IJOICR
10.5005/jp-journals-10012-1140
Cold Shoulder to Basal Implant: Its Time to Acknowledge Endosteal Implant
CASE REPORT
Cold Shoulder to Basal Implant: Its Time to Acknowledge
Endosteal Implant
1
Vaibhav Shukla, 2Dharti Gajjar, 3Reema Shukla, 4Sorabh R Jain
ABSTRACT
Introduction: Basal implant being a boon in implant dentistry
but sometimes behavioral outcome is whimsical.
Aim: Replacing basal implants with endosteal implants.
Case description: This article refers to the management phases
for failing basal implants. Although fractured portion of basal
implant was cumbersome to remove leading to bone defect
and hence endosteal implant with bone graft was successfully
placed.
Conclusion: Management of broken basal implants with
endosteal implants.
Clinical significance: Though basal implants failure rate is less,
but in such a case where fracture may occur, can be managed
by replacing with endosteal implants with the protocol.
Keywords: Bicortical implants, Implant failure, Endosteal
implants, Bone graft.
How to cite this article: Shukla V, Gajjar D, Shukla R, Jain
SR. Cold Shoulder to Basal Implant: its Time to Acknowledge
Endosteal Implant. Int J Oral Implantol Clin Res 2015;6(3):73-75.
Source of support: Nil
Conflict of interest: None
INTRODUCTION
Crestal and basal implants are endosseous aids to
create osseointegrated points of retention for fixed or
removable dentures. These two types of implants are
not only differentiated by the way they are inserted
and by the way forces are transmitted. Rather, the more
substantial differences lie in the planning and execution
of prosthodontic care and, most of all, in the postinsertion
treatment regime. For this reason, the literature on
basal implants has introduced the terms ‘orthopedic
technique’ and ‘orthopedic implant’ to mark a clear
distinction between them and the well-known term
‘dental implant’.1, 2
1,3,4
Private Practitioner, 2Assistant Professor
1,3
Saraswati Dental Hospital, Allahabad, Uttar Pradesh, India
2
Department of Dentistry, Saraswati Medical College, Allahabad
Uttar Pradesh, India
4
Dr Jain Dental Care, Mumbai, Maharashtra, India
Corresponding Author: Vaibhav Shukla, Private Practitioner
Saraswati Dental Hospital, Allahabad, Uttar Pradesh, India
Phone: +919892290929, e-mail: reemaace@gmail.com
International Journal of Oral Implantology and Clinical Research, September-December 2015;6(3):73-75
The characteristics of basal bone lies in the property
of constant remodeling, therefore it provides excellent
quality cortical bone for retention of these unique and
highly advanced implants.3 Basal bone is defined as the
osseous tissue of the mandible and maxilla underlying the
alveolar processes.4 It is relatively fixed and unchangeable
framework of the mandible and maxilla.5 The basal bone
is always present throughout life; it is very strong and
forms the stress bearing part of our skeleton. Dental
implants when placed in this bone can also be loaded
with teeth immediately. This science is already proved in
orthopedic implants (hip/knee replacements). Once the
patient is fitted with the artificial joint he is asked to start
using it immediately. Also bacterial infection chances are
reduced because basal aspect of implant is far present in
basal bone.6,7
However, mobile implants replacements, especially,
basal implants are always a perplexing task and
restoration of area with endosteal implants8 with good
prognosis is another challenging job, which is performed
in the underlying case.
CASE DESCRIPTION
A 65-year-old male patient reported to the dental
operatory with a chief complaint of an abnormally
moving upper left back teeth along with pain while
eating food since 2 weeks. Pain was acute, intermittent,
dull aching, mild in nature, but, aggravated on biting
food and ultimately spun into acute pain last 2 days.
His medical and family history was noncontributory
along with no history of trauma. His past dental history
revealed splinted maxillary and mandibular porcelain
fused to metal restorations present alongside crossing
midline. Intraoral examination revealed in maxillary left
posterior region, implant supported splinted PFM crowns
with grade I mobility. On radiographic evaluation, 2
radiopaque structures of approximately measuring 2 mm
in diameter and 12 mm in length are seen in 25, 26 region
and another radiopaque structure of approximately
8 × 10 mm was observed in 27 region (Fig. 1). Inferior
edges of radiopaque structures in relation to 25 and 26
may be fused with the floor of the maxillary antrum. All
these were suggestive of immediately loaded, cortically
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Vaibhav Shukla et al

