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Removal of a Horizontally Displaced Dental Implant below the Mandibular Canal.

ABSTRACT: A clinical case of a horizontally displaced dental implant, which moved below the level of the mandibular canal during surgery is presented together with a brief review of the comparable published cases. The bone mineral density and the morphology of the alveolar ridge were analyzed at the site of osteotomy, and the low bone density of 265.32 ± 86.41 Hounsfield Units was found in the area. The factors related to implant displacement were: the anatomical features of bone structure, and the applied mechanical pressure during the implant insertion. The displacement of the dental implant below the level of the mandibular canal during implantation can be a severe complication. Its removal requires the safest surgical approach to avoid damaging the inferior alveolar nerve. The description of one clinical case does not provide grounds for drawing definite conclusions. To avoid similar incidents, detailed radiographic assessment before implantation is necessary; it is also important to follow the surgical protocols of implant placement into soft bone and to create conditions for a good visibility and sufficient control of bleeding during surgery.

SUBMITTER: Fakih KA

PROVIDER: S-EPMC10065860 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Removal of a Horizontally Displaced Dental Implant below the Mandibular Canal.

Fakih Khodor Ahmed KA Edreva Maria Stiliyanova MS Stoichkov Biser Borisov BB

Case reports in dentistry 20230324

A clinical case of a horizontally displaced dental implant, which moved below the level of the mandibular canal during surgery is presented together with a brief review of the comparable published cases. The bone mineral density and the morphology of the alveolar ridge were analyzed at the site of osteotomy, and the low bone density of 265.32 ± 86.41 Hounsfield Units was found in the area. The factors related to implant displacement were: the anatomical features of bone structure, and the applie ...[more]

PMID: 37006703

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Project description:Background and Objectives: The gold standard for a successful prosthetic approach is the osseointegration of an implant. However, this integration can be a problem in cases where the implant needs to be removed. Removing the implant with minimal damage to the surrounding tissues is important. Osteocytes cannot survive below -2 °C, but epithelial cells, fibroblasts, and other surrounding tissue cells can. Remodeling can be triggered by cryotherapy at temperatures that specifically affect osteocyte necrosis. In this study, we aimed to develop a method for reversing the osseointegration mechanism and for protecting the surrounding tissues by bone remodeling induced by CO2 cryotherapy. Materials and Methods: In this study, eight 2.8 mm diameter, one-piece mini implants were used in New Zealand rabbit tibias. Two control and six implants were tested in this study. After 2 months of osseointegration, a reverse torque force method was used to remove all osseointegrated implants at 5, 10, 20, and 30 Ncm. The osseointegration of the implants was proven by periotest measurements. Changes in bone tissue were examined in histological sections stained with toluidine blue after rabbit sacrifice. The number of lacunae with osteocyte, empty lacunae, and lacunae greater than 5 µm and the osteon number in a 10,000 µm2 area were calculated. Cryotherapy was applied to the test implants for 1 min, 2 min, and 5 min. Three implants were subjected to cryotherapy at -40 °C, and the other implants were subjected to cryotherapy at -80 °C. Results: Empty lacunae, filled osteocytes, lacunae >5 µm, and the osteon count around the implant applied at -40 °C were not significantly different from the control implants. The application of -40 °C for 1 min was found to cause minimal damage to the bone cells. The implants, which were applied for 1 min and 2 min, were successfully explanted on the 2nd day with the 5 Ncm reverse torque method. Test implants, which were applied cold for 5 min, were explanted on day 1. Tissue damage was detected in all test groups at -80 °C. Conclusions: The method of removing implants with cryotherapy was found to be successful in -40 °C freeze-thaw cycles applied three times for 1 min. To prove implant removal with cryotherapy, more implant trials should be conducted.

Project description:BackgroundIn the Netherlands about 18,000 procedures with implant removal are performed annually following open or closed reduction and fixation of fractures, of which 30-80% concern the foot, ankle and lower leg region. For clean surgical procedures, the rate of postoperative wound infections (POWI) should be less than ~2%. However, rates of 10-12% following implant removal have been reported, specifically after foot, ankle and lower leg fractures. Currently, surgeons individually decide if antibiotics prophylaxis is given, since no guideline exists. This leads to undesirable practice variation. The aim of the study is to assess the (cost-)effectiveness of a single intravenous gift of Cefazolin prior to implant removal following surgical fixation of foot, ankle and/or lower leg fractures.MethodsThis is a double-blind randomized controlled trial in patients scheduled for implant removal following a foot, ankle or lower leg fracture. Primary outcome is a POWI within 30 days after implant removal. Secondary outcomes are quality of life, functional outcome and costs at 30 days and 6 months after implant removal. With 2 x 250 patients a decrease in POWI rate from 10% to 3.3% (expected rate in clean-contaminated elective orthopaedic trauma procedures) can be detected (Power = 80%, 2-sided alpha = 5%, including 15% lost to follow up).DiscussionIf administration of prophylactic antibiotics prior to implant removal reduces the infectious complication rate, this will offer a strong argument to adopt this as standard practice of care. This will consequently lead to less physical and social disabilities and health care use. A preliminary, conservative estimation suggests yearly cost savings in the Netherlands of € 3.5 million per year.Trial registrationThis study is registered at Clinicaltrials.gov ( NCT02225821 ) and the Netherlands Trial Register ( NTR4393 ) and was granted permission by the Medical Ethical Review Committee of the Academic Medical Centre on October 7 2014.

Dataset Information

Removal of a Horizontally Displaced Dental Implant below the Mandibular Canal.

Publications

Removal of a Horizontally Displaced Dental Implant below the Mandibular Canal.

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