Fractured Implants Research Articles

A Conservative Technique for Fractured Implant Abutment Screw Retrieval on an Internal Connection Implant: Proof of Concept.

Broken screw removal from the implant connection is a common but challenging process. Several proposed methods and technical solutions may result in unsuccessful removal; thus, a novel, more conservative, risk-free method is proposed as a first attempt. The proposal is to use a silicon restoration holder to be twisted counterclockwise on the dried surface of the broken fragment inside the implant connection. This method, within the limitations of a minimal case series, yielded 100% results; however, despite previous attempts with less conservative techniques, this approach showed no efficacy. This article aims to promote the use of silicon restoration holders as a minimally invasive first attempt at broken screw retrieval treatment before considering other options.

Clinical Outcomes of Dental Implant Fractures: A Case Series and Analysis of Influencing Factors.

To observe and analyse patients with dental implant fracture and explore the factors influencing the fracture with the aim of providing reference for physicians' clinical work. The clinical data of 19 patients with dental implant fracture who visited the Department of Implantology of our hospital between 2007 and 2019 were retrospectively observed and analysed, and the fracture's influencing factors (e.g. the fracted implant site, implant diameter and connection mode, upper prosthetic method and fracture site) were analysed and investigated. The fractured implants comprised 12 Straumann implants (5 fractured at the smooth dental neck and 7 atop the central screws), 5 Bego implants (4 fractured at the smooth dental neck and 1 atop the central screw), 3 Lifecore implants fractured atop the central screws and 1 Anthogyr implant fractured atop the central screw. Of the 19 patients, 6 had anterior dental implant fracture, and 13 had posterior dental implant fracture (21 fractured implants in total). Maxillary anterior dental implant fracture was observed in 6 patients (8 implants), maxillary posterior implant fracture was observed in 3 patients (3 implants), and mandibular posterior dental implant fracture was observed in 10 patients (10 implants). A good implant system design, appropriate implant diameter and reasonable upper prosthetic method are key to maintaining long-term stability of a dental implant.

Artificial intelligence applications in dental implantology: A narrative review

Artificial intelligence (AI) has a substantial impact on various domains of society, including its significant role in revolutionizing dental care. These technological innovations have transformed dental treatment, expediting efficiency and innovation in the field. This review focuses on the substantial advancements in AI-based research in dental implantology, exploring the various applications of AI to enhance dental implant care. Comprehensive data from databases, including PubMed, Scopus, Web of Science, Cochrane, and Google Scholar, was thoroughly scrutinized and presented. AI has significantly impacted healthcare and dental implantology by enhancing efficiency, diagnosis, and clinical decision-making. In dental implantology, AI plays a crucial role in several aspects, such as implant identification, implant planning, prediction, and peri-implantitis management. AI models, including machine learning and deep learning, have been applied to identify implant brands accurately, outperforming dental professionals in some cases. Implant planning has been streamlined using AI to evaluate bone dimensions and locate critical anatomical landmarks. Using patient data and radiographic features, AI-driven prediction models proved as powerful tools for predicting implant success and peri-implantitis risk. Additionally, AI helps in the early recognition of complications like fractured implants and bio-tribocorrosion.

Characteristics and Risk Factors for the Fracture of One-Piece Implants.

The one-piece dental implant was originally designed to overcome the structural weaknesses of the two-piece implant. However, a fractured one-piece implant requires removal because the abutment cannot be repaired or replaced to support new prosthetic restorations. The aim of this study was to clarify the features and risk factors for fracture of the one-piece implant. This study was designed as a retrospective case series research. The subjects were patients who were treated for fractures of the one-piece implant at a clinic in Japan between 2012 and 2021. Fractures of the one-piece implant were diagnosed by cone-beam computed tomography, and the association between age and duration from implant placement to fracture was analyzed by one-way ANOVA followed by the Tukey test. Eighteen patients and 20 one-piece implants (under 39years: 5 patients and 6 implants; 40-59years: 7 patients and 7 implants; over 60years: 6 patients and 7 implants) had fractures in their one-piece implants. Of the fractured implants, 11 had a diameter of 3mm, and 9 had a diameter of 4mm. The mean durations up to implant fracture were 662days in the younger group, 1467days in the middle group, and 1239days in older group, and the duration was significantly shorter in the younger group. In addition, 83.3% of fracture implants in the younger group were in the molar region. All fractures of the one-piece implants occurred under the bone margin. Two patients had torus mandibularis, and 1 patient was had bruxism. One-piece implants in younger patients that are located in the lower molar position are the most susceptible to implant fracture, and the fracture occurred under the bone margin in all cases.

