The management of a failed Linkow blade-supported fixed prosthesis after 25 years: a case report

The aim of this study was to present and discuss the management of a case of peri-implantitis of Linkow blades - supported fixed prosthesis. A healthy 47-year-old male was referred to our Department for the management of a maxillary Linkow blades - supported fixed prosthesis that had been in function for 25 years. The patient complained about purulent drainage and mobility of the maxillary prosthesis. Physical examination revealed a severe mobility of the maxillary fixed prosthesis with bilateral exposure of Linkow blades. A panoramic radiograph showed the bilateral presence of radiolucent areas in correspondence of the two maxillary Linkow blades that were located in correspondence of the left and right first and second molars, suggestive for bone loss, and the presence of a residual fractured portion of an implant in the upper left canine region. The patient refused any type of further fixed implant-supported prosthetic options. Therefore, the treatment plan included the removal of maxillary implant devices with a subsequent removable prosthesis. Under local anesthesia, maxillary crestal incisions were made to raise a mucoperiosteal flap, that allowed to observe a complete failure of both Linkow blades, that were no longer osseointegrated. A gentle explantation procedure was performed to minimize the bone trauma and to maintain the integrity of the walls of the alveolar housing. Then, the removal of all the present connective tissue was performed too. Dental practitioners should carefully elaborate an appropriate both surgical and prosthetic plan in patients that present the failure of maxillary Linkow blades, in order to limit the risks for possible intraoperative or postoperative complications. The major risk of failed Linkow blades, in comparison with failed conventional screw-shaped implants, is the great amount of inflammatory connective tissue around the blades, that carries the risk of major bleeding.