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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (1): 126-133. doi: 10.19723/j.issn.1671-167X.2022.01.020

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Clinical classification and treatment decision of implant fracture

LI Yi,YU Hua-jie,QIU Li-xin()   

  1. Fourth Clinical Division, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100025, China
  • Received:2020-03-16 Online:2022-02-18 Published:2022-02-21
  • Contact: Li-xin QIU E-mail:qiulixin@263.net

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Abstract:

Objective: To propose a set of two-dimensional clinical classification of fractured implants based on the follow-up of fracturing pattern of implant body and peri-implant bone defect morphology of 32 fractrued implants, and summarize the treatment decisions of fractured implants according to this new set of classification, so as to provide guidance for clinical practice. Methods: During 25 years of clinical practice, clinical records of 27 patients of 32 fractured implants in 5 481 patients with 10 642 implants were made. The fracturing pattern of implant body, implant design, peri-implant bone defect morphology and treatment options were analyzed. A set of two-dimensional clinical classification based on the morphology and bone absorption of implant fracture was proposed. The treatment decision-making scheme based on the new classification of implant fracture was discussed. Results: In the new classification system, vertical fracture of implant neck (Type 1 of implant fracture morphology, F1) and horizontal fracture of implant neck (Type 2 of implant fracture morphology, F2) were common, accounting for 50% and 40.6% respectively, while deep horizontal fracture of implant body (Type 3 of implant fracture morphology, F3) (9.4%) were rare, while the three types of bone defects (D1, no bone defect or narrow infrabony defects; D2, wide 4-wall bone defects or cup-like defects, D3, wide 3-wall or 2-wall defects) around implants were evenly distributed. In the two-dimensional classification system of implant fracture, F1D1 (31.3%) and F2D2 (25%) were the most frequent. There was a significant positive correlation between F1 and D1 (r=0.592, P < 0.001), a significant positive correlation between F2 and D2 (r=0.352, P=0.048), and a significant negative correlation between F1 and D2 (r=-0.465, P=0.007). The most common treatment for implant fracture was implant removal + guided bone regeneration(GBR) + delayed implant (65.6%), followed by implant removal + simultaneous implant (18.8%). F1D1 type was significantly related to the treatment strategy of implant removal + simultaneous implantation (r=0.367, P=0.039). On this basis, the decision tree of implant fracture treatment was summarized. Conclusion: The new two-dimensional classification of implant fracture is suitable for clinical application, and can provide guidance and reference for clinical treatment of implant fracture.

Key words: Dental implants, Implant fracture, Treatment decision

CLC Number: 

  • R783

Figure 1

The diagram, clinical photos and peri-apical radiographs of the two-dimensional clinical classification of fractured implants From left to right: F1, vertical fracture of implant neck; F2, horizontal fracture of implant neck; F3, deep horizontal fracture of implant body; D1, no bone defect or narrow infrabony defects; D2, wide 4-wall bone defects or cup-like defects; D3, wide 3-wall or 2-wall defects. From top to bottom: the diagram, clinical photos and peri-apical radiograph."

Figure 2

Two clinical situations on the two-dimensional clinical classification of fractured implants A, the clinical photograph of the implant fracture morphology of F1D1 type; B, the clinical photograph of the bone defect of F1D1 type; C, the peri-apical radiograph of F1D1 type; D, the clinical photograph of the implant fracture morphology of F2D2 type; E, the clinical photograph of the bone defect of F2D2 type; F, the peri-apical radiograph of F2D2 type."

Table 1

The characteristics of 32 fractrued implants in 27 patients"