Management of a Fractured Implant Abutment Screw: A Case Report

In an abutment - Implant fracture, it is generally a challenge for the clinician to remove the fractured fragments. A fractured abutment screw of a single crown or fixed dental prostheses supported by an endosseous implant is a complication. In some cases, the screw cannot be removed, and alternative solutions should be considered. This clinical report describes a fractured abutment screw prostheses and cold welded screw , which was impossible to retrieve.

Guided Bone Regeneration with BoneHealTM Membrane after Explantation of Fractured Implant: Case Report

Implantoprosthetic rehabilitation has become the main method to reestablish totally or partially edentulous patients, with a high success rate. However, some complications can cause implant loss. The main one is periimplantitis, with bone loss around the osseointegrated implant. However, implant fractures or incorrect implant position may compromise implant rehabilitation and require implant removal. Several techniques can be used for implant explantation, and the dental surgeon should opt for the easiest and most conservative technique, ensuring the greatest preservation of remaining bone tissue and aiming at the future reinstallation of another osseointegrated implant. Sometimes, associated Guided Bone Regeneration techniques may be necessary in conjunction with future implant installation, using various procedures or biomaterials. The purpose of this article is to present the case of a patient who underwent explantation of a fractured implant. A polypropylene membrane (BoneHealTM) was used and an implant was reinstalled 8 months after explantation.

Reduced fracture load of dental implants after implantoplasty with different instrumentation sequences. An in vitro study.

To assess the mechanical stability of implants after implantoplasty and thermocyclic loading, the residual thickness of the instrumented areas and neighbouring tooth injury due to implantoplasty. Using a phantom head simulator and maxillary model implants were subjected to an implantoplasty procedure. Thirty implants were randomly assigned to receive one of three instrumentation sequences. After instrumentation, injury on neighbouring teeth was assessed. Instrumented implants and non-instrumented controls were subjected to 1.2 million cycles of thermo-mechanical loading in a chewing machine. Afterwards, maximum fracture load for all implants and an additional five pristine control implants was tested. Generally, damage of neighbour teeth was a frequent finding (33±56% of all cases) with considerable inter-group differences. No considerable inter-group difference for the residual implant thickness was found for different areas assessed. No implant fractured during cyclic loading. Fracture load was reduced after cyclic loading of uninstrumented implants from 2,724±70N to 2,299±127N, and after implantoplasty to 1,737±165N, while no effect by the instrumentation sequence could be observed. Both implantoplasty and cyclic loading were shown to reduce the implants' maximum bending strength. Cyclic loading in a laboratory masticator, simulating a five-year equivalent of chewing, did not result in fractured implants. Since neighbouring tooth injury was assessed often, care should be taken with the selection of suitable instruments.

Technique for Converting A Fractured Implant Locator Abutment to A Custom Implant Cast Post and Core.

This technique article describes an efficient, cost effective and time saving procedure using the fractured abutment as a custom cast post and core when an overdenture abutment is fractured and attempts to retrieve the fractured segment fail.

Dual-Purpose 3D-Printed Surgical Template for Removal of Fractured Implant and New Implant Placement

Dental implants may fracture, and frequently excessive bone removal has to be performed in order to remove the apical fragment. In such instances, staged bone augmentation is indicated, creating more trauma, longer treatment time, and additional cost to the patient. Virtual surgical planning and guided surgery may increase the accuracy of the procedure and reduce treatment time. Through a case report, we show the use of digital planning and guided surgery to optimize implant removal, simultaneous implant placement, and bone augmentation.

Mechanical failure of 113 uncemented modular revision femoral components.

