J Korean Assoc Oral Maxillofac Surg.  2011 Oct;37(5):406-414.

Thermally induced bone necrosis during implant surgery: 3 case reports

• Jo KH
• Yoon KH
• Park KS
• Bae JH
• You KH
• Han JH
• Shin JM
• Baik JS
• Jeon IS
• Cheong JK

Abstract

Thermally induced bone necrosis during implant surgery is a rare phenomenon and a potential contributing factor to implant failure. The frictional heat generated at the time of surgery causes a certain degree of necrosis of the surrounding differentiated and undifferentiated cells. The bone necrosis occurred in the mandible in all three cases, leading to a soft tissue lesion and pain. In each case, radiolucent areas appeared in the middle and apical portions of the implant 4 weeks after surgery. Thermally induced bone necrosis did not improve following systemic antibiotic medication, necessitating surgical treatment. The nonintegrated implants were removed, and meticulous debridement of dead bone and granulation tissue was performed. Then, new implants were implanted along with the placement of autogenous and xenogenic bone covered with a collagen membrane. No further complications occurred after re-operation. The radiolucencies around the new implants gradually resolved entirely, and the soft tissue lesions healed successfully. At 4-5 months after reoperation, implant loading was initiated and the implant-supported restorations have been functioning. The aim of this case report is to present the successful clinical treatment of three cases suspected to be caused by thermally induced bone necrosis after implant drilling.

Keyword

Osteonecrosis; Heat stress; Dental implants

MeSH Terms

Collagen
Debridement
Dental Implants
Friction
Granulation Tissue
Hot Temperature
Mandible
Mandrillus
Membranes
Necrosis
Osteonecrosis
Reoperation
Collagen
Dental Implants

Figure

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  Fig. 1. A: Preoperative radiography. B: Postoperative radiography. Implants were placed on areas #36, 37, 45, 46, and 47 in the mandible. C: The radiolucency around the middle portion of the #37, 45, 46, and #47 implants was noted, and was particularly remarkable at #37 and #45. D: Actual photograph at 4 weeks. The implants were removed, and a large bony defect was seen. E: Actual photograph at 4 weeks. The implants were removed, and a large bony defect was seen. F: New implants were placed along with bone grafts. Kyu-Hong Jo et al: Thermally induced bone necrosis during implant surgery: 3 case reports. J Korean Assoc Oral Maxillofac Surg 2011

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  Fig. 2. A: After 3 weeks, gingival inflammation was noted along with continuous pain. B: The implant was removed (after 1 month), and a large bony defect was seen. Kyu-Hong Jo et al: Thermally induced bone necrosis during implant surgery: 3 case reports. J Korean Assoc Oral Maxillofac Surg 2011 C: First surgery radiography: Implant was successfully placed on areas #45 and 47. D: After 1 month, a new implant was placed on area #46 because a large bony defect was present at area #45, which manifested as a large radiolucency with the middle portion being larger than the coronal and apical portions. E: After 2 months, a new implant was placed on area #45. F: At 5 months after the second surgery, the final prosthesis was delivered. Kyu-Hong Jo et al: Thermally induced bone necrosis during implant surgery: 3 case reports. J Korean Assoc Oral Maxillofac Surg 2011

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  Fig. 3. A: First surgery: Post operative radiography. B: A radiolucent area appeared on the radiograph 3 weeks after surgery. The middle portion of #32 implant was remarkably radiolucent. Kyu-Hong Jo et al: Thermally induced bone necrosis during implant surgery: 3 case reports. J Korean Assoc Oral Maxillofac Surg 2011 C: Bony dehiscence was noted after 4 weeks. D: The implant was removed, and a bone defect was observed. E: The Osstem implant (GS type 3.5×11.5 mm) was replaced with GBR. F: At 4 months after the second surgery, the final prosthesis was delivered. Kyu-Hong Jo et al: Thermally induced bone necrosis during implant surgery: 3 case reports. J Korean Assoc Oral Maxillofac Surg 2011

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