Management of an implant case that required retreatment: a case report

A segmental osteotomy with 3D virtual planning to move a malpositioned dental implant

Background

Correct positioning and alignment of dental implants are crucial to successfully meet the aesthetic and functional criteria in implant-prosthetic rehabilitation. When an implant is in the wrong position, especially in the esthetical zone, there are limited options to solve it. Some techniques have been described to reposition implants, such as reverse torque, trephine drills, and segmental osteotomies; current approaches aim to reduce the damage of the periimplant tissues.

Case presentation

A 20-year-old man with good general health was referred to the oral and maxillofacial surgery department of the CES University, Medellin Colombia in 2017, He had undergone a previous camouflage orthodontic therapy for a dental Class III, which finished in 2014, posteriorly a dental implant was placed in 2015 to replace upper right lateral incisor (1.2) before vertical growth of maxilla was complete; therefore, the implant was retained in a coronal position. A segmental osteotomy was suggested to reposition the implant in a more caudal position, a 3D surgical cut guide obtained by virtual planning was used to increase osteotomy accuracy and lower human error, to avoid the risk of damaging the adjacent tissues and to achieve a predictable result.

Conclusions

The segmental alveolar osteotomy is an effective alternative to reposition an implant; however, it must be carefully planned because human error remains a possibility that may affect the final result. Therefore, 3D planning is a better way to minimize these mistakes during the surgical procedure and the final position of the implant.

Malpositioned osseointegrated implants relocated with segmental osteotomies: a retrospective analysis of a multicenter case series with a 1- to 15-year follow-up

PURPOSE

This multicenter case series evaluates retrospectively the clinical outcomes of malpositioned implants surgically relocated in a more convenient position by segmental osteotomies.

MATERIALS AND METHODS

Authors who published, on indexed journals or books, works about malpositioned implant correction by segmental osteotomies were contacted. Five centers, out of 11 selected, accepted to participate in this study. The dental records of patients who underwent implant relocation procedures were reviewed. Implant survival rates were analyzed and a blinded assessor examined clinical photos and periapical radiographs to evaluate esthetic outcome (pink esthetic score [PES]) and changes of marginal bone level over time. Patients were requested to fill a verbal rating scale form about discomfort, compliance, and satisfaction related to the procedure.

RESULTS

Fifteen malpositioned implants relocated by segmental osteotomies were followed for a period ranging from 1 to 15 years (mean 6.0 ± 3.9 years). The overall implant survival rate from baseline to the last follow-up visit was 100%. The mean marginal bone loss was 0.36 mm at the 12-month follow-up visit and no relevant further changes were observed at the following examinations. Significant esthetic improvement was recorded at 1-year examination with PES evaluation (p < .0001). Patients' feedback described this procedure as not excessively invasive and uncomfortable, reporting a high final satisfaction rate.

CONCLUSIONS

The present study suggests that implant relocation with segmental osteotomies could be an effective alternative method to correct the position of unrestorable malpositioned implants in a single-stage surgery.