[Removal of fractured cylindrical implants]

The implant fracture is a rare but significative complication which requires a specific treatment for the surgical removal of the fractured fixture and the modification of the initial prosthetic plan. On the basis of the most recent studies and of a case personally observed in which both the osteointegrated supporting implants of a maxillary overdenture were fracturated, epidemiological, etiopathogenic, diagnostic and therapeutical aspects of this complication are analyzed. Clinical situations most at risk are emphasized, including implant-supported maxillary overdenture, and the major etiologic factors, represented by defects in implant design or material and physiologic or biomechanical overload. The diagnostic criteria are described along with the three therapeutical possible options: 1) removal of the fractured implant, replacement of the implant and refabrication of the prosthesis; 2) modification of the existing prosthesis leaving the fractured portion of the implant in place; 3) modification of the fractured implant and refabrication of a portion of the prosthesis. Three surgical removal technics are then illustrated (block-section, vestibular approach, occlusal approach), with the emphasis on the one choosed in the case examined, in which the ostectomy around the remaining fixture has been carried out with a trephine drill in order to contain the bone loss.