supported restorative designs and were confirmed by
the patient. However, a thin radiolucent line is seen at
the junction of shaft and basal portion of implants in
relation to 25, 26 region which is suggestive of fractured
implant. For implant supported bridge to be planned,
inadequate bone is anticipated. Hence, horizontal and
vertical alveolar bone augmentation with simultaneous
placement of endosseous implants were planned. For
vertical bone augmentation, as patient is not willing for
secondary donor site, from left maxillary canine region,
autogenous graft is planned. Also, Bio-oss and titanium
mesh for horizontal bone augmentation is planned. After
contributing all factors, patient was explained regarding
surgical treatment for the replacement of previously
placed implant. In the treatment plan, cantilever bridge
was present in mandibular right posterior segment which
was agreed by the patient to get it replaced, but refused
to get long span bridge replaced and underneath teeth
to restore. Hence, after taking refusal and informed
consent for the surgical procedure and explaining all
potential complications associated with the same, he was
undertaken for the treatment of maxillary left posterior
region and mandibular right posterior region substituting
with endosteal implants and conventional screw retained
splinted fixed prosthesis.
with titanium screws. Three endosseous implants
(Osstem, GS system, South Korea) were placed with
cover screw alongwith Bio-oss (Geistlich Pharmaceutical,
Wolhusen, Switzerland) was used to cover the entire
area contained in titanium mesh (Micromesh, Stryker
Leibinger, Kalamazoo, MI) (Fig. 3). Three fixation screws
were also used to stabilize and prevent micromovement
of the mesh. Subsequently, sutures were placed and
primary wound closure was achieved. Also, periodontal
dressing (Coe pack, GC America Inc, USA) was placed
to facilitate healing.9 Postsurgical and oral hygiene
instructions with prescription of antibiotics and
painkillers and was recalled after 7 days for suture
removal. Subsequently, three endosteal implants (Osstem,
GS system, South Korea) were placed in mandibular
right region followed by sutures and removal after
7 days. Uneventful healing was observed for a period of
6 months with regular intervals. After 6 months, cover
screws were exposed and healing abutment was placed
for 15 days. Then, Implant level impressions were made
and screw retained fixed prosthesis was placed with
implant protected occlusion. Patient was motivated for
oral prophylaxis procedure and follow-up after every 6
months.

Surgical Procedure
A preoperative chlorhexidine rinse was asked for the
patient. An posterior superior alveolar nerve block and
greater palatal block and infiltration with 2% lidocaine
with 1:100000 lac adrenaline was administered. Then,
a crestal incision was made with vertical releasing
incision witnessing full thickness flap raised. On
successful exposure, meticulous removal of the earlier
placed implants was carried out by keeping in mind
not to leave any fractured segments (Fig. 2). After
retrieval, bleeding points were created. A rectangular
corticocancellous block graft, from maxillary left canine
region, was harvested using trephine bur, which was Fig. 2: Retrieved implants with prostheses
subsequently shaped, positioned and then held firmly

Fig. 1: Preorthopantograph Fig. 3: Post orthopantograph showing endosteal implants

with prostheses

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Cold Shoulder to Basal Implant: Its Time to Acknowledge Endosteal Implant
DISCUSSION
Basal implantology is a new category of treatment with
new broad indications and almost no limitations. 10
Cortically supported implants are placed for immediate
loading. However, implant fractured location suggestive
of excessive loading and flexural stresses leading to
failure of the plan.11 Hence, no other option left except
to remove and replace the edentulous region. With few
options left of removable prosthesis or fixed, patient
opted for implant with delayed loading. For proper
oral hygiene maintenance, screw retained prosthesis
was opted as ease in retrieval. Patient did not opted for
restoration of his long span bridge which may lead to
certain other problems, lately, however, motivated for
future treatment.
Screw retained fixed prosthesis was placed with
implant protected occlusion after 6 months for ease in
maintenance.
CONCLUSION
Basal implants, though, has its own advantages and
disadvantages, in which, one of a complication is
fracture of it. If basal implants are fractured, especially
discoid implants, then it would leave a big size defect
after retrieval. Hence, replacing with endosteal implants
alongwith the help of grafts can get more predictable and
successful outcome.
CLINICAL SIGNIFICANCE
Basal implants, especially, discoid implants, if retrieved,
would flaw the bone. So, other alternatives would
International Journal of Oral Implantology and Clinical Research, September-December 2015;6(3):73-75
IJOICR
be to replace with endosteal implants. But endosteal
implants would need a favorable position. Hence, in one
appointment itself, endosteal implants were placed with
grafts and hence achieved successful outcome.
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