A dental implant is an artificial tooth root replacement that is surgically anchored into the jawbone to support a prosthetic tooth. Dental implants are commonly used to replace missing teeth and restore chewing function. In most cases, dental implants are a permanent solution and osseointegrate with the jawbone, meaning the bone grows around and fuses with the implant over time. However, in some situations, a dental implant may need to be removed and potentially reinserted. This article will explore the reasons why a dental implant may need to be removed and whether a dental implant can be successfully reinserted after removal.
Why Might a Dental Implant Need to be Removed?
There are several reasons why a dentist may recommend removing a dental implant:
Implant Failure
Dental implant failure occurs when the implant does not successfully integrate with the bone, a process known as osseointegration. This is most likely to happen early on after the initial surgery. Signs of failure include looseness of the implant, pain or discomfort around the implant site, or infection. If the implant fails to osseointegrate, it will need to be removed.
Peri-implantitis
Peri-implantitis is a gum infection that occurs around a dental implant. It is caused by plaque accumulation and can lead to inflammation, bleeding, and bone loss around the implant. Peri-implantitis often occurs due to poor oral hygiene and if left untreated, it can cause the implant to loosen or fail. Removing the infected implant is sometimes necessary to resolve peri-implantitis.
Bone Loss Around the Implant
One of the risks after implant placement is progressive bone loss around the implant over time. This can occur due to excessive bite forces, poor positioning of the implant, or chronic inflammation around the implant. If the bone loss is significant enough, it can lead to loosening of the implant, which may then need to be removed.
Fracture of the Implant
Dental implants can sometimes fracture due to factors like improper placement, excessive bite forces, or poor quality of implant material. A fractured implant is unable to properly support the crown restoration and will need to be removed.
Damage to Surrounding Structures
In rare cases, a dental implant could damage nearby tooth roots, nerves or sinus cavities. This may require the implant to be removed to prevent further complications.
Preparation for Orthodontic Treatment
If orthodontic treatment is needed after a dental implant placement, the implant crown may need to be removed so that the implant does not interfere with tooth movement. The implant itself may be left in place during orthodontic treatment and later restored once treatment is complete.
Implant Placement in Wrong Position
Incorrect positioning of a dental implant, such as too close to nearby teeth or anatomically vital structures, may require the implant to be removed and potentially repositioned or replaced with a smaller diameter implant.
Unsatisfactory Cosmetic Results
In some cases, a patient may be unsatisfied with the aesthetic appearance of the implant crown. The implant itself may be integrated successfully, but if the crown shape, size or color is unacceptable to the patient, the crown can be removed and replaced on the integrated implant.
Can a Dental Implant be Reinserted After Removal?
Whether or not a dental implant can be reinserted after removal depends on the reason for removal and the condition of the implant and surrounding bone:
Early Implant Failure
If the dental implant failed to osseointegrate shortly after initial placement, it is often possible to replace it with a new implant. This is considered early implant failure. As long as there is adequate bone remaining, the new implant can be placed in the same site right away or after some time to allow further healing. The success rates for reinserting implants after early failure are usually very high.
Chronic Infection Must be Treated First
If the implant was removed due to infection like peri-implantitis, the infection must be fully treated and resolved before placing another implant. Antibiotics, extensive cleaning, and sometimes bone grafting may be needed to get rid of the infection and allow sufficient bone to integrate a new implant.
Depends on Amount of Bone Loss
If the implant was removed due to progressive bone loss around the implant, whether it can be replaced depends on how much bone remains. If there is not enough bone height or width remaining, bone grafting would be necessary to rebuild the bone before attempting to place another implant.
Fractured Implants Cannot be Reused
A fractured or broken implant cannot be reinserted. However, once the fractured implant is removed, it may be possible to place a new implant into the existing site, assuming adequate bone remains around the area.
Orthodontic Treatment Requires Confirmation of Integration
If an implant was healthily integrated but the crown was removed for orthodontic treatment, the same implant can usually be restored with a new crown once orthodontics is complete. The dentist will confirm the implant remains sturdily integrated after orthodontic movement before taking this approach.
