SOS - A standardized approach to restoring broken implants

SOS A standardized approach to restoring broken implants - the ABraCadabra way

Presented by Dr. Ian Hönig and Dr. Vladislav Dvoyris

Fracture of dental implants is one of the most severe complications in implant-supported restorations and probably the most under-reported in the literature. Current research discussing dental implant fractures names a multitude of etiologies for this complication, viz. implant manufacturing flaws, metal fatigue, “mechanical overload” (by itself poorly defined), and peri-implant bone resorption.

However, disregarding the etiology, implant extraction is the obvious treatment choice in these cases, followed by bone augmentation and, if possible, repeated implant placement, hoping that the new implant’s fate will be better than the old one. These procedures are complicated, time-consuming, costly and annoying for the clinician and the patient alike.

In the following clinical case, we will describe a new method for saving fractured implants, creating a new, stable platform and restoring the implant anew with a telescopically retained restoration.

Introduction

A panoramic X-ray shows four mandibular implants loaded by a Dolder bar applying severe distal leverage, which caused loss of bone support around the implants and, subsequently, led to cervical fractures of both distal implants.

The Dolder bar in place, before removal

The patient, a 79-year-old male, wasn't interested in removal of the fractured implants or in any complex surgery, and requested that an attempt would be made to salvage the implants and load them with a new overdenture.

After removal of the bar, the fractured hexagons of both distal implants are clearly seen

Treatment Plan

Our treatment of choice in this case would be to restore the fractured implants (SOS System, Abracadabra Implants Ltd., Or Yehuda, Israel), and build new telescopic abutments on the other implants (ChairSide, Abracadabra Implants Ltd., Or Yehuda, Israel), while maintaining strict parallelism

Due to the relatively mesial position of the implants, we decided to use ChairSide 1 abutments on the mesial implants; while the distal, repaired implants, will receive ChairSide 2 transgingival abutments to decrease the supragingival height and the leverage as much as possible.

Loading the mesial implants with ChairSide 1 telescopic abutments

The ChairSide 1 abutment bases are placed on the implants.

The abutment bases are fixed to the implants using a flexible post with a fixation screw on its gingival end. Note the parallel alignment of the abutment supragingival shoulders.

The plastic drivers are removed. The posts follow the intraoral projection of the slightly angulated mesial implants.

The posts are then bent using a metallic bender.

The bending is complete when the bender's shoulder touches the abutment base shoulder.

The abutment injection sleeves are placed. Note that they are not yet parallel, and an additional step is required.

An acrilic injection guide, made by the Abracadabra technical support center, is used to fix the injection sleeves in a strictly parallel alignment.

After fixation of the sleeves, flowable dual-cure core buildup composite is injected simultaneously in both sleeves.

After 5 minutes, the injection sleeves are cut with a diamond bur for easier removal.

The injection sleeves are then removed.

The final abutments - at this point, only an occlusal adjustment is necessary. Note the inter- and intra-abutment parallelism.

Repairing the Fractured Implants

The right distal implant is exposed and the fractured hexagon is removed with a diamond bur, leaving a rough surface.

A guide is then screwed in, to guide the polishing burs and center them on the long axis of the implant.

Low-speed carbide burs are used to flatten and polish the implant’s surface.

A double-threaded screw is connected to the implant. A cyanoacrylate glue (Loctite 4061, Henkel, Dusseldorf, Germany) is used for additional retention of the screw and the restoration.

An SOS tissue-level abutment base is connected to the implant, and will be used as a housing for the ChairSide 2 telescopic retainer.

A bone graft is added (Bond Apatite, Augma Biomaterials, Pardes Hana, Israel) and the flap is repositioned and sutured.

The left distal implant undergoes a similar procedure.

The double clockwise-counterclockwise thread of the SOS fixation screw requires the use of two ratchets to fasten the screw and fix the SOS abutment base in place.

At this point, we need to build the ChairSide 2 inverse telescopic abutments on the implants repaired with SOS. To maintain parallelism between these abutments and the mesial ChairSide 1, we will use the patented Abracadabra Parallelomaker.

The Abracadabra Parallelomaker

Sleeves are placed on the ChairSide 1 mesial abutments, and the Parallelomaker arms are connected.

Composite is then injected in the ChairSide 2 abutment bases on the distal implants, and the Parallelomaker is connected to keep the abutment formers in place.

In the end, the ChairSide 1 mesial abutments height is reduced. The ChairSide 2 abutments are seen distally. Note their supragingival height - only ~1mm above the soft tissue.

The old denture is relined and telescopic sleeves (for ChairSide 1) and attachments (for ChairSide 2) are fixed. The sleeves and attachments are made of PTFE and perfectly parallel to each other.

The patient goes home with a temporary denture. A permanent denture can be delivered after healing of the soft-tissue.

Panoramic X-ray showing the repaired implants and the new telescopic ChairSide 1 and SOS-ChairSide 2 abutments.

Follow-Up and Permanent Denture

The permanent denture was delivered to the patient after 1 month.

Note that while the telescopic sleeves of ChairSide 1 are made of PTFE, the telescopic retainers of ChairSide 2 are metallic.

Follow-up 3 months after the procedure. Note the ChairSide 1 and ChairSide 2 telescopic abutments, and their parallelism. Note the healing of the peri-implant mucosa following the procedure.

This SOS case is a sample case, performed at the ABraCadabra clinical support center in November 2018.

Prosthetics and Surgery: Dr. Ian Hönig, Dr. Avi Glickstein, Dr. Vladislav Dvoyris
Follow-up: Dr. Alex Rachlis
Lab: Marcel Madioni, MDT - Abracadabra Technical Support Center

For more information visit the Abracadabra website

Created By

Vladislav Dvoyris

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