We evaluated a large database with mechanical failure of a single uncemented modular femoral component, used in revision hip arthroplasty, as the end point and compared them to a control group treated with the same implant. Patient- and implant-specific risk factors for implant failure were analyzed. All cases of a fractured uncemented modular revision femoral component from one manufacturer until April 2017 were identified and the total number of implants sold until April 2017 was used to calculate the fracture rate. The manufacturer provided data on patient demographics, time to failure, and implant details for all notified fractured devices. Patient- and implant-specific risk factors were evaluated using a logistic regression model with multiple imputations and compared to data from a previously published reference group, where no fractures had been observed. The results of a retrieval analysis of the fractured implants, performed by the manufacturer, were available for evaluation. There were 113 recorded cases with fracture at the modular junction, resulting in a calculated fracture rate of 0.30% (113/37,600). The fracture rate of the implant without signs of improper use was 0.11% (41/37,600). In 79% (89/113) of cases with a failed implant, either a lateralized (high offset) neck segment, an extralong head, or the combination of both were used. Logistic regression analysis revealed male sex, high body mass index (BMI), straight component design, and small neck segments were significant risk factors for failure. Investigation of the implants (76/113) showed at least one sign of improper use in 72 cases. Implant failure at the modular junction is associated with patient- and implant-specific risk factors as well as technical errors during implantation. Whenever possible, the use of short and lateralized neck segments should be avoided with this revision system. Implantation instructions and contraindications need to be adhered to and respected. Cite this article: Bone Joint J 2020;102-B(5):573-579.

Fractures of implant fixtures: a retrospective clinical study

BackgroundThe aim of this study was to evaluate the factors that may affect implant fixture fractures.MethodsPatients who experienced implant fixture removal at Seoul National University Bundang Hospital from 2007 to 2015 due to implant fixture fracture were included. Implant/crown ratio, time of implant fracture, clinical symptoms before implant fracture, treatment of fractured implants, and the success and survival rate of the replaced implants were evaluated retrospectively.ResultsThirteen implants were fractured in 12 patients. Patient mean age at the time of fracture was 59.3 years. Of the 13 implants, 7 implants were placed at our hospital, and 6 were placed at a local clinic. The mean crown/implant ratio was 0.83:1. The clinical symptoms before fracture were screw loosening in five implants, marginal bone loss in five implants, and the presence of peri-implant diseases in five implants. All the fractured implants were removed, and 12 out of the 13 sites were re-implanted. Parafunctions were observed in two patients: one with bruxism and one with attrition due to a strong chewing habit.ConclusionsSeveral clinical symptoms before the fracture of an implant can predict implant fixture failure. Therefore, if these clinical symptoms are observed, appropriate treatments can be taken before more serious complications result.

Human non-decalcified histology of three dental implants 45\u2009months under function\u2014a case report

BackgroundFracture of an implant is a quite rare event but represents an important opportunity to evaluate the peri-implant bone tissue response to implant overload in human beings. This study aimed to evaluate bone tissue around three fractured titanium implants retrieved from a human maxilla, by histomorphometric and birefringence analyses.Case reportFor this, the implants and the surrounding bone were removed after having been united to a tooth in function for 45 months, by a 4-mm internal diameter trephine bur, following an undecalcified section was obtained. The results showed a rate of 77.3% of bone-to-implant contact (BIC) and 80.3% of bone area filling within the limits of the implant threads. Under circularly polarized light microscopy investigation, the amount of the transverse collagen fibers was of 48.11%, and the amount of the longitudinal collagen fibers was of 51.89%.ConclusionWithin the limitation of this study, the possible cause of the implant fracture could be the association of overload, inadequate implant diameter, and fragile internal hexagon connection.

