Never Trust a Fart

A long, long time ago someone told me: “Never trust a fart.”

I don’t really remember who said it, but the meaning was crystal clear — sometimes that fart comes with… let’s just say unexpected extras.

And funny enough, every time I go in to remove an osseointegrated implant, that phrase pops into my head.

You’ll hear it all the time:

“I always take them out with the retriever.”

“Piece of cake.”

Or the macho chest-beating version: “I go beyond 200 N/cm.”

My advice? Don’t invent. Play it safe.

The truth? Removing an osseointegrated implant — and I’m not talking about the ones just hanging on by the tip or outside the bony walls — is often a real challenge, whether titanium or ceramic.

And the more posterior in the maxilla, the more complicated it gets.

This week’s case

A lovely 46-year-old woman, full of energy, loves to dance. She came in with implants in the maxilla that were supposed to last a lifetime… but only lasted a couple of years.

She was desperate because #26 fractured at the platform — the crown could no longer be screwed on. Dentate patient, poor mouth opening, lower teeth all in place, mouth breather… the only thing missing was a dog biting my leg to make it harder.

The procedure

Golden rule: Always take a CBCT. Never approach these cases blind. When things get dark, that scan is your lighthouse. You will often hear from some “surgeons “ it’s not necessary , and of course from those big shots surgeons everything is “easy “ and “straight forward…. 🐂 💩

1. Access → Take a deep breath and open a clean mucoperiosteal flap to expose the fractured implant.

2. Know the brand → Universal retrievers exist, but brand-specific tips can make a world of difference.

3. Plan A →

   • Place the retriever.

   • Try to remove it without exceeding 200 N/cm.

   • You can go higher, but 200 is a safe zone to avoid breaking surrounding structures.

     
     

4. Didn’t work? → Use a trephine to loosen the crestal part and try again.

   
   

5. Platform broke? →

   • Deep breath.

   • Now it’s piece by piece.

   • Create a mesial or distal channel with a Lindeman bur (cuts only at the tip), then use a slim elevator.

   • Remember: an implant is osseointegrated — no periodontal ligament. It won’t just “pop” out. Be patient.

   
   

6. Drill by drill, breath by breath →

   
   

   • Keep the patient calm.

   • Eventually, the pieces will loosen and come out.

That’s what happened in this case.

After removal

• Clean the site thoroughly — titanium debris included.

• If enough bone remains, you can plan immediate replacement.

• If not, delay. Evidence shows lower survival rates when placing implants in failed implant sites immediately.

Either way, from that point on, it’s back to standard implant care.

The moral

Never trust a fart.

And never trust the removal of an osseointegrated implant.

Because you never know when the shit will happen.

Have a great weekend,

Andre