions and answers. Clin Exp Dent Res. 2019 Dec 21;5(6):712–24.
Misch CE, Perel ML, Wang HL, Sammartino G, Galindo-Moreno P, Trisi P, et al. Implant Success, Survival, and Failure: The International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. Implant Dent. 2008 Mar;17(1):5–15.
Montes CC, Pereira FA, Thomé G, Alves EDM, Acedo RV, de Souza JR, et al. Failing Factors Associated With Osseointegrated Dental Implant Loss. Implant Dent. 2007 Dec;16(4):404–12.
Bowkett A, Laverty D, Patel A, Addy L. Removal techniques for failed implants. Br Dent J. 2016 Feb 12;220(3):109–14.
Froum S, Yamanaka T, Cho SC, Kelly R, St James S, Elian N. Techniques to remove a failed integrated implant. Compend Contin Educ Dent. 2011 Sep;32(7):22–6, 28–30; quiz 31–2.
Stajčić Z, Stojčev Stajčić LJ, Kalanović M, Đinić A, Divekar N, Rodić M. Removal of dental implants: review of five different techniques. Int J Oral Maxillofac Surg. 2016 May;45(5):641–8.
Schwarz F, Derks J, Monje A, Wang H. Peri‐implantitis. J Clin Periodontol. 2018 Jun 20;45(S20).
Anitua E, Piñas L, Begoña L, Alkhraisat M. Prognosis of Dental Implants Immediately Placed in Sockets Affected by Peri-implantitis: A Retrospective Pilot Study. Int J Periodontics Restorative Dent. 2017 Sep;37(5):713–9.
Chee W, Jivraj S. Failures in implant dentistry. Br Dent J. 2007 Feb 10;202(3):123–9.
Dental endosseous implants. The Journal of the American Dental Association. 2004 Jan;135(1):92–7.
Porter JA, von Fraunhofer JA. Success or failure of dental implants? A literature review with treatment considerations. Gen Dent. 2005;53(6):423–32; quiz 433, 446.
Lee JH, Frias V, Lee KW, Wright RF. Effect of implant size and shape on implant success rates: A literature review. J Prosthet Dent. 2005 Oct;94(4):377–81.
Sanivarapu S, Moogla S, Kuntcham R, Kolaparthy L. Implant fractures: Rare but not exceptional. J Indian Soc Periodontol. 2016;20(1):6.
el Askary AS, Meffert RM, Griffin T. Why do dental implants fail? Part I. Implant Dent. 1999;8(2):173–85.
Chee W, Jivraj S. Failures in implant dentistry. Br Dent J. 2007 Feb 10;202(3):123–9.
Becktor JP, Isaksson S, Sennerby L. Survival analysis of endosseous implants in grafted and nongrafted edentulous maxillae. Int J Oral Maxillofac Implants. 2004;19(1):107–15.
Sendyk D, Chrcanovic B, Albrektsson T, Wennerberg A, Zindel Deboni M. Does Surgical Experience Influence Implant Survival Rate? A Systematic Review and Meta-Analysis. Int J Prosthodont. 2017 Jul;30(4):341–7.
Lindquist LW, Carlsson GE, Jemt T. Association between Marginal Bone Loss around Osseointegrated Mandibular Implants and Smoking Habits: A 10-year Follow-up Study. J Dent Res. 1997 Oct 1;76(10):1667–74.
SCHOU S. Implant treatment in periodontitis‐susceptible patients: a systematic review. J Oral Rehabil. 2008 Jan 20;35(s1):9–22.
Balshi TJ, Wolfinger GJ. Dental Implants in the Diabetic Patient. Implant Dent. 1999;8(4):355–9.
Farzad P, Andersson L, Nyberg J. Dental Implant Treatment in Diabetic Patients. Implant Dent. 2002 Sep;11(3):262–7.
Froum S, Yamanaka T, Cho SC, Kelly R, St James S, Elian N. Techniques to remove a failed integrated implant. Compend Contin Educ Dent. 2011 Sep;32(7):22–6, 28–30; quiz 31–2.
Vercellotti T. Piezoelectric surgery in implantology: a case report--a new piezoelectric ridge expansion technique. Int J Periodontics Restorative Dent. 2000 Aug;20(4):358–65.
Tonetti MS. Risk factors for osseodisintegration. Periodontol 2000. 1998 Jun 23;17(1):55–62.
Smith L, Rose T. Laser explantation of a failing endosseous dental implant. Aust Dent J. 2010 Jun 21;55(2):219–22.
Monje A, Nart J. Management and sequelae of dental implant removal. Periodontol 2000. 2022 Feb;88(1):182–200.
Iezzi G, Piattelli A, Mangano C, Degidi M, Testori T, Vantaggiato G, et al. Periimplant Bone Response in Human-Retrieved, Clinically Stable, Successful, and Functioning Dental Implants After a Long-Term Loading Period. Implant Dent. 2016 Jun;25(3):380–6.
Kolonidis SG, Renvert S, Hämmerle CHF, Lang NP, Harris D, Claffey N. Osseointegration on implant surfaces previously contaminated with plaque. Clin Oral Implants Res. 2003 Aug 17;14(4):373–80.
Berglundh T, Persson L, Klinge B. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. J Clin Periodontol. 2002 Dec 15;29(s3):197–212.
Chrcanovic BR, Kisch J, Albrektsson T, Wennerberg A. Factors influencing the fracture of dental implants. Clin Implant Dent Relat Res. 2018 Feb 6;20(1):58–67.