Analysis of risk factors of 19 fractured implants

Objective: To analyze the incidence and possible risk factors of 19 fractured implants out of 8 468 implants in 3 184 cases. Methods: During the 22-year clinical practice, clinical records of 18 patients with 19 fractured implants in 3 184 cases with 8 468 implants were analyzed to determine the following factors: location of the fractured implants, prosthodontics option, date of implant fracture, dimensions of fractured implants, complications prior to implant fracture and parafunctional habit. An evaluation of fractured implants was performed to identify possible factors that may predispose an implant to a higher risk of fracture. Results: Overall, the average duration of service of the implants was (7.0±4.5) years. Implant fracture occurred in 7 Camlog implants, 7 Nobel replace implants, 3 Ankylos implants and 2 Brånemark implants. No Thommen implant fractures were recorded. Amongst the 19 fractured implants, 8 occurred at the thinnest wall portion of the implant neck, 8 at the end of screw and 3 at the self-tapping thread region. All fractures were observed after functional loading. Furthermore, 9/19 (47.4%) of fractures occurred in the maxilla, indicating similar incidence rates in both arches (P=0.065). Most of fractures (16/19) occurred in the molar region and 18/19 in single implant-supported restorations. Totally 17 cases had received metal occlusal restorations. In 6 cases (35.5%), previous bone destruction apically extending to the level of implant fracture was documented before any clinical signs of fracture. Three fractured implants were removed and simultaneously re-implanted with larger-diameter implants, while the rest of the cases were left to heal, followed by a second-stage surgery. Conclusions: Within the limitation of this analysis, the study demonstrated that appropriate implant-abutment connection design, implant diameter, prosthetic strategy and bone resorption are crucial to the long-term performance of implants. There is no significant difference of fractures rates in both archs.

A Step-By-Step Technique for the Piezosurgical Removal of Fractured Implants.

With the increasing popularity of dental implants, the removal of fractured implants has become a major challenge for clinicians. Several tools can be used for the removal of osseointegrated implants; however, few of these have the characteristics of easy control, selective cutting, and rapid healing. In this study, the authors describe a step-by-step technique for the removal of osseointegrated fractured implants via multiple peri-implant osteotomies performed using a piezoelectric device and appropriate inserts. All patients ended with primary wound closure without any soft tissue dehiscence and no healing problems during the postoperative period. As the use of ultrasonic inserts enables precise and selective cuts, piezosurgical implant removal is an attractive alternative to trephine burs or rotary drills.

PC391: The incidence of fractured implants according to clinical factors

PC391: The incidence of fractured implants according to clinical factors

Silicone Metacarpophalangeal Arthroplasty for Osteoarthritis: Long-Term Results.

To demonstrate that silicone metacarpophalangeal (MCP) arthroplasty provides excellent long-term outcomes with a low complication rate in osteoarthritis patients. A consecutive cohort of 35 patients with osteoarthritis of 1 or more MCP joints undergoing anatomically neutral silicone MCP arthroplasty was followed over a 15-year period. Functional outcomes including strength and range of motion (ROM), as well as complications, were recorded. All patients were available for long-term assessment including radiographs and outcomes questionnaire. Average follow-up for the cohort of 35 patients (40 implants) was 8.3 years (range, 2-17 years). Average age was 58 years (range, 42-80 years) with 22 men and 13 women. In 31 patients, a single MCP joint was involved (middle finger, 20; index finger, 10; little finger, 1). The dominant hand was involved in 23 patients. Seven (of 14) patients had a concomitant RCL reconstruction of the index finger MCP joint; no other digit had a collateral ligament reconstruction. Average final visual analog scale pain score was 0.3 of 10. Average final active ROM arc was from 4° (range, 0°-20°) to 73° (range, 50°-90°) of flexion. One patient had a revision MCP arthroplasty for a 97% clinical survivorship. Radiographs demonstrated fractured implants in 5 of 40 (12.5%) implants, but none exhibited instability, pain, or ROM deterioration. Average Michigan Hand Outcomes Questionnaire score was 82 (of 100) at final follow-up. Silicone arthroplasty is effective in the treatment of primary MCP osteoarthritis. Implant survivorship is 97% (clinical) and 88% (radiographic) in long-term follow-up. Therapeutic IV.

Bits and Pieces: A Crowd-Sourced Series of 54 Cases of Fractured Hormonal Implants

