To our knowledge, this is the study with the largest sample size reporting the performance, in the clinical practice, of the application of counter-torque technique for the removal of nonmobile dental implants. In this retrospective analysis, the counter-torque method demonstrated to be highly predictable, showing a high success rate. The fracture of the implant (0.65% at the implant apical third) was the only detected complication. The principle mechanism of implant explantation was the application of shear stress to break the osseointegration of the implant. Atraumatic implant explantation could be achieved. Besides, this technique demonstrated to be efficient in the removal of nonmobile implants surrounded by different bone levels, ranging from 0–25% to 76–100%.

Due to the low percentage of explantation failures with the counter-torque technique detected in this cohort and the retrospective design of this study, it has not been possible to detect risk factors that could be associated with implant fracture during the explantation or the need to use trephine burs. The influence of the bone quality in the implant removal could not also be assessed. Thus, future prospective studies would be useful to establish a scientifically sound protocol for dental implant explantation using the counter-torque strategy.

Nevertheless, the procedure described in this report has shown to be efficient and safe for the atraumatic removal of nonmobile dental implants and preserving the tissues [6, 7].

Based on previous publications, this strategy enables the direct installation of a dental implant in the extraction site which could maximize the time and cost-efficiency of the treatment [8, 9].