Nik Sisodia presents some of the most common complications that can arise during and after dental implant surgery.
As with any surgical procedure, implant dentistry presents some risks to the patient. Fortunately, with competent treatment and appropriate aftercare, the overall risk of complications from dental implants is comparatively infrequent and generally rectifiable.
There are relatively few contraindications for dental implants, and implant survival rates are frequently reported as being around 95%. However, the skill of the practitioner plays a significant role, with implant survival figures dropping to just 73% when placed by inexperienced practitioners (Setzer and Kim, 2014).
The following are among the most common complications arising during and after dental implant surgery.
Surgical risks
Bleeds
Bleeding is usually kept under control by the surgeon, however, accidents can occasionally occur, which may necessitate measures such as vasoconstrictive medication, cauterisation or ligation. Postoperative bleeding can occur due to failure to stabilise the flap, tearing of soft tissues, or an inappropriately modified temporary prosthesis.
Infection
All surgery carries at least a small risk of infection. Patient adherence to proper oral hygiene post-surgery not only reduces the risk of this, but also promotes faster healing.
Nerve damage
Accidental nerve damage can result in numbness, enhanced sensory perception, lingering pain and other sensory alterations. In minor instances, this complication will likely resolve itself. However, between five and 15% of those experiencing this may find that these alterations persist beyond a year following surgery.
Making a prognosis regarding this complication is a not a simple task, as diagnosing the exact nature of the damage is challenging (Annibali et al, 2008).
Sinus problems
Without careful planning and placement, implants in the maxilla can protrude into the sinus cavity. This can result in the implant becoming loose and can lead to infections. Some patients will have insufficient bone in this area to support the implant, and a sinus lift is usually required in these cases (Nam and Kim, 2014).
Short-term risks
Osseointegration failure
The formation of a direct connection between implant and bone is fundamental to the success of the procedure. In a small minority of cases, this process fails to occur to the necessary degree, resulting in implant failure.
There are a great number of factors with the potential to adversely affect osseointegration, including the patient’s general health and the interaction of various medications (Ouanounou, Hassanpour and Glogauer, 2016). What factors and the degree to which they affect the osseointegration process is an area of active debate and requires further study.
While a small measure of bone loss is something of an inevitability (Byrne, 2015), implants are deemed to have failed when any of the following are observed:
- Presence of pain following primary healing
- Clinical implant mobility
- Uncontrolled progressive bone loss, or in excess of 50% bone loss around the implant
- Uncontrolled exudate (Misch et al, 2008).
Long-term risks
Peri-implant disease
Tissues surrounding implants are at greater risk of plaque-associated infections than organic teeth.
Peri-implant mucositis is a completely reversible inflammation of the soft tissues, frequently likened to gingivitis.
Peri-implantitis is a progressive inflammation of the hard and soft tissue surrounding the implant, thought to be caused by bacterial infection and/or biomechanical overload, it is the implant equivalent of periodontitis. Peri-implantitis can disrupt osseointegration, increase pocket formation and cause bone resorption.
While periodontitis can lead to implant failure, this is not a foregone conclusion – with timely intervention it can be possible to save the implant (BDA, 2015).
Beyond ensuring implant stability, the best way of preventing peri-implant diseases is for the patient to maintain their oral hygiene and for the accumulation of plaque to be prevented (Pranskunas et al, 2016).
Gingival recession
The result of a loss of alveolar bone and tissue, this can reveal the metal abutment, which may be of particular concern to the patient if treatment occurred in the aesthetic zone. Gingival recession also increases the likelihood of peri-implant disease (Warreth, Boggs and Ibieyou, 2014).
Mechanical failure
While a rare occurrence, dental implants can fracture. This is usually caused by biomechanical or physiological overload, arising from either the mechanics of the implant or patient behaviour (for instance, bruxism can apply significant forces to the implant), or a combination thereof.
In circumstances where only the abutment fractures, it may be possible for the implant fixture to be saved. In other circumstances, the damage is likely to be catastrophic and require removal and replacement (Gealh et al, 2011). More generally, the prosthesis will be subject to wear and tear, though the extent to which this will affect it varies depending on the material used and the level of maintenance it receives (Tinsley, Watson and Preston, 2002).
Avoiding complications
In order to provide implant surgery with a minimal risk of complication, extensive training and experience is both necessary and valuable. The aforementioned complications are among the most common, but are not an exhaustive list and implant dentists must be ready to deal with these and many more eventualities.
For cases requiring bone grafting, still more complications can arise. While many dentists are considering focusing on this growing field, the additional training and material expense attached to being able to provide this service is steep.
Dental implants can be a challenging procedure, with the individual needs of the patient requiring substantial planning and management.
Ten Dental operates several award-winning practices in the London area, with highly-trained clinicians that can handle referrals for a wide range of implant treatments – from single tooth restorations to full mouth rehabilitations.
In order to avoid complications, a high level of surgical acumen combined with substantial investment in materials and technology is highly desirable. Implant failure can be costly and difficult to correct, and worse still, the affect it can have on a patient’s wellbeing can be enormous.
For the references, email [email protected].
If you are interested in implant dentistry, or you’re thinking of entering the field of dental implants, visit the Implant Dentistry Show on Saturday 26 January 2019. For more information visit www.implantdentistryshow.co.uk, call 01923 851779 or email [email protected].
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