Study ObjectiveThe fracture of hormonal implants, including Implanon, Nexplanon (both from Merck & Co, Inc), and histrelin acetate is rare. Our aim was to describe patient demographic characteristics, mechanisms, and consequences of fractured implants by surveying physicians' experience via listservs and social media. Design, Setting, Participants, Interventions, and Main Outcome MeasuresWe developed a Research Electronic Data Capture survey for physicians regarding their experience with implant fracture, including patient characteristics, mechanism of fracture, changes in menstrual bleeding patterns, time from insertion to fracture, and time from fracture to seeking care. We distributed the survey to providers in listservs for the North American Society for Pediatric and Adolescent Gynecology, the Family Planning Fellowship, the Ryan Program, and the Facebook Physician Moms Group and Facebook OB-GYN Mom Group. We performed descriptive analyses. ResultsWe received 42 survey responses, representing 54 discrete implant fractures of which 70% (n=14) were Nexplanon, 26% (n=38) were Implanon, and 4% (n=2) were histrelin acetate. Mechanisms of implant fracture included patient manipulation (23%, n=12), unintentional trauma (11%, n=6), interpersonal violence (8%, n=4), lifting/carrying (6%, n=3), fracture with removal (6%, n=3), and unknown (47%, n=25). Bleeding pattern was not altered in 78% (n=42) of cases. Time interval between placement and fracture was less than 2 years for 63% (n=34) of cases. Thirty-nine percent (n=21) of patients presented for care more than 1 month from the time of fracture. ConclusionPatients should be counseled about potential for hormonal implant fracture, advised against excessive manipulation of implants, and counseled to present for care immediately upon noticing an implant fracture. Surveying physicians through listervs and social media is an effective strategy to increase the reporting of rare complications and events.

Evaluation of the Etiologies of Implant Fracture in Patients With Fractures of the Implants of Lower Limbs' Long Bones.

Background:Orthopedics implants are important tools for treatment of bone fractures. Despite available recommendations for designing and making the implants, there are multiple cases of fracture of these implants in the body. Hence, in this study the frequency of failure of implants in long bones of lower extremities was evaluated.Methods and Materials:In this cross-sectional study, two types of fractured implants in the body were analyzed and underwent metalogical, mechanical, and modeling and stress-bending analysis.Results:The results revealed that the main cause of fractures was decreased mechanical resistance due to inappropriate chemical composition (especially decreased percentages of Nickel and Molybdenum).Conclusions:It may be concluded that following the standard chemical composition and use of optimal making method are the most important works for prevention of failure of implants.

Human bone reactions around implants with adverse interfacial bone strain over 20 years

It has been accepted that bone damage and subsequent resorption occurs in cases of adverse interfacial bone strain. Fractured implants represents an important opportunity for evaluating the bone response to overstrain. The objective of the study was to analyze the bone morphology and morphometry around retrieved fractured implants in humans. Five fractured implants retrieved after 22.4 (± 2.8) years were used in the present study. The investigation was conducted in a transmitted brightfield and circularly polarized light Microscope. The parameters considered were the total bone area, total bone remodeling area, bone-remodeling rate (BRR), and bone transverse collagen fibers orientation (CFO). For grouped samples, the BRR was 51.9% (± 10) while the transverse CFO was 13.0% (± 9.7). The interthread BRR was 58.1% (± 4.0) for level 1 and 40.4% (± 12.8) for level 2 with a significant decrease in BRR (p = 0.019) as a function of depth along the implant length. Both bone level and bone quality attains stability to a certain level with respect to implant neck fracture following physiologic interaction between mechanical and biological inputs. The BRR significantly decrease as function of threads depth.

Management of a Fractured Implant Abutment Screw: A Clinical Report

In an abutment screw fracture, it is generally a challenge for the clinician to remove fractured fragments. In some cases, the screw cannot be removed, and alternative solutions should be considered. This clinical report describes the replacement of a ball attachment with a fractured screw, which was impossible to retrieve, with a cast dowel with ball attachment. The patient who presented to the Department of Prosthodontics, Yeditepe University, Faculty of Dentistry was a 65-year-old woman, wearing a mandibular complete denture supported by two implants for 4 years. She complained about the loss of retention of the denture because of the fractured abutment screw, and it was found that another dentist had previously tried to retrieve the fractured screw with no success. It was decided to construct a cast dowel with ball attachment to improve retention without sacrificing the implant. The interior of the implant and the fractured screw were machined with a rotating instrument. An impression was taken with a metal strip and silicone-based materials. In the laboratory, a stone die was generated from the impression, and a custom-made cast dowel with ball attachment was constructed. It was then cemented with glass ionomer cement and connected to the denture with the direct method. The alternative procedure described in this clinical report was successful for the removal of the fractured abutment screw and use of the existing denture.