Risk factors of dental implant failure – Dr Martin Wanendeya Ten DentalFeatured Products Promotional Features
Posted by: The Probe 11th December 2019
Dental implants are widely used for effectively and predictably replacing damaged or missing teeth, with average survival rates of 95.4% after 10 years.[i] The popularity of dental implants can be attributed to the fact that they are able to provide functional and aesthetic results superior to that of removable solutions such as dentures. Yet, complications can occur from implant treatment that result in failure and loss of the implant. Being aware of the risk factors that can affect a dental implant’s long-term success is essential in order to be better prepared in case something goes wrong. Taking quick, corrective action enables clinicians to prevent additional and more serious problems from occurring.
Bone quality and quantity
Achieving primary stability is important to ensuring the survival of an implant, as this facilitates optimal healing and osseointegration.[ii] Patients at a higher risk of implant failure include those with poor bone quality and quantity, as treatment failure may be associated with excessive bone loss and impairment of the healing process.[iii] Slight bone loss over several years is considered normal and unlikely to affect a patient’s implant directly. However, an implant is typically deemed a failure if there is bone loss of more than 1.5 millimetres in the first year following placement, and more than 0.2 millimetres every year after.[iv], [v] Patients who lack adequate bone height, width or length can undergo a bone grafting procedure to ensure there is healthy bone mass available to support osseointegration. Bone grafting can be performed at the same time as or prior to implant placement, and can greatly improve the functional and aesthetic outcome of treatment.
Oral hygiene and smoking
Peri-implantitis is one of the most common risk factors of implant failure, with an estimated prevalence ranging from 10% to 40%.[vi] This inflammatory disease shares some similarities to periodontitis in that it is caused by bacterial colonisation and a subsequent failure to remove this bacteria from the oral cavity. If left untreated, peri-implantitis can destroy the soft and hard tissue, resulting in deterioration of the bone structure supporting the implant and eventual loss of the implant.[vii] A combination of effective oral hygiene at home and professional dental cleaning within the practice is vital to prevent peri-implantitis.
It is important that patients take some responsibility for disease prevention. As such, they should be educated on the impact smoking can have on implant treatment – as well as on their general health – and support made available to encourage cessation. Smoking has been proven to negatively affect the oral microbiome, potentially altering the peri-implant environment and contributing to the prevalence of peri-implantitis.[viii]Smoking can also impede wound healing following implant surgery. Carbon monoxide produced by cigarette smoke has a higher affinity for haemoglobin, which reduces oxygenation of healing tissue. In addition, the cytotoxic effects of smoking can disrupt body cell repair and defence.[ix]
Another common risk factor of implant failure is poor surgical execution during implant placement. This includes the surgeon overheating the bone – due to the friction caused by high torque surgical equipment – which damages the implant bone bed and can contribute to failure of the implant.[x] Poor surgical execution may also refer to improper implant positioning, which can potentially damage or subject the implant and its components to non-axial loading during mastication. This increases the risk of implant or peri-implant bone fractures, which often occur in the posterior of the oral cavity as a result of high load in this region.[xi]
Failure due to poor surgical execution of dental implant therapy can be easily avoided with proper treatment planning, implant site development, the use of surgical guides, and a good understanding of the restorative aspects of the procedure. This emphasises the importance of having the relevant training and qualifications to provide dental implants. Equally, practitioners can refer patients for implant treatment. The award-winning team of dental implantologists at Ten Dental+Facial have the knowledge and skills to treat both simple and complex cases. They offer a seamless referral service – no matter whether you choose to refer for comprehensive implant treatment, or for implant surgery with a plan that the patient is returned to you to have their implant restored.
As with any other oral surgical procedure, dental implant therapy is not totally free from complications. Early detection and treatment of potential problems is key to saving implants from failure and loss. Bone quality and quantity, oral hygiene, smoking, and surgical execution are just some of the many elements that must be considered as part of the treatment planning process if clinicians are to achieve a desirable outcome. So long as practitioners are aware of the risk factors that can affect treatment, they can take steps to mitigate them as much as possible and ensure the long-term success of dental implants.
For more information visit www.tendental.com or call on 020 33932623
[i] Jung, R. E., Zembic, A., Pjetursson, B. E., Zwahlen, M. and Thoma, D. S. (2012) Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years. Clinical Oral Implants Research. 23(Suppl. 6): 2-21. DOI: 10.1111/j.1600-0501.2012.02547.x.
[ii] Javed, F., Ahmed, H. B., Crespi, R. and Romanos, G. E. (2013) Role of primary stability for successful osseointegration of dental implants: Factors of influence and evaluation. Interventional Medicine & Applied Science. 5(4): 162–167. DOI: 10.1556/IMAS.5.2013.4.3. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3873594/. [Last accessed: 01.07.19].
[iii] Chrcanovic, B. R., Albrektsson, T. and Wennerberg, A. (2017) Bone Quality and Quantity and Dental Implant Failure: A Systematic Review and Meta-analysis. The International Journal of Prosthodontics. 30(3): 219-237. DOI: 10.11607/ijp.5142.
[iv] Albrektsson, T., Zarb, G., Worthington, P. and Eriksson, A. R. (1986) The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1: 11-25.
[v] Geraets, W., Zhang, L., Liu, Y. and Wismeijer, D. (2014) Annual bone loss and success rates of dental implants based on radiographic measurements. Dentomaxillofac Radiol. 43(7): 20140007. DOI: 10.1259/dmfr.20140007. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170845/#b2. [Last accessed: 01.07.19].
[vi] Charalampakis, G., Jansåker, E. and Roos-Jansåker, A-M. (2014) Definition and Prevalence of Peri-Implantitis. Curr Oral Health Rep. 1: 239-250. DOI: 10.1007/s40496-014-0031-x.
[vii] Prathapachandran, J. and Suresh, N. (2012). Management of peri-implantitis. Dental Research Journal. 9(5): 516–521. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612185/. [Last accessed: 01.07.19].
[viii] Pimentel, S. P., Fontes, M., Ribeiro, F. V., Corrêa, M. G., Nishii, D., Cirano, F. R., Casati, M. Z. and Casarin, R. C. V. (2018) Smoking habit modulates peri-implant microbiome: A case-control study. Journal of Periodontal Research. 53(6): 1-9. DOI: 10.1111/jre.12597.
[ix] Levin, L. and Schwartz-Arad, D. (2005) The Effect of Cigarette Smoking on Dental Implants and Related Surgery. Implant Dentistry. 14(4): 357–363. DOI: 10.1097/01.id.0000187956.59276.f8.
[x] Esposito, M., Hirsch, J-M., Lekholm, U. and Thomsen, P. (1998) Biological factors contributing to failures of osseointegrated oral implants (I) Success criteria and epidemiology. Eur J Oral Sci. 106: 527-551.
[xi] Mantena, R. S., Gottumukkala, S. N. V. S., Sajjan, S., Raju, A. R., Rao, B. and Iyer, M. (2015) Implant Failures – Diagnosis and Management. Int J Clin Implant Dent. 1(2): 51-59. DOI: 10.5005/jp-journals-10004-1034.
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