Dental implants are titanium posts surgically placed into the jawbone, offering a fixed and stable replacement for missing teeth. Dentures are removable prosthetic devices that sit on the gums, replacing multiple or all teeth. While implants are designed for permanence, circumstances sometimes necessitate their removal. Dental implants can be removed and subsequently replaced with a traditional denture prosthetic. This transition is typically considered a last-resort measure when continued implant use is no longer advisable due to medical complications or structural failure.
The Conditions Requiring Implant Removal
The most frequent medical reason for removal is peri-implantitis, a progressive disease comparable to periodontal disease that affects the tissues surrounding the implant. It begins with soft tissue inflammation and advances to destructive bone loss around the fixture due to bacterial infection. When significant supporting bone is lost, the implant becomes unstable and must be removed (explantation) to halt further bone destruction.
Another common scenario involves a failure of osseointegration, the process where the jawbone fuses directly with the implant surface. Early failure occurs when this fusion never takes place, often within the first year, leaving the implant loose. Late failure, occurring years later, is often linked to excessive force (bruxism) or systemic medical changes that compromise bone density.
Structural or positional issues can also mandate removal, especially if the implant was placed incorrectly. Malpositioning can cause poor load distribution, resulting in bone loss or nerve impingement that causes chronic pain. Patients may also elect for removal due to financial changes, maintenance complexity, or dissatisfaction with the aesthetic outcome.
The Surgical Process of Removing Dental Implants
The technique used to remove an implant depends on the degree of osseointegration—how firmly it has fused with the jawbone. If the implant failed early and is loose, removal can sometimes be achieved non-surgically using specialized instruments to gently unscrew the fixture. This method minimizes trauma to the surrounding bone and soft tissue.
When an implant is well-integrated, a surgical approach is required to disrupt the bone connection. The conservative counter-torque technique uses specialized instruments to apply a controlled reverse rotational force, unscrewing the implant while preserving bone structure.
If counter-torque fails, a trephine bur is used; this hollow drill removes a small ring of bone surrounding the fixture. This effective method results in some bone volume loss. Following removal, the site is cleaned and often managed with a bone graft to fill the defect. Grafting restores lost bone volume, creating a smoother ridge contour better able to support a denture prosthetic.
Transitioning from Implants to Denture Use
After the implant is removed and the site is managed, a healing period must occur before fitting the replacement denture. This recovery allows soft tissues to close and bone graft material, if used, to mature, typically spanning several weeks to a few months. During this time, a temporary denture may be worn, though it will require frequent adjustments as the gums and bone contour change.
Once the surgical site is completely healed and stable, an impression is taken to fabricate the permanent denture. These traditional prosthetics rely on the underlying gum tissue and bony ridge for support and retention, using suction and a precise fit. Adjusting to the function of these removable devices can be significant for patients accustomed to the fixed stability of implants.
The primary challenge of transitioning back is continued bone resorption. Since the jawbone is no longer stimulated by an implant, it slowly shrinks over time. This progressive bone loss causes the denture to become loose, requiring relining procedures every few years to maintain fit. While dentures are a less invasive and cost-effective solution, the patient must adapt to reduced chewing efficiency and the need for nightly removal and cleaning.