Explant / Dental Implant Removal - Leading Implant Centers

A surgical dental implant removal is called an explantation. The removal of the implant takes place from the jawbone.

Dental implants are metal posts that are usually made of titanium and serve as a replacement for a tooth root. Following a longer healing period, the dentist reconstructs dentures such as a dental crown or dental bridge on the treated site.

In rare cases, bacteria can colonize in the treated areas, which in turn leads to the formation of plaque. The plaque, which is a biofilm of bacterial waste products and leftovers, often causes deep tooth pockets. As a result, other harmful bacteria penetrate into the region of the implant. Occasionally, the affected dental implant is unable to grow together with the bone of the jaw, so that a surgical removal, so an explantation, must be made. Thus, the penetration of bacteria threaten inflammation or even abscesses.

Overview of this article

Removal of dental implant

The removal of a dental implant is rarely required. The survival rate after 5 years is high at 96.8 percent. In this case, titanium implants have the property of osseointegrating, ie, to grow together with the bone, and to enter into an ankylosing connection with the adjacent jawbone.

Occasionally, however, the dental implant must be removed because, for example, there is a progressive peri-implantitis (periodontitis inflammation). Another reason for the explantation is damage to the implant. Some patients also suffer from allergies to the materials found in the dental implant. By the removal of the implant worse damage should be avoided.

Sometimes the wearing of a dental implant from the outset only temporarily provided, for example, to fix an orthodontic appliance or to allow a temporary dental care.

Which procedures are available for an explantation?

The extraction

If the dental implant is already loose, there is the option to remove it by unscrewing it. For this purpose, the dentist uses an incisor or premolar forceps or a Luer bone tongs, with which he grips the implant and gently unscrews it. An older steel implant is easier to unscrew than a modern osseointegrated (bone-fused) titanium implant because it is usually surrounded by connective tissue.

Another possible method of unscrewing consists in a two-part dental implant by means of a torque wrench. The dentist inserts this instrument into the implant and turns it out with force.

Lindemann milling machine

In order to remove an osseointegrated dental implant, the so-called Lindemann milling machine is often used. However, this method has the disadvantage that it leads to extensive bone loss and can affect adjacent areas. This circumstance in turn has a negative effect on a new supply. There is also the risk of a bone defect.

Trephine milling machine

A trephine milling machine is a cylindrical drill, which is hollow on the inside. At its front it is equipped with sharpened points. The trephine adapts to and drills around the diameter of the dental implant. Similar to a tube, it runs vertically along the implant. Prior to this procedure, it is necessary to remove existing superstructures such as a dental crown. This procedure allows the trephine drill to be attached to the dental implant.

One of the advantages of the trephine tiller is the low loss of bone substance compared to the use of a Lindemann tiller. Depending on the diameter of the respective implant, different widths of the trephine drill are available.

Laser Explantation

Minimally invasive techniques include laser-guided explantation. In this case, an Erbium-YAG laser is used. Laser explantation is considered an alternative to mechanical procedures.

Piezosurgical explantation

Another method of treatment is piezosurgical explantation. Similar to removing tartar, the dentist treats the bone with the help of vibrations to remove the implant. First, the tip of the piezo device is set in vibration - sufficient cooling is absolutely necessary here. By applying light pressure, the tip gradually advances to the apex of the dental implant.

Is removal of the dental implant painful?

Of course, before treatment, the patient will receive local anesthesia or anesthesia. However, there is a risk of pain if the effect of the narcotic is inadequate. This risk is especially present when the patient suffers from inflammation. Thus, in the case of acute inflammation, which is often the cause of explantation, local anesthesia may be inadequate, requiring more extensive anesthesia.

Pain is often seen after the procedure. For example, during explantation it is necessary to cut soft tissue and suture it again. In addition, the removal of a larger piece of jaw occurs. Following the operation, therefore, the use of painkillers is recommended.

Ist das Entfernen des Zahnimplantats schmerzhaft?

Vor der Behandlung erhält der Patient selbstverständlich eine lokale Betäubung oder eine Narkose. Allerdings besteht die Gefahr, dass es zu Schmerzen kommt, wenn die Wirkung der Betäubungsmittel unzureichend ausfällt. Dieses Risiko ist vor allem dann vorhanden, wenn der Patient unter einer Entzündung leidet. So kann im Falle einer akuten Entzündung, die oft der Grund für die Explantation ist, eine örtliche Betäubung unzureichend sein, sodass eine umfangreichere Narkose erfolgen muss.

Schmerzen zeigen sich häufig nach dem Eingriff. So ist es bei der Explantation erforderlich, Weichteile aufzuschneiden und wieder zu vernähen. Darüber hinaus erfolgt das Entfernen eines größeren Kieferstücks. Im Anschluss an die Operation empfiehlt sich daher der Gebrauch von Schmerzmitteln.

Can a dental implant be used again after the explantation?

Even after the explantation of a dental implant, there is basically the option to insert an implant once more, but this depends on the individual case. While in some patients, immediately after removal, a new implant can be used, in others, only the bone must be rebuilt, which is done by bone substitute material or the patient's own substances.

However, to prevent further inflammation, it is important that the new implant be free of harmful bacteria. Among the decisive factors is the consistent hygiene of the dentist when inserting the implant. The patient also has the opportunity to contribute to success through thorough oral hygiene, which includes, for example, the use of dental floss or interdental space brushes.

What are the costs for an explantation?

How much an explantation ultimately costs, depends on the duration and effort of the procedure. While loose implants can easily be removed with forceps due to peri-implantitis, resulting in lower costs, other explantations require bone milling. This requires the surgeon more materials and drugs, which in turn increases the price. Therefore, the cost of an explantation usually varies between 20 and 150 euros.

Does the health insurance cover the costs of the procedure?

In Germany, there is no billing position for the removal of a dental implant. The dentist therefore does not have the opportunity to bill the explantation through the health insurance. For this reason, the fee regulations for dentists (FRD) applies. These are private bills, which the patient has to carry himself.

For privately insured patients, there is at least the possibility of a partial reimbursement by the health insurance if the implants belong to the insurance benefits.

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