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Table of Contents
CASE REPORT
Year : 2015  |  Volume : 5  |  Issue : 2  |  Page : 106-109

Re-osseointegration of loosened implant in a splinted fixed prosthesis


1 Department of Maxillofacial Prosthodontics and Implantology, HKE's Dental College and Research Centre, Gulbarga, Karnataka, India
2 Department of Paediatric Dentistry, HKE's Dental College and Research Centre, Gulbarga, Karnataka, India
3 Department of Maxillofacial Prosthodontics and Implantology Prosthodontics, Dental College and Research Centre, Azamgurd, Uttar Pradesh, India

Date of Web Publication15-Sep-2016

Correspondence Address:
Ramesh Chowdhary
Department of Maxillofacial Prosthodontics and Implantology, HKE's Dental College and Research Centre, Gulbarga - 585 102, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-6781.190432

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   Abstract 

Various studies have proved the success of the osseointegration concept if proper and strict protocols are followed for the success. In clinical practice, certain situations arise that makes the clinician to modify his treatment modality, to favor the final outcome of the treatment.  This paper presents a clinical case report of re-osseointegration of the loosened bead implant occurred during the torque application to tighten the abutment during cementation, which was splinting along with the adjacent well-osseointegrated implant using fixed partial denture prosthesis. The clinical outcome suggests that proper stabilization of a loosened implant can re-osseointegrate the implant.

Keywords: Loosened implant, re-osseointegration, splinting


How to cite this article:
Chowdhary R, Chowdhary N, Mishra SK. Re-osseointegration of loosened implant in a splinted fixed prosthesis. J Dent Implant 2015;5:106-9

How to cite this URL:
Chowdhary R, Chowdhary N, Mishra SK. Re-osseointegration of loosened implant in a splinted fixed prosthesis. J Dent Implant [serial online] 2015 [cited 2022 Jan 25];5:106-9. Available from: https://www.jdionline.org/text.asp?2015/5/2/106/190432


   Introduction Top


Various studies have proved the success of the osseointegration concept when proper and strict protocols are followed for the success. [1],[2],[3],[4],[5] Such as sterile protocols, [6] flap design, [7] and loading time. [8],[9] Since few years, the focus of implant treatment has been on the immediate loading of implants placed in either the mandible or maxilla. [10]

Few clinical studies of immediate loading have demonstrated variable success for full-arch rehabilitation whereas other studies have focused on the immediate loading and restoration of single and multiple tooth implants in various areas of the oral cavity have proven to have a high degree of success. [10]

The reported case is splinting, of an accidentally loosened Endopore Implant (Innova corp, Toronto, Canada), after 5 months of osseointegration.


   Case report Top


A 47-year-old woman reported to the dental clinic with a loosened four-unit fixed partial denture in related to missing of the maxillary left second premolar and molar, wherein first maxillary premolar and second molar were abutments.

Intraoral findings showed loosened metal-ceramic fixed partial denture, due to fracture of endodontically treated maxillary left premolar which was abutment for the prosthesis. This was confirmed with the orthopentagram showing radiolucency in relation to the first premolar [Figure 1]. The situation was explained to the patient, and with her concern, the prosthesis was removed. The fractured premolar was also removed. The socket was curettaged for any granulation tissue. After debridement, it was found that due to severe bone loss, the socket was not favorable for immediate implantation. Hence, endosseous implants were planned in the second premolar and first molar areas, with a cantilever first premolar to be designed in the prosthesis. Individual crown in relation to the prepared upper second molar was also planned.
Figure 1: Orthopentograph showing infected 24 supporting the loosened fixed bridge

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A 12 mm in length and 5 mm in diameter and 10 mm × 5 mm each wide Endopore (Innova Corp., Toronto, Canada) dental implants were surgically placed in the second premolar and first molar region, respectively. The osteotomy was performed as per the instructions of the manufacturer, and both the implants were placed, with radiographic confirmation that the apical aspect of the beaded implant was at least 2.5 mm short of the floor of the maxillary sinus. The surgical site was appropriately closed to ensure primary closure and hemostasis using a vicryl suture of 4.0 (Johnson & Johnson, India). The patient was prescribed to take ofloxacin and ornidazole tablet (Ordant, Dr. Reddy's Laboratory, India) 500 mg, twice daily for 5 days to prevent any infection, and piroxicam (Dolonex-DT, Pfizer, India), twice daily for 5 days for control of pain and inflammation.

After 5 months of healing phase, osseointegration was confirmed both clinically and radiographically. Subsequent procedures were followed with the placement of healing caps and continued with impression procedure. Metal-ceramic fused prosthesis was fabricated with the implant in the second premolar and implant with the first molar region as retainer crowns, along with an anterior pontic in relation to the missing first premolar region.

