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CASE REPORT
Year : 2011  |  Volume : 14  |  Issue : 1  |  Page : 102-105

Re-osseointegration of loosened implant in a splinted fixed prosthesis


1 Branemark Osseointegration centre India, Gulbarga, India
2 Department of Maxillofacial Prosthodontics and Implantology, Dental College and Research Centre, Azamgurd, Uttar Pradesh, India

Date of Acceptance31-Jan-2011
Date of Web Publication11-Apr-2011

Correspondence Address:
R Chowdhary
Branemark osseointegration centre India, Golden Plaza Complex, Court road, Gulbarga
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1119-3077.79259

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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-osseoingrated implant by using fixed partial denture prosthesis. The clinical outcome suggests that proper stabilisation of a loosened implant can re-osseointegrate the implant.

Keywords: Loosened implant, re-osseointegretion, splinting


How to cite this article:
Chowdhary R, Chowdhary N, Mishra S K. Re-osseointegration of loosened implant in a splinted fixed prosthesis. Niger J Clin Pract 2011;14:102-5

How to cite this URL:
Chowdhary R, Chowdhary N, Mishra S K. Re-osseointegration of loosened implant in a splinted fixed prosthesis. Niger J Clin Pract [serial online] 2011 [cited 2020 Mar 29];14:102-5. Available from: http://www.njcponline.com/text.asp?2011/14/1/102/79259


   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 focussed on the immediate loading and restoration of single and multiple tooth implants in various areas of the oral cavity that 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 female patient complained of loosened fixed partial denture of upper arch. On clinical examination it was revealed that, there was a fixed partial denture in relation to 24 and 27 as abutments, replacing missing 25 and 26, of which 24 abutment tooth was mobile. Radiographical findings showed fracture of endodontically treated left first premolar with periapical lesion surrounding the tooth [Figure 1]. The situation was explained to the patient that the mobile abutment tooth has to be extracted and that the existing prosthesis will be not of any use. After locally anesthetizing the area with 2 ml of lidocaine (lignox Warren Pharmaceutical, Mumbai, India) the prosthesis was removed and the fractured premolar was also extracted. The socket was curettaged to remove the granulation tissue at the apex. 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 second premolar and first molar edentulous areas, with an anterior premolar cantilever to be designed in the prosthesis. An individual was planned for the second molar which was a prepared abutment tooth of the previous prosthesis.
Figure 1: Orthopentogragh showing infected 24 supporting the loosened fixed bridge

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A 12-mm long and 5-mm wide endopore implant (Innova Corp) and another 10-mm long and 5-mm wide endopore dental implants were surgically placed in second premolar and first molar region respectively after required osteotomy was performed as per the instructions of the manufacturer. An radiographic confirmation was dine after the placement to confirm the apical aspect of both the beaded implant was at least 2.5 mm short of the floor of the maxillary sinus. The flap was approximated with a vycril suture of 4.0 (Johnson and Johnson ltd, Mumbai, India) for primary closure. The patient was prescribed to take ofloxacin and ornidizole tablet (Ordant, Dr. Reddy's Laboratory,Hyderabad India) 500 mg, twice daily for 5 days to prevent any infection and piroxicam (Dolonex-DT, Pfizer,Mumbai, 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 placement of healing caps and continued with impression procedure. Metal-fused ceramic prosthesis was fabricated for implant in second premolar and first molar region as retainer crowns, along with a anterior pontic in relation to the missing first premolar region.

During the process of tightening the abutment screw with the spring-loaded torque wrench (Hitec torque wrench, Isreal) for the second premolar region implant with 30 Ncm torque led to the rotation of the implant with breakage of the callus (newly formed bone) around the implant with bleeding from the crest of the implant and severe momentary pain to the patient. On clinical examination it was noticed that the implant in relation to second premolar was mobile and rotating in the osteotomy site [Figure 2]. On immediate radiograph no radiolucency was noticed surrounding the implant. As the abutments were already tighten to the implant, it would have taken the same amount the torque to loosen the abutment from the mobile implant, if it was planned to allow the loosened implant to be buried and allowed to re-osseointegrate. The situation was explained to the patient and with her consent it was planned to retain the mobile implant in the same position and splint it along with the adjacent firm and osseointegrated implant in relation to first molar region. Thus, allowing it to reosseointegrate. After the occlusion interferences were checked the prosthesis was cemented with provisional cement (Improve, Nobel biocare, Gotenborg, Sweden) [Figure 3], [Figure 4]. The patient was asked to have soft diet for a period of 3 months. 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 4 th month assured that favorable re-osseointegration had taken place in relation to second premolar region implant. The prosthesis was retrieved through the access holes in the crowns and ailing implant was clinically assessed for any mobility. When clinical examination was satisfactory, the prosthesis was re-cemented back with improve provisional cement. 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 os­seointegreted 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-osseointegretion 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 maintenances of secure implant to host bone fixation, which also says that direct implant bone contact is necessary for success of an implant. [5]

In this case presented, it explains a unique treatment modification for a loosened implant, which was splinted with adjacent osseointegrated implant in fixed prosthesis form and functionally loaded. As per the manufacturer's instructions, Endopore implant is not meant to be immediately loaded, as they are sintered porous-surfaced implants. But 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 μm (range 50-150 μm) gives 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 is that, there is ingrowth of bone, a very high interface shear strength and high interface tensile strength [Table 1]. 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 which was not infected and affected with peri-implantitis. [11]
Table 1: Summary of bone-implant interface strength determinations

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


   Conclusions 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 are cemented.

 
   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;8:16-72.  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, Linden U, Bergstrom C, et al. Survival of the Branemark 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, Branemark 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 ten-year period. Scand J Plast Reconstr Surg Suppl 1977;16:132.   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 incision on the success rate of implant osseointegration. Int J Oral Maxillofacial 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.Ibanez 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 osseointegretion potential. Oral Health 2000;51-8.  Back to cited text no. 11
    


    Figures

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

  [Table 1]


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