Implants: A two-way relationship

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  Posted by: The Probe      4th February 2020

Today, implants have a success rate of 80-95% over 15 years in cases where the patient has a healthy mouth, while over 90% demonstrate successful osseointegration to the jaw bone.[i] Still, implant placement is not without its challenges – if the right steps are not taken during and after treatment, there is a risk that an implant can fail.

Usually if an implant fails early – in other words, a few weeks or months after placement – it is due to poor osseointegration caused by premature loading, improper preparation of the recipient site, bacterial contamination or poor mechanical stability of the implant.[ii] This indicates that, to a certain extent, the outcome of treatment rests on the performance of the dentist. That being said, there are certain pre-disposing factors that can affect the result later on down the line, including age (patients over 60 have been shown to be at significantly higher risk of implant failure), a diagnosis of diabetes and being postmenopausal.[iii] It is for this reason that case selection and screening is absolutely essential, and why all risk factors must be taken into consideration before treatment gets underway.

However, when talking of implant success, it is important to consider the role of the patient. After all, while the clinician might be the provider of treatment and, therefore, responsible for ensuring a successful outcome, if the patient doesn’t continue to look after the implant properly once it has been inserted, there is always the risk that it might not work. Where an implant fails at a later stage, it is often due to peri-implantitis, which can be caused by poor oral hygiene practises and smoking, amongst other things. Peri-implantitis is also more common in patients that have a history of periodontitis.ii

To maximise the chances of preventing peri-implantitis, patients must be educated on the risk factors. Unfortunately, there is still a lack of understanding about implant maintenance post-treatment, as well as how and why peri-implant disease occurs. Why this is remains to be proven, but one study has suggested that patient knowledge – or lack thereof – can depend on the experience of the practitioner. Indeed, it found that those treated by a highly experienced clinician (group B) were made much more aware about the maintenance of implants. Moreover, 46.7% understood that implants require greater care than natural teeth. By comparison, just 20% of group A were aware that greater attention was needed, and only 60% said that they were given instructions on how to care for their implant.[iv] This not only indicates that excellent patient-clinician communication is essential to ongoing implant maintenance and success rates, but that perhaps there is room for improvement when it comes to practitioners’ ongoing involvement. So, what can be done?

First and foremost, patients should be made aware from the consent process that implants are not the same as normal teeth despite appearances and, as such, cannot be cared for in the same way. This will not only help to clear up any medico-legal complications that could occur later on down the line,[v] but enforce the message early on that maintenance is the key to success. Ultimately, practitioners need to let patients know that even if treatment goes well, there is still a risk of failure if the implant is not looked after properly. It is also the practitioner’s duty of care to recommend the use of reliable oral healthcare products that will enable patients to effectively maintain their implant at home, and ensure patients understand the correct techniques they are supposed to use. Where compliance is an issue, it may mean the patient requires additional assistance during recall appointments as well as more regular examinations. As long as clinicians can prove that they are doing their utmost to support the patient, there is not much more that can be done – at least as far as education is concerned anyway.

After all, a practitioner must also implement a tailored periodontal and peri-implant maintenance programme that involves both plaque control and documentation of clinical parameters, including bleeding on probing, peri-implant pocketing and stability of crestal bone levels.[vi] The frequency very much depends on the risk status of the patient, but examinations should be carried out regularly regardless. Leaving the patient will only increase the risk of failure and jeopardise the chances of long-term success.

To maximise implant longevity, it can help to utilise an implant that facilitates maintenance. Complete with an innovative zirconia collar, TBR’s Z1® implant system encourages the soft tissue to heal around the implant in a manner that closely resembles natural gingival growth. This acts as an antibacterial shield to prevent inflammation and infection at the gingival and crestal bone level. Indeed, zirconia surfaces demonstrate a lower affinity to bacteria compared to titanium,[vii] making the Z1® an ideal choice for any practitioner looking to boost results.

Implant success is never guaranteed, but with the correct maintenance from all parties, and an effective partnership between the patient and practitioner, it is much easier to keep failure at bay.

 For more information on the Z1® implant, visit tbr.dental, email support@denkauk.com or call 0800 707 6212

 

Author: Mr. Matthieu Dupui, Biomedical engineer, TBR Marketing Product Manager since 2013

 

[i] University College London Hospitals NHS Foundation Trust. Dental Implants: General information for patients. Accessed online 21 November 2019 at https://www.uclh.nhs.uk/PandV/PIL/Patient%20information%20leaflets/Dental%20Implants%20-%20General%20Information.pdf

[ii] Bansal P, Dhanya, Bansal P, Singh H, Shanta. Dental Implant Maintenance- “How to Do?” & “What to Do”- A Review. J Adv Med Dent Scie Res 2019;7(3):24-29. Accessed online 21 November 2019 at http://jamdsr.com/uploadfiles/7DENTALIMPLANTMAINTANANCEvol7issue3pp24-29.20190401070948.pdf

[iii] Moy PK, Medina D, Shetty V, Aghaloo TL. Dental implant failure rates and associated risk factors. Int J Oral Maxillofac Implants. 2005; 20(4):569-77. Accessed online 21 November 2019 at https://www.ncbi.nlm.nih.gov/pubmed/16161741

[iv] Walia K, Belludi SA, Swamy S. A Comparative and a Qualitive Analysis of Patient’s Motivations, Expectations and Satisfaction with Dental Implants. J Clin Diagn Res. 2016; 10(4):23-26. Accessed online 21 November 2019 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866243/

[v] Grey EB, Harcourt D, O’Sullivan D, Buchanan H, Kilpatrick NM . A qualitative study of patients’ motivations and expectations for dental implants. Br Dent J 2013; 214: E1. Accessed online 21 November 2019 at https://www.nature.com/articles/sj.bdj.2012.1178

[vi] Association of Dental Implantology. ADI Guidelines on peri-implant monitoring and maintenance. Accessed online 21 November 2019 at https://www.dentinaltubules.com/sites/default/files/upload/attachments/ADI%20-%20implant%20monitoring%20%26%20maintenance.pdf

[vii] Rimondini, L., Cerroni, L., Carrassi, A., Torricelli, P. Bacterial colonisation of zirconia ceramic surfaces: an in vitro and in vivo study. Int. J. Oral Maxillofac. Implants. 2002; 17(6): 793-798. Accessed online 21 November 2019 at https://www.researchgate.net/publication/10969412_Bacterial_Colonization_of_Zirconia_Ceramic_Surfaces_An_in_Vitro_and_in_Vivo_Study.


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