Unfortunately, with the use of 30 Ncm force with the torque wrench during tightening of the abutment screw of the implant in the position of second premolar region led to a rotation of the implant with breakage of the callus (newly formed bone) around the implant and severe momentary pain to the patient. On clinical examination, it was noticed that the implant in relation to the second premolar was mobile and rotating in the osteotomy site [Figure 2]. On immediate radiograph, no radiolucency was noticed surrounding the implant. As both the abutments were tightened to the implant, it would take the same amount of the torque to loosen the abutment from the mobile implant if thought for burying the implant for further sometime. The situation was explained to the patient, and with her concern, it was planned to retain the mobile implant in the same position and immobilize it as it would be splinted along with the adjacent firm and osseointegrated implant in relation to the first molar region, thus allowing it to re-osseointegrate. Hence, the bridge was cemented [Figure 3]. Occlusal interference was checked for, and the patient was asked to have a soft diet for 3 months [Figure 4]. Clinical and radiological assessments were conducted regularly every month up to 3 months to assess any bone loss or peri-implant lesion around the ailing implant. The radiograph taken at the 4 th month assured that favorable re-osseointegration had taken place in relation to the second premolar region implant. The prosthesis was retrieved through the access holes in the crowns and ailing implant assessed for any mobility. When the clinical examination was satisfactory, the prosthesis was recemented back. The radiograph taken after 1 year showed no peri-implant radiolucency [Figure 5].
Figure 2: Intraoral radiograph taken immediately after abutment tightening showing the loosened 25 beaded implant and the osseointegrated 26 implant

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Figure 3: Intraoral radiograph immediately after cementation showing the splinted implants in the prosthesis

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Figure 4: Prosthesis in function immediately after cementation

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Figure 5: Intraoral radiograph taken after 1 year postcementation of the prosthesis showing re-osseointegration in relation to 25 implant

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   Discussion Top


It has revealed that the success of an endosseous dental implant is dependent on the formation and maintenance of the secure implant to host bone fixation, which also says that direct implant-bone contact is necessary for the success of an implant. [5]

In this case report, it explains a unique treatment modification for a loosened implant, which was splinted with the adjacent osseointegrated implant in fixed prosthesis form and functionally loaded. As per the manufacturer's instructions, Endopore implants are not meant to be immediately loaded as they are sintered porous-surfaced implants. However, the same sintered porous-surfaced implants which have three-dimensional interlocking with bone and having approximately 85 volume percent porosity and an average pore size of approximately 100 mm (range 50-150 mm) give a strong sintered structure. These implants are truncated conical ranging from 5 to 12 mm in length. The major differences between this surface design and that of the other implants are that there are, in the growth of bone, very high interface shear strength and high interface tensile strength. This could be the additional reason for the re-osseointegration after implant mobility, along with the stability and immobilization of the implant got from the splinting of the loosened implant to the fixed implant. [11]

Thus, indicating that loosened implants which are not ailing due to any pathological change, if stabilized adequately, can re-osseointegrate and improve the prognosis of the restoration. This procedure could be a unique method in the management of failing implants, thus indicating that failing of implants can also occur due the clinical mismanagement during prosthesis restoration.


   Conclusion Top


Splinted, loaded, and re-osseointegrated of a loosened implant shows a unique circumstance of osseointegration. Further clinical research as well as in vitro studies is needed, to consolidate the possibilities of immediate loading of beaded or threaded implants in certain situations of mobility, when the prosthesis is cemented.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Buser D, Mericske-Stern R, Bernard JP, Behneke A, Behneke N, Hirt HP, et al. Long-term evaluation of non-submerged ITI implants. Part 1: 8-year life table analysis of a prospective multi-center study with 2359 implants. Clin Oral Implants Res 1997;8:161-72.  Back to cited text no. 1
    
2.
Lazzara R, Siddiqui AA, Binon P, Feldman SA, Weiner R, Phillips R, et al. Retrospective multicenter analysis of 3i endosseous dental implants placed over a five-year period. Clin Oral Implants Res 1996;7:73-83.  Back to cited text no. 2
    
3.
Lekholm U, Gunne J, Henry P, Higuchi K, Lindén U, Bergström C, et al. Survival of the Brånemark implant in partially edentulous jaws: A 10-year prospective multicenter study. Int J Oral Maxillofac Implants 1999;14:639-45.  Back to cited text no. 3
    
4.
Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;10:387-416.  Back to cited text no. 4
    
5.
Brånemark PI, Hansson BO, Adell R, Breine U, Lindström J, Hallén O, et al. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl 1977;16:1-132.  Back to cited text no. 5
    
6.
Scharf DR, Tarnow DP. Success rates of osseointegration for implants placed under sterile versus clean conditions. J Periodontol 1993;64:954-6.  Back to cited text no. 6
    
7.
Scharf DR, Tarnow DP. The effect of crestal versus mucobuccal incisions on the success rate of implant osseointegration. Int J Oral Maxillofac Implants 1993;8:187-90.  Back to cited text no. 7
    
8.
Lazzara RJ, Porter SS, Testori T, Galante J, Zetterqvist L. A prospective multicenter study evaluating loading of osseotite implants two months after placement: One-year results. J Esthet Dent 1998;10:280-9.  Back to cited text no. 8
    
9.
Ibañez JC, Jalbout ZN. Immediate loading of osseotite implants: Two-year results. Implant Dent 2002;11:128-36.  Back to cited text no. 9
    
10.
Petrungaro P. The immediate restoration of dental implants in conjunction with maxillary sinus elevation procedures: An initial report of 77 implant sites. Int Mag Oral Implantol 2002;4:6-17.  Back to cited text no. 10
    
11.
Pilliar RM. Processing and properties of endosseous dental implant surfaces: Design for increased osseointegration potential. Oral Health 2000:51-8.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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