ALX Re-implantation after Explantation of Implant with Peri-implantitis

Case Summary 🔎

Patient Information

• Age/Sex: 80-year-old Male

• Systemic Condition: Medically healthy

Clinical Findings

• Tooth Site: #15 (maxillary right second premolar)

• Oral examination: Peri-implantitis with significant bone loss around #15 implant

• Diagnosis: Peri-implantitis with old implant requiring replacement

Treatment Plan 

1. Existing prosthesis and fixture at #15, #16, #17 removed

2. Thorough debridement and curettage performed to remove infected tissue and granulation tissue

3. New ALX-IT implants were placed at #15 and #16, replacing the failed implants and restoring occlusal stability

4. Delivery of final zirconia prosthesis

   
   

Clinical Summary

The existing prosthesis and fixture at #15 were removed due to failure. Following thorough debridement and curettage to eliminate infected and granulation tissue, a new ALX-IT implant was placed at #15 in an area of severe bone destruction where achieving primary stability is usually challenging. An additional ALX-IT implant was placed at #16.

Both implants were successfully placed, and occlusal stability was re-established with a definitive zirconia prosthesis splinting #15, #16, and the existing #17 implant

Case Presentation

1️⃣ Pre-Op

• The preoperative radiographs of the #15 site reveal a failed implant with severe bone loss and insufficient vertical bone height to the maxillary sinus.

2️⃣ Surgery

• The implant at #15 was removed due to peri-implantitis. Because of the severe inflammation.

• Explanted atraumatically with extraction forceps, without the need for a dedicated implant removal device

• Panoramic view after #15 implant removal

• Intraoral view after #15 implant removal, showing an extensive osseous defect following complete debridement due to advanced bone destruction.

• Subsequent drilling was performed with the ALX drill, followed by a Ø4.0 final drill, intentionally penetrating the sinus floor according to the calculated drilling length

ALX KIT

• A sinus bone graft was performed using DM Bone after drilling, and the osteotomy was finalized prior to implant placement.

• An ALX implant (ALX-IT35510WT) was placed at #16, and another ALX implant (ALX-IT35512WT) was placed at #15.

• #16 Achieve 30→35Ncm

• #15 Despite severe bone loss, the ALX deep-wide threads engaged the remaining bone, achieving 15 Ncm primary stability

• The peri-implant gap was filled with Neo Bone, and guided bone regeneration (GBR) was performed for the surrounding defect using additional bone graft and a collagen membrane.

• The site was finally closed with sutures

3️⃣ Post-Op

• Post operative panoramic view

• 1 month after surgery, well healed soft tissue

• After 6 months, intraoral scanning was performed for the final prosthesis fabrication

4️⃣ Final restoration

• At 6 months post-op, stable peri-implant tissue was observed around the fixtures, followed by delivery of the final prosthesis for #15,16,17

• Intraoral and panoramic views after delivery of final prosthesis