Case Study: Guided Mandibular Implant Replacement, Four Failing Implants to Six
Four failing implants in the mandible were explanted and replaced with six new implants in prosthetically driven positions. Adding two fixtures spread the load over more support than the failed reconstruction had. TrueGuide Dental planned the case from the CBCT and the intraoral scan and printed the surgical guide.
Case at a Glance
Arch: mandible
Presentation: four failing implants
Explanted: four implants, with a counter-torque removal device
Placed: six implants in prosthetically driven positions
Guide: pin-fixated printed surgical guide with sleeve-controlled angulation and depth
Grafting: residual osseous defects grafted before the osteotomies were prepared
Loading: delayed, with healing abutments placed and the flap sutured
Surgical visits: one, for explantation, grafting and placement
Surgical Sequence
Planning: the six new implant positions were designed from the intended prosthesis, so the angulation and depth of the failed fixtures were treated as anatomy to work around, not as a template to repeat.
Explantation: the four failing fixtures were removed with a counter-torque removal device, which lifts the implant out along its own axis and preserves the surrounding cortical plate for immediate re-instrumentation.
Site management: the sites were debrided of granulation tissue and the residual osseous defects were grafted before the osteotomies were prepared.
Guided osteotomies: drilling followed the manufacturer protocol through a pin-fixated printed guide, with sleeve-controlled angulation and depth at every site.
Healing protocol: the implants were closed with healing abutments and the flap was sutured, so osseointegration was allowed to proceed before the arch was loaded.
Outcome
The replacement implants sit where the restoration needs them, which is what keeps the emergence profile, the screw-access position and the long-term maintenance predictable.
What the Literature Reports
Getting a replacement right on the first attempt matters more than most retreatment decisions. Across 24 studies and 1,947 implants placed at previously failed sites, survival is 96.7 percent at one year, but a second replacement at the same site falls to 83.6 percent at one year and 77.8 percent at a mean of 3.6 years.
Planning and guides by TrueGuide Dental. Surgery performed by the treating clinician.
Plan a Similar Case
Upload the CBCT, intraoral scan and Rx on the Submit a Case page or call (201) 255-4233. Guide packages are on the TrueGuide Pro page, and the other four cases are on the Case Studies page. What each guide rests on, and why fixation pins matter, is covered in Surgical Guide Types.
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