1-. Failed implant removal can be a very easy or very difficult process depending on several factors:
-Implant platform integrity.
-Type of implant connection.
-Cause of the implant failure.
-Amount of bone loss around the implant.
2-. The decision of removing the implant and immediate replacement will depend of many factors such as:
-Soft tissue presence.
-Cause of failure.
-Remaining bone availability.
-Primary Stability achieved.
-Proper prosthetic guide.
-Communication with important structures.
3-. The different degrees of integration on a fully osseointegrated implant will be represented basically in 3 parts over the implant body:
– Coronal 1/3.
– Mid 1/3.
– Apical 1/3.
4-. The implant removal protocol based on the chances of extracting the implant with counter torque will be determined by the 3 areas of implant integration.
In order to be able to remove an implant fully integrated with counter torque will force us to break the osseointegration of coronal 1/3 and maybe mid 1/3 on very rough implant surfaces.
To be able to do so, we need to make sure that after trephining the areas to break the bone implant contact, the simple counter torque is enough.