Take out these broken titanium implants and place ceramic ones — at least they don’t break!

This is a true story.

I had a super awkward week in July where we saw a bunch of fractured titanium implants — white brands, premium brands, all of it…It didn’t matter who made them. They were snapping and pooping!

Now, you know I’m a pure ceramic implant lover — I love them!!! And in the last 12 years of practice, I’ve never seen a single fracture in a Pure Straumann® ceramic implant I placed.

Zero.

Some people say we’re overreacting — that we just don’t place enough ceramic implants to see the real fracture rates. Others say I’m too picky and selective about where I place ceramics (which is true, by the way). Whatever it is… for me, ceramic implant fracture is still kind of a myth. (I’m not saying they never break — I’ve treated a few fractured ceramic implants — but none of them were mine, and definitely none were Pure Straumann.)

What’s funny is that at every ceramic implant meeting, one of the top questions I get is:“How do you retrieve a broken ceramic implant?”And I’m like:“Wait wait wait… for that to happen, it has to actually break!”

Sure, everything in nature breaks eventually, but the fracture rate in this latest generation of ceramic implants is less than 3% globally — that’s across all brands, sizes, and types of cases (from singles to full-mouth rehabs).And if we’re talking anterior single-unit cases? The fracture rate might be under 1%. Crazy low.

So back to this week...

"Dr Chen can you "Replace" this by ceramic ones"

A patient showed up with two fractured Nobel Replace implants (actually the name says it all....just replace them...) in the posterior mandible. CBCT showed these 8mm suckers were sitting real close to the IAN.

And then she hit me with a line I’ll never forget:

"Dr. Chen, I had a bridge fracture… can we please remove these titanium implants and place those ceramic ones — the ones that at least don’t break?"

Oh My God !… that was music to my ears!Something I thought I’d never hear in my career.

Of course, we still had to do the painful part — the surgery. Both platforms were wrecked. One had a broken screw still torqued in.

Liliana, my assistant, tried to keep it light: “Well, it’s not all bad… at least it’s the 4th quadrant and you’ve got a clear view.”Yeah… right 🙄

Posterior Maxilla Broken Implants / Platform and Screw

From there it was just good ol’ dentistry:

Pick your blade, open a mucoperiosteal full-thickness flap, go in with the piezo or a lindeman bur to free up some of the coronal buccal bone, grab the counter-torque implant extractor, and pray it untorques before hitting 200 Ncm.

(Pro tip: It’s totally normal to sweat a little during this part 😅)

If it doesn’t come out at 200 Ncm — don’t be a macho man. Take a breath, remove more bone, and try again. If the platform’s too messed up for an extractor to grip inside the implant, well... it’s time to go old school with a trephine + elevator.

And in those cases, go gently with the bone removal. No messing with the IAN. Always have a clear mental map of where that nerve is in relation to the implant.

Implant Explantation Step By Step

Here’s my step-by-step protocol for fractured implant removal:

A. CBCT

B. Open full-thickness flap

C. 2mm trephine at the collar + implant extractor (max 200 Ncm)

D. If over 200 Ncm → more trephine → retry

E. If the platform is too damaged for the extractor → trephine and elevator (Important: The last 2mm you have to unscrew, not luxate like a tooth. No PDL — these implants are ankylosed in bone.)

Watch out for vital structures. Clean the site well — titanium debris is no joke!

Anyway…Even though titanium is supposed to be super fracture-resistant, I’m seeing more of these cases lately. Maybe it’s fatigue. Maybe mechanical overload. Maybe bad designs. But it’s happening.

And the truth is: Both titanium and ceramic implants are hard to remove once the extractor doesn’t work. At that point, it’s just oral surgery 101.

In This case the extractor worked..... ufff

Implant Extractor in Action

But honestly… the way this lady handled the situation — clear-headed, long-term focus, knew what she wanted — I loved it.

I had to write ✍️ it down so I wouldn’t forget.

Have a great summer!

— Andre