Implant
numner		 Gender Age/
years		 Fractured
implant
position		 Implant brand Implant
diameter/mm		 Time of the
implant insertion		 Time of the
implant fracture		 Type of the
implant fracture		 Type of the
bone defect		 Treatment
decision of
the fractrued
implant
1 Male 70 26 Camlog 5.00 2004-07 2015-05 F1 D1 Decision 2
2 Female 48 26 Nobel replace 4.30 2011-01 2016-07 F1 D1 Decision 2
3 Female 63 36 Nobel replace 4.30 2012-09 2017-09 F1 D1 Decision 2
4 Female 63 37 Nobel replace 4.30 2012-09 2017-10 F1 D1 Decision 2
5 Male 51 46 Nobel replace 4.30 2011-04 2018-02 F1 D1 Decision 3
6 Male 70 25 Camlog 3.80 2004-07 2015-09 F1 D1 Decision 3
7 Male 55 36 Camlog 3.80 2003-02 2015-12 F1 D1 Decision 2
8 Female 35 16 Ankylos 3.50 2010-03 2018-07 F1 D1 Decision 2
9 Female 62 26 Camlog 3.80 2014-09 2018-08 F1 D1 Decision 2
10 Male 46 16 Nobel replace 4.30 2012-03 2019-01 F1 D1 Decision 2
11 Male 65 26 Camlog 5.00 2004-07 2015-09 F1 D2 Decision 2
12 Female 62 37 Camlog 5.00 2014-10 2018-08 F1 D2 Decision 2
13 Male 46 46 Nobel replace 4.30 2005-04 2014-03 F1 D2 Decision 2
14 Male 47 36 Ankylos 3.50 2010-06 2015-03 F1 D2 Decision 2
15 Female 74 36 Nobel replace 4.30 2006-11 2014-10 F1 D3 Decision 2
16 Female 57 36 Nobel replace 4.30 2005-07 2016-09 F1 D3 Decision 2
17 Male 31 46 Ankylos 3.50 2011-03 2018-01 F2 D1 Decision 2
18 Male 53 26 Nobel replace 4.50 2009-02 2018-08 F2 D2 Decision 4
19 Male 54 15 Ankylos 3.50 2011-07 2019-03 F2 D2 Decision 2
20 Male 54 16 Ankylos 3.50 2011-07 2019-03 F2 D2 Decision 2
21 Male 62 37 Nobel replace 4.30 2010-09 2018-04 F2 D2 Decision 2
22 Male 57 46 Nobel replace 4.30 2011-07 2016-08 F2 D2 Decision 2
23 Male 53 27 Nobel replace 4.50 2003-04 2016-08 F2 D2 Decision 2
24 Male 79 24 Ankylos 3.50 2009-10 2019-06 F2 D2 Decision 3
25 Male 55 36 Branemark 3.75 2003-11 2015-12 F2 D2 Decision 2
26 Female 67 14 Ankylos 3.50 2010-08 2016-09 F2 D3 Decision 2
27 Female 67 26 Ankylos 3.50 2010-08 2012-06 F2 D3 Decision 2
28 Male 68 36 Ankylos 3.50 2011-09 2019-01 F2 D3 Decision 2
29 Male 43 36 Ankylos 3.50 2008-02 2015-03 F2 D3 Decision 2
30 Male 51 35 Nobel replace 4.30 2011-11 2018-12 F3 D1 Decision 5
31 Male 64 46 Thommen element 4.50 2012-03 2019-06 F3 D2 Decision 2
32 Female 56 36 Branemark 3.75 1995-07 2010-09 F3 D3 Decision 2

Figure 3

The treatment process and effect of the treatment decision 1: remove the fractured implant and insert a new implant simutaniously According to the clinical situation (A) and the peri-apical radiograph evaluation (B), the fracture type of the implant was F1D1. Use a fine fissure bur to remove the fractured implant and avoid the bone loss around the implant (C). Insert a new implant with larger diameter (Thommen SPI contact 6.0 mm×11 mm) simutaniously (D, E). The peri-apical radiograph evaluation after 3 years showed the treatment result was stable (F)."

Figure 4

The treatment process and effect of the treatment decision 2: Remove the fractured implant, finish guided bone regeneration simutaniously, and re-implant after 6 to 8 months According to the clinical situation (B) and the peri-apical radiograph evaluation (A), the fracture type of the implant was F3D3. Use a fine fissure bur to remove the fractured implant (C). Guided bone regeneration was done simutaniously (D). After 6 months, the soft tissue was healed (E) and the bone was repaired (F). A new implant (Thommen SPI contact 4.3 mm×12.5 mm) inserted (G, H). The peri-apical radiograph after 3 years showed the treatment effect was stable (I)."

Figure 5

The treatment decision flow based on the new two-dimentional classification of 32 fractured implants in this paper Type of the implant fracture: F1, vertical fracture of implant neck; F2, horizontal fracture of implant neck; F3, deep horizontal fracture of implant body. Type of the bone defect: D1, no bone defect or narrow infrabony defects; D2, wide 4-wall bone defects or cup-like defects; D3, wide 3-wall or 2-wall defects. Treatment decision: Decision 1, remove the fractured implant and insert a new implant simutaniously; Decision 2, remove the fractured implant, finish guided bone regeneration simutaniously, and re-implant after 6-8 months; Decision 3, remove the fractured implant, and insert a new implant in other sites; Decision 4, remove the fractured implant, restore with the traditional method (fixed partial denture or removable partial denture); Decision 5, embed the implant broken end."

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