case_images: PMC5516738_01
case_images: Preoperative radiographic view (panoramic X-ray image). Implant of #37 area shows the broken abutment screw off the implant fixture inside.
case_images: CRID2017-9640517.001.jpg
case_images: PMC5516738_01_CRID2017-9640517.001.jpg
case_images: fig1
case_images: A 70-year-old male requested Department of Periodontology to remove the implant fixture at second molar region of left mandible (Figure 1).
case_images: Conventional removal method applied on #37 region. (a) Preoperative state showing a gingival defect. (b) Implant removal using a trephine bur (external diameter: 6 mm, internal diameter: 5 mm; Biomet, Warsaw, IN, USA), elevator (Hu-Friedy, Chicago, IL, USA), and root forceps (Hu-Friedy, Chicago, IL, USA). (c) The implant and the surrounding alveolar bone removal. ((d) and (e)) Immediate bone grafting [Osteon II 0.5 g (particle size 0.5~1.0 mm) and collagen membrane 15 x 20 mm; Genoss, Suwon, Korea] on the implant removal socket. (f) Suture for a primary wound closure.
case_images: CRID2017-9640517.002.jpg
case_images: PMC5516738_01_CRID2017-9640517.002.jpg
case_images: fig2
case_images: After placing buccal and lingual flap properly, interrupted suture was given on the spot for primary closure (Figure 2).
case_images: Postoperative radiographic view (periapical X-ray image). (a) Implant fixture with a fractured abutment screw. (b) Implant removal site filled with a bone grafting material.
case_images: CRID2017-9640517.003.jpg
case_images: PMC5516738_01_CRID2017-9640517.003.jpg
case_images: fig3
case_images: Periapical X-ray image verified the complete implant removal after the surgery (Figure 3).
case_images: Postoperative radiographic view (panoramic X-ray image). Implant reinstallation on #37 region four months after the implant removal.
case_images: CRID2017-9640517.004.jpg
case_images: PMC5516738_01_CRID2017-9640517.004.jpg
case_images: fig4
case_images: Two months after the surgery, completely cured soft tissues of the surgical site were verified; thus reinstallation of an implant was planned and carried out four months later (Figure 4).
case_images: PMC5516738_02
case_images: Preoperative radiographic view (panoramic X-ray image). Implants of right maxilla area show a severe alveolar bone loss lesion.
case_images: CRID2017-9640517.005.jpg
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case_images: fig5
case_images: A 66-year-old female who had discomfort on implants of first premolar, second premolar, and first molar region of right maxilla came to Department of Periodontology (Figure 5).
case_images: Advanced and mixed removal methods applied on #14, #15, and #16 regions. (a) Supragingival eruption state of an implant fixture. (b) Implant prosthodontics removal state showing a lack of keratinized gingiva and peri-implant tissue impairment. (c) Exposure of upper portion of the implant fixture and severe surrounding alveolar bone loss. (d) Implant removal using the Neo FR Kit (NeoBiotech, Seoul, Korea) on #14 and #16 regions and using the trephine bur (external diameter: 5 mm, internal diameter: 4 mm) on #15 region and the surrounding alveolar bone. (e) Implant removal socket showing a perforation of the sinus inferior wall and maintenance of the internal schneiderian membrane. (f) Tension-free suture for a natural healing progress.
case_images: CRID2017-9640517.006.jpg
case_images: PMC5516738_02_CRID2017-9640517.006.jpg
case_images: fig6
case_images: Immediate implant reinstallation was impossible on the same site because of the alveolar bone loss and a need for inflammation treatment (Figure 6).
case_images: Vertical augmentation of alveolar ridge applied on the implant removal site. (a) Severe vertical resorption state four months after the implant removal. (b) Narrow alveolar ridge. (c) Insertion of a tenting screw (Dentium, Seoul, Korea) and application of a GORE-TEX membrane TR6Y (W. L. Gore & Associates Inc., Flagstaff, Arizona, USA). ((d) and (e)) Bone grafting using a Bio-Oss 1.0 g (Geistlich Pharma AG, Wolhusen, Switzerland), and GORE-TEX membrane covering the site and supported by the tenting screw. (f) Suture for a primary wound closure.
case_images: CRID2017-9640517.007.jpg
case_images: PMC5516738_02_CRID2017-9640517.007.jpg
case_images: fig7
case_images: These sites were supported by tenting screws (Dentium, Seoul, Korea) to secure vertical height (Figures 7 and 8(c)).
case_images: Postoperative radiographic view (periapical X-ray image). (a) Implant fixture with severe surrounding alveolar bone loss. (b) Implant removal site. (c) Vertical augmentation of an alveolar ridge.
case_images: CRID2017-9640517.008.jpg
case_images: PMC5516738_02_CRID2017-9640517.008.jpg
case_images: fig8
case_images: Panoramic X-ray image verified successful implants removal (Figures 8(a) and 8(b)). These sites were supported by tenting screws (Dentium, Seoul, Korea) to secure vertical height (Figures 7 and 8(c)).
case_images: Postoperative radiographic view (panoramic X-ray image). Implant reinstallation on #14 and #16 regions four months after the implant removal.
case_images: CRID2017-9640517.009.jpg
case_images: PMC5516738_02_CRID2017-9640517.009.jpg
case_images: fig9
case_images: Four months after this treatment, two implants were reinstalled at first premolar and first molar regions (Figure 9).