Aspects in post-orthodontic removal of Orthosystem implants

Problems encountered in the removal of a temporary anchorage device, such as the Orthosystems implant, specially designed for orthodontic anchorage purposes after insertion at the palatal side of the maxilla, are presented and discussed.

The removal of these osseo-integrated implants was originally described to be executed by means of bone cutting around the implant with a trephine explanation burr. However, situations can be encountered in which the orthodontic tooth movement resulted in close contact between the implant and neighbouring teeth or the nasal cavity.

Trephine burr bone cutting around the implant can thereby lead to damage of the adjacent tooth with subsequent endodontic problems or perforation of the nasal cavity. In these cases, simple untightening by counterclockwise torque or if unsuccessful, removal of the transmucosal part of the fixture allowing creeping mucosal covering of the implant, should be considered. Furthermore, generation of CT-scan images performed after completion of active orthodontic therapy, with retraction of the upper anterior teeth, seems to be justified and indicated for planning the appropriate removal procedure.

Retrospectively, the use of the longer version of the Orthosystems implant (6 mm in length) seems to be obsolete when para-median locations are chosen. Three cases are presented to illustrate these problems.