Clinical case
Implant explantation poorly positioned in an aesthetic sector and subsequent regeneration with block grafting. Clinical case
Performing an explantation in the aesthetic sector produces a defect that often leaves a bone loss that must be regenerated through different procedures. Bone block grafting can be an alternative in cases where simultaneous vertical and horizontal bone regeneration is required. In this clinical case we show the explantation of a poorly positioned implant in the aesthetic sector, impossible to rehabilitate, which must be explanted and the defect subsequently regenerated so that a new implant can be positioned, this time in a situation that allows us a predictable and aesthetically satisfactory rehabilitation.
Replacement with an immediate post-extraction implant is a very common technique for teeth located on the aesthetic front, especially the maxilla. In many cases, in order to stabilise these implants, the aim is to increase their length (apical anchorage) and the morphology or the previous defect left by the alveolus sometimes forces us to an excessive over-angulation of the implant or a too vestibularised placement, with the subsequent difficulty of an adequate prosthetic rehabilitation1,2. Therefore, to perform a correct planning of each of the cases in this area it should be carried out leaving for a later phase (either completely postponed after healing or during early bone healing) the placement of the implant, allowing us to correct some of these errors1-3.
When a patient presents an implant located in the aesthetic sector with infectious problems or incorrect placement, which prevents its correct rehabilitation, the treatment plan is complicated, since the case must be started again, but in both hard and soft tissue with worse conditions that at the beginning of the treatment4. Therefore, having a technique that allows removing the implant with the least possible bone loss in the area is ideal, since this ensures a better starting situation for the new implant regeneration and rehabilitation6. The used atraumatic explantation kit (KEXIM- Biotechnology Institute®)5-8 ensures the removal of the implant without damaging the bone tissue in which it is located, in a quick and simple way, being able to subsequently insert a new implant in the same area and surgical procedure in those cases where it is indicated.
In this clinical case, there is an implant placed in an erroneous position in the anterior sector, in an area where the rehabilitation space is seriously compromised (lateral incisor zone), and where one must be as conservative as possible in the explantation to have a better chance. In the development of the case, the planning performed for its explantation, regeneration and subsequent insertion of a new implant is shown, along with its prosthetic rehabilitation and the follow-up of the case over time to verify that the stability of the treatment performed is maintained.
Anitua, E
DDS, MD, PhD. Private practice in oral implantology, Eduardo Anitua Clinic, Vitoria, Spain. Instituto
Universitario para la medicina oral regenerativa e implantología – (University Institute for Regenerative Medicine and Oral Implantology – UIRMI) (UPV/ EHU Eduardo Anitua Foundation), Vitoria, Spain. BTI Biotechnology institute (BTI), Vitoria, Spain.