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ePaper created 2015-11-17, 15:11:47 | version 1.38.0
Discussion Theresultsofthisstudysupporttheimmediate replacement of failed dental implants after ex- traction. The clinical protocol followed for the management of failed dental implants would enhance the possibility of osseointegration of dental implants placed in infected sites. The positive outcomes of this protocol could be relatedtothe decrease inthe bacterial load through the removal of the infected im- plant. The SEM analyses showed that bacterial plaque still adhered to the implant surface uponremoval,andthisrepresentsafirststepin the cleaning ofthe extraction socket.Adequate socket curettage to remove any granulation tissue andthe drilling ofthe socketwould addi- tionally contribute to the mechanical deconta- mination of the socket. Furthermore, place- mentofPRGF-Endoretinthesocketcouldhave had an antimicrobial effect. It has been re- ported that PRGF-Endoret has antimicrobial effects against Candida albicans, Enterococcus faecalis, Streptococcus agalactiae, Streptococ- cus oralis, Staphylococcus aureus and Staphy- lococcusepidermidis.21, 22 Allofthesemeasures would reduce the risk of infection and early im- plant failure. Implant primary stability is crucial for im- plant osseointegration and is the result of me- chanical anchoring (direct contact) of the im- plant to the host bone.23 Implant primary sta- bility serves to prevent excessive implant micromovements and thus permit implant osseointegration.24 The insertion torque of the dental implants placed in this study was 36 ± 16 N cm. Engelke et al. have concluded that an insertion torque of > 30 N cm is advis- able to obtain adequate primary stability and a torque of ≤ 11 N cm is considered a risk factor that increases the likelihood of implant fail- ure.25 Different methods to remove osseointe- grated dental implants have been described. Some of them include trephining a bone block in which the dental implant is present and the use of a thin bur at low speed with irrigation to separate the implant from the surrounding bone.1, 19 These methods have the limitation of beingtraumaticandofjeopardizingtheexplan- tation socket forfuture implant placement. In this study, the use of an implant extrac- tion kit was efficient and minimally invasive in removing dental implants while preserving the alveolar bone. This made it feasible to replace thefailedimplantimmediately.Thisimmediate replacement of failed implants reduced the numberofsurgicalproceduresrequiredtotreat the patient. In a recent study,81 patients were treated with the same implant extraction kit to remove 158 nonmobile implants from the maxillae and themandible.1 Withthekit,theconservationof hardandsofttissueispossibleandimplantfail- ure can be resolved within a shorter period and at reduced cost by avoiding advanced tissue regeneration techniques. Conclusion Atraumatic implant explantation permitted the preservation of viable tissue and the immediate placementofanewimplant.Theimplantsurvival andmarginalbonelossoutcomeswouldsupport the immediate placement ofdentalimplants in a socketaffectedbyperiimplantitis. Competinginterests EA is the Scientific Director of BTI Biotechnol- ogy Institute (Vitoria, Spain) and head of the Eduardo Anitua Foundation (Vitoria, Spain). MHA and RT are scientists at BTI Biotechnol- ogy Institute (Vitoria, Spain). Volume 1 | Issue 1/2015 13Journal of Oral Science & Rehabilitation P eriim planti ti s: Imme di ate i mplant re place me nt Eduardo Anitua,*† Mohammad Hamdan Alkhraisat† & Ricardo Tejero† * Private practice in oral implantology, Vitoria, Spain † Eduardo Anitua Foundation, Vitoria, Spain Co rre spo ndi ng au tho r : Dr. Eduardo Anitua Calle José María Cagigal, 19 01007 Vitoria Spain T +34 945 16 0653 F +34 945 16 0657 eduardoanitua@eduardoanitua.com T +34945160653 F +34945160657