STANDARDIZED EXPLANTATION PROTOCOLS FOR DENTAL IMPLANT REMOVAL: AN EVIDENCE-BASED REVIEW OF MINIMALLY INVASIVE RETRIEVAL TECHNIQUES

Abstract

Objective: Failing osseointegrated dental implants often require removal, yet no consensus-based, evidence-graded protocol exists to guide clinicians in selecting a minimally invasive explantation technique. This review synthesizes the available evidence on reverse-torque/counter-torque, trephine and bur, piezoelectric, and laser-assisted explantation systems, with the aim of clarifying their comparative success, invasiveness, and the quality of the supporting evidence base. Methods: A narrative literature review was conducted using PubMed/MEDLINE, Embase and Scopus for English-language publications from 2005 to 2025, combining terms for dental implant explantation, removal technique, reverse torque, counter-torque, trephine, piezosurgery, and laser-assisted removal. Systematic reviews, comparative in vitro and in vivo studies, and clinical case series reporting explantation technique, success outcome, complications, or residual bone volume were prioritized for narrative synthesis. Results: Across pooled systematic-review data, reverse-torque and counter-torque ratchet techniques (CTRT) are the most frequently reported and most conservative first-line options, with success rates in the range of 87–94% and low reported morbidity. Trephine and bur techniques achieve comparably high or higher success (94–100%) at the cost of greater bone removal and a small but real risk of sinus perforation or implant/instrument fracture. Piezoelectric surgery offers selective, nerve- and soft-tissue-sparing cutting but at the expense of longer operative time, while laser-assisted systems (Er,Cr:YSGG, Er:YAG, CO2) demonstrate superior bone preservation and reduced thermal/mechanical artefact in vitro compared with trephine burs. Across all modalities, the underlying evidence is dominated by retrospective case series and in vitro models, with pooled cohorts rarely exceeding 1,200 implants across nearly two decades of literature, inconsistent definitions of explantation “success,” and follow-up data for reimplantation outcomes that are sparse or absent. Conclusion: Reverse-torque/CTRT techniques should remain the first-line, most conservative approach, escalating to resective (trephine, bur), piezoelectric or laser-assisted techniques according to residual apical bone height and torque thresholds. However, the field lacks randomized controlled trials, standardized outcome definitions, and long-term reimplantation data. Development of a formally graded, consensus-based explantation protocol is warranted.