Incorrectly Positioned Implants May be Replaced
If the implant was poorly positioned or too close to vital structures, removing and replacing it in a better position is often possible, provided bone quality and quantity are sufficient at the new planned site.
What is the Success Rate of Reinserting Dental Implants?
When appropriate conditions exist, the success rate of replacing a failed or removed dental implant is usually very high. However, exact success rates depend on various factors:
Reason for Initial Implant Failure
If the first implant failed to osseointegrate due to poor bone quality or quantity or other biologic factors, the new implant may be at higher risk of failure again. But if the initial failure was due to surgical trauma/error or an infection that has been cured, the success rate for re-attempt is up to 98%.
Amount of Bone Present
Adequate bone volume and density are key for dental implant osseointegration. If bone grafting is needed before re-attempting implant placement, the success rate is somewhat lower – 90-95% on average.
General Health of Recipient
Overall health conditions like diabetes or osteoporosis can impact success rates. In healthy recipients with good bone density, success rates exceed 95%. But in those with significant medical issues, the rate may be closer to 85-90%.
Avoiding Initial Causes of Failure
Taking steps to correct issues that caused the first implant failure greatly improves success of subsequent implants. For example, proper treatment planning, good surgical technique and infection control optimize outcomes.
Implant Location in the Jaw
Implants placed in the front part of the jaw have slightly higher success rates than those placed in the back part of the jaw. Front sites tend to have denser bone.
Single vs. Multiple Implants
Single implant success rates are generally higher than multiple adjacent implants. Having adequate space between new implants also boosts the prognosis.
Experience Level of Surgeon
More experienced implant surgeons are likely to have higher re-implantation success rates due to their advanced skills and knowledge of best practices that maximize implant integration.
| Reason for initial failure | Expected success rate of re-implantation |
|---|---|
| Infection | 95-98% |
| Early failure due to poor osseointegration | 90-95% |
| Bone loss around implant | 85-90% with bone grafting |
| Fractured implant | 95-98% if adequate bone remains |
| Incorrect positioning | 95-98% if repositioned properly |
Steps for Reinserting a Dental Implant
If it is determined that reinserting a dental implant is appropriate, the steps generally include:
Removal of Failed Implant
The failing or failed implant must be completely removed, often using a trephine drill. Any infected or damaged bone is also debrided.
Bone Grafting Procedures if Necessary
If bone volume is inadequate for new implant placement, bone grafting can help regenerate bone at the site. Various materials like autogenous bone or bone substitutes may be used.
Allow Time for Healing After Grafting
If bone augmentation was needed, the grafted site is allowed to heal for several months before attempting a new implant. This allows the graft to fully incorporate and regenerate bone.
New Implant Placement Surgery
Once the site has healed properly, new implant surgery is performed, following precise placement based on restorative needs. Initial stability is checked.
Healing Period for Osseointegration
There will be a healing period of several months to allow the new implant to integrate with the bone before restoring it with a crown or bridge. Proper osseointegration is verified before restoration.
New Crown Placement on Integrated Implant
With the reinserted implant successfully integrated, an abutment is placed and new crown fabricated. The restoration is attached to complete the process.
Key Takeaways
– Dental implants may require removal due to failure, infection, fracture or other complications in some cases.
– Whether or not the implant can be replaced depends on the reason for removal, amount of bone remaining, and control of infection or other factors that caused initial failure.
– Under optimal conditions, implants removed for reasons like failure to osseointegrate or incorrect position often can be successfully reinserted in the same site.
– If bone loss occurred around the initial implant, bone regeneration procedures are usually needed before re-attempting implant placement.
– Proper treatment planning, technique, infection control and maintenance of implants can help minimize the need for implant removal and replacement.
– Overall, high long-term success rates of over 95% are achievable for reinserting dental implants when done properly under appropriate circumstances.
Conclusion
While dental implants are intended to be permanent, circumstances like infection, implant fracture or failure to integrate can necessitate removal. Provided adequate bone volume remains and any infections are resolved, the same implant site can often be successfully retreated with a new dental implant in select cases. However, the amount of remaining bone and reasons the original implant failed must be evaluated to determine feasibility and expected prognosis. With proper case selection and execution, dental implants that require removal can frequently be replaced with the potential for excellent long-term results.
