# A Novel, Minimally Invasive Method to Retrieve Failed Dental Implants in Elderly Patients
###### Abstract  
This practice-based study presents the clinical outcomes of a minimally invasive method for retrieving failed dental implants from elderly patients. Traditional removal methods for failed dental implants include rephination and other invasive procedures. That can be a special concern for the elderly, since aging exacerbates oral surgery-related morbidity and anxiety. This retrospective cohort study gathers data from 150 patients seen in a private clinic. Their implants (\(n=199\)) failed due to biological, mechanical, or iatrogenic causes, and were removed as part of their treatment plan. Collected data included: (1) implant location (maxilla/mandible, anterior/posterior region), (2) reasons for implant retrieval, (3) connection type, (4) removal torque, and (5) operatory procedure--flapless and using a counter-torque removal kit, whenever possible. Flapless/minimally invasive retrieval was successful for 193 implants (97%). The remaining six implants demanded rephination (open-flap). The most common reasons for implant retrieval (81%) involved biological aspects, whereas iatrogenic (12%) and biomechanical (7%) reasons were less common. The surgical technique used was not associated to connection types or removal torque. Authors conclude that a counter-torque ratchet system is a minimally invasive technique with a high success rate in retrieving implants from elderly patients. Present findings support its use as a first-line approach for implant retrieval in that population.  
dental implant; elderly; minimally invasive surgery; implant removal +
Footnote †: journal: Medical  
to be relatively traumatic [13], with significant damage to the bone around the implant. Moreover, straying from the long axis of the implant is a possibility, which can be critical with narrow ridges [11]. More recently, piezoelectric devices have become a popular choice for osteotomy [14]. Although invasiveness tends to be reduced, the latter method still results in the removal of healthy bone.  
Traditional implant retrieval techniques are inadequate for many elderly patients. Preoperative anxiety may be overwhelming and healing may be impaired in many cases; therefore, surgical trauma should be minimal in the elderly [15]. Peculiarities of that population have driven the development of minimally invasive devices for implant retrieval and other procedures [6].  
Less invasive approaches for implant retrieval include reverse screws and high torque wrenches. Their use may be more acceptable by the elderly, since those approaches do not demand osteotomy or even flap elevation. Those devices combine a more comfortable procedure for the patient with much lower tissue trauma. Moreover, better preservation of peri-implant tissues enables immediate placement of a new implant in many cases [12].  
Previous attempts to retrieve implants conservatively have showed promising results, including the study by [PERSON] [16; 17]. However, a large number of patients (13%) still needed traditional removal. That study used a reverse torque instrument that could reach a maximum of 200 Ncm, whereas a higher torque may still be safe. Moreover, there is no published data about a minimally invasive implant removal protocol for the elderly. Therefore, the aim of this study was to evaluate the success rate of a minimally invasive method of implant retrieval in elderly patients.