Abstract
BackgroundA non-invasive method has recently been introduced to remove osseo-integrated palatal implants by using the implantation ratchet which is designed to screw in or unscrew the implants. Although a proof of concept has been published, the torque involved to successfully explant have not been investigated so far. The aim of this study was to assess the removal torque required to explant osseo-integrated and orthodontically utilized palatal implants, and to identify potentially influencing variables.Materials and methodThirty-one consecutive patients (15 females, 16 males; mean age 24.1 ±7.4 years) with fully osseo-integrated and previously orthodontically loaded palatal implants (Orthosystem®: diameter 4.1mm/length 4.2mm/sandblasted with large grits (SLA) surface) were randomly assigned to either clockwise or counter-clockwise non-invasive explantation. The respective explantation tool with an electric torque control was placed on the abutment connection of the implant and secured by an occlusal screw.The primary outcome studied was maximal removal torque (MRT) needed to detach the implant from its socket which was recorded individually together with other potentially influencing secondary outcomes (gender, age, orthodontic loading time, use of local anaesthetics). Student’s t-test was used to contrast MRT difference for the gender, type of suprastructure, use of local anaesthetics, and rotational direction.Spearman correlations was used to investigate associations between MRT and patient’s age or duration loading time.ResultsAverage MRT (148.6 ± 63.2N/cm) using ratchet as a non-invasive removal method of palatal implant was considered safe. The triangular head fractured of palatal implant at a torque level of 300.1 Ncm. Significantly higher explantation were recorded for male patients compared to female patients (182.0 ± 63.0 Ncm vs 112.8 ± 40.8 Ncm; P=0.001). On the other side, the mean removal torque for palatal removal in clockwise direction was non-significantly different (158.3 ± 58.6 Ncm) compared to counter-clockwise direction (139.4 ± 67.9 Ncm). Neither patient’s age (p=0.324) nor loading time (p=0.214) were significantly correlated with removal torque values.ConclusionsPertinent literature on this subject is practically non-existent, as orthodontics is presumably the only discipline where implant removal represents a treatment success. Mean MRT for successful palatal implant removal was 148.6±63.2Ncm, but a large spectrum was observed (minimum 31.5Ncm, maximum 272.8Ncm). This obvious heterogeneity underlines the importance to investigate possible influencing factors. The safe and simple non-invasive method for palatal implant removal necessitates moderate, but not high torque MRTs, independently of the torque direction. The necessary MRT seems clearly influenced by gender, but less so by patient’s age or loading time.
Highlights
Reliable anchorage is required in various orthodontic treatment approaches to achieve satisfactory result
The necessary maximal removal torque (MRT) seems clearly influenced by gender, but less so by patient’s age or loading time
The purpose of the present study was to assess the maximal removal torque recorded at removal by for unscrewing successfully osseo-intergrated and orthodontically loaded palatal implants by contrasting gender, type of suprastructure, use of local anaesthetics, and rotational direction
Summary
Reliable anchorage is required in various orthodontic treatment approaches to achieve satisfactory result. Rough-surfaced palatal implants are an established and reliable approach to reinforce orthodontic anchorage [13, 17, 25]. They are clinically satisfactory when their entry point into the cortical bone is at between the anterior-posterior level of the maxillary first and second premolars—perpendicular to the palatal surface [13]. Its removal was only possible surgically using a hollow cylinder trephine This standard method removes the implant together with a larger bone volume and is considered invasive and is not free of complications [5]. The aim of this study was to assess the removal torque required to explant osseo-integrated and orthodontically utilized palatal implants, and to identify potentially influencing variables
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