Re-implantation of Failing Implants Using ALX System and Final Restoration with CL-Link

Case Summary 🔎

Patient Information

• 77 y/o, Female

• Past Medical History: Osteoporosis (taking oral medication once a week)

• Dental History: Multiple implants previously placed on both arches; recurrent peri-implantitis and bone loss noted around maxillary left posterior implants

• C.C.: “I feel discomfort and swelling around the upper left implants”

• Diagnosis: Peri-implantitis with severe bone defect in the maxillary left posterior area (#25–27)

Introduction

A 77-year-old female patient with a history of osteoporosis presented with discomfort and swelling in the maxillary left posterior region. Clinical and radiographic examination revealed advanced peri-implantitis around previously placed implants, accompanied by significant bone loss and soft tissue inflammation.

Considering the compromised bone quality due to both peri-implantitis and systemic bone metabolism, a comprehensive treatment plan was established focusing on complete removal of the failing implants, guided bone regeneration, and re-implantation using the ALX system known for its excellent initial stability in poor bone conditions.

After a sufficient healing period, final restoration was completed using the CL-Link system, providing a precise and stable prosthetic connection while ensuring functional recovery and esthetic harmony.

Treatment Plan

1. Removal of existing abutments and failed fixtures (#25–27)

2. Thorough debridement and bone grafting for ridge reconstruction

3. Re-implantation after 5 months using ALX fixtures (#25: ALXIT44510, #26: ALXIT55010, #27: ALXIT55010)

4. Placement of healing abutments and soft tissue maturation

5. Intraoral scanning and fabrication of final prosthesis using CL-Link system

6. Delivery of final prosthesis and post-restorative evaluations

Case Presentation

1️⃣ Pre-Op

• Intraoral photograph and panoramic radiograph taken on the first visit showing severe peri-implant bone loss around the #25-27, with the fixture threads exposed. Replacement with new fixtures was planned after removal of the existing failing fixtures

  

• Using a bur to section and remove the existing prosthesis around #25-27 in preparation for fixture removal

• After bridge removal, the remaining abutments on #25-27 are exposed

  

• Bone graft materials was placed to restore the alveolar ridge and promote regeneration before re-implantation

• The significant bone defect is clearly visible in the panoramic radiograph

  

  
  

2️⃣ Surgery

• 5 months after grafting, the edentulous area shows stable soft tissue healing with adequate keratinized gingiva

• A full-thickness flap was elevated to expose the alveolar ridge at the #25-27 area. The grafted bone appears well-maintained with sufficient ridge width and height

  

• An ALX-IT 4.5 x 10mm, cuff 4mm was placed at #25, with D221 bone density

• An ALX-IT 5.0 x 10mm, cuff 5mm was placed at #26, with D332 bone density

  

• ALX-IT fixtures were placed. #25 - ALX-IT 4.5 x 10mm, cuff 4mm, D221, 40N/cm

  #26 - ALX-IT 5.0 x 10mm, cuff 5mm, D332, 30N/cm

  #27 - ALX-IT 5.0 x 10mm, cuff 5mm , D332, 30N/cm

• After implant placement, bone grafting was performed around the exposed threads and between the fixtures to enhance bone volume and achieve stable ridge contour

  

• After placement of all 3 fixtures and bone graft material, suture was done

• Post-op panoramic radiograph showing the placement of 3 ALX fixtures with ideal positioning and parallelism

  

• 3 months post-surgery, the healing abutments were removed, revealing well-healed soft tissue with healthy contours around the implant site

• Scan posts were connected to the 3 fixtures to capture accurate digital impression

  

•  Scanning view

• The soft tissue around the implants showed excellent healing and stable gingival contour, providing a healthy foundation for the final restoration

  

3️⃣ Final Restoration

• The final prosthesis was fabricated using the CL-Link system, allowing for a precise and passive fit on the 3 ALX fixtures.

• Buccal view after final prosthesis delivery shows harmonizing with adjacent natural teeth

  

• Occlusal view shows excellent crown morphology and harmonious occlusal contact

• Final panoramic radiograph after prosthesis delivery shows 3 ALX implants (#25-27) with well-integrated bone support and accurately seated restoration

  

  
  

Conclusion

This case demonstrates the successful management of peri-implantitis and bone defect in a 77-year-old osteoporotic patient through the use of ALX implants and final restoration with CL-Link.

After removal of the failed fixtures and thorough bone grafting, the re-implanted ALX fixtures achieved excellent primary stability even in compromised bone conditions. The subsequent healing period allowed for sufficient osseointegration and soft tissue maturation, resulting in a favorable surgical and prosthetic outcome.

The final prosthesis fabricated with the CL-Link system provided accurate fit, functional stability, and esthetic harmony, restoring the patient’s masticatory function and comfort.

This case highlights the clinical reliability of ALX implants in re-implantation cases and the precision of the CL-Link system in achieving a long-term, predictable restorative result, even in elderly patients with systemic bone metabolism concerns.