Reducing implant complications with improved patient behaviours

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  Posted by: Dental Design      17th April 2024

Dental implants are widely considered a safe, effective and patient-preferred solution for missing teeth. In appropriate situations, when delivered by suitably trained and skilful clinicians, implant therapies can transform a patient’s life. However, it is essential that they really understand what the surgery entails, as well as the role they will need to play post-operatively to maintain oral hygiene and facilitate the best results. Not only does this ensure informed consent, but it will also lead to more satisfied patients.

Changing lives

Traditionally, dentures have been the go-to solution for missing teeth. However, changing societal trends and pressures have created negative attitudes towards the removable restorations.[i]

For partially or fully edentulous patients, dental implants have become the gold-standard solution. They can restore a person’s ability to eat and speak properly, while improving their smile aesthetics and boosting their self-confidence. Quality of life has been shown to increase for patients who receive implants, especially with regards to their social interactions, emotional health and self-esteem.[ii]

Modern products, techniques and technologies have facilitated significant success in the implantology field. The literature shows implant survival rates of 95.5% at one-year post-placement,[iii] 93.2-96.4% at 10 years,[iv]and 89.5% after 20 years.[v] This means that many patients can enjoy the benefits of treatment for decades, or even for the rest of their lives – when they properly care for their implant and restoration, of course.

Bumps in the road

Despite the exceptional survival rates recorded, dental implants are not without their potential complications. Several factors can affect their success, including the patient’s age, gender and systemic health.[vi] Lifestyle factors must also be considered. Smoking, for example, may not be a contraindication for treatment, but it has been shown to increase the risk of implant failure b
y 140%.[vii]When it comes to the implants themselves, mechanical, biological and technical complications can occur, such as biomechanical overloading and fractures in the framework or prosthetic.[viii] One of the most common issues is peri-implantitis. This can develop from residual cement on the restoration, but is more often associated with plaque accumulation and biofilm formation.[ix]

Preventing the preventable

As is true for periodontitis, peri-implantitis is very often preventable. A Swiss study found that, while most patients were aware of dental implants (almost 80% of participants), they possessed poor knowledge regarding the post-operative care that is required for the long-term success of treatment.[x] Preventive measures should, therefore, be put in place even before treatment has begun. For example, patients must be educated on the risk of infection and its impact on their implants well in advance. The importance of long-term maintenance must also be emphasised.[xi]

The implementation of an effective and systematic oral hygiene routine – which minimises plaque and biofilm – is integral to reducing the risk of peri-implant diseases.[xii] Evidence also suggests that a lack of interproximal cleaning, in particular, increases the chance of peri-implantitis.[xiii] That’s why professional advice should cover oral hygiene techniques and products, tailoring guidance to ensure that individuals understand exactly what they should do at home to look after their implants.

From a professional perspective during review appointments and check-ups, regular probing pocket depth and bleeding on probing scores are important for monitoring patients post-implant placement and identifying early signs of disease. They can also be utilised to manage any peri-implant mucositis or peri-implantitis that does occur to reduce symptoms before more damage is caused.[xiv]

Encouraging positive patient behaviour  

Ensuring patients really understand the importance of oral hygiene around an implant is critical for the success of treatment, but also for obtaining informed consent. A fully informed patient must have realistic expectations of their implant treatment from the outset, which will increase their satisfaction with the outcome achieved too.[xv] So, how can this be consistently achieved in the practice?

The way that treatment is discussed with the patient from the beginning is key. If they truly appreciate the role they must play and the impact their actions have on their dental implants, they are far more likely to implement necessary changes to their routine or maintain a high standard of oral hygiene.

For the best outcomes, dental professionals can utilise Chairsyde – a state-of-the-art patient consultation platform. Containing a comprehensive library of animations, the system can be used to explain a patient’s current oral health status, their need for treatment and the procedure itself (benefits and risks included), in a way that they will understand clearly. There are also videos to demonstrate oral hygiene techniques and show how disease progression can be prevented, supporting informed consent and patient compliance.

With tools like this, the benefits and risks of dental implants can be more accurately and concisely communicated with patients. With their cooperation, the risk of complications can be minimised and treatment outcomes optimised.

For more information, or to book a demo, please visit www.chairsyde.com

or call 020 3951 8360

[i] Hellyer, P. The older dental patient – who cares?. Br Dent J 211, 109–111 (2011). https://doi.org/10.1038/sj.bdj.2011.618

[ii] Sargozaie N, Moeintaghavi A, Shojaie H. Comparing the Quality of Life of Patients Requesting Dental Implants Before and After Implant. Open Dent J. 2017 Aug 31;11:485-491. doi: 10.2174/1874210601711010485. PMID: 29114333; PMCID: PMC5646019.

[iii] den Hartog L, Slater JJ, Vissink A, Meijer HJ, Raghoebar GM. (2008). Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction. J Clin Periodontol 35:1073-1086

[iv] Howe MS, Keys W, Richards D. Long-term (10-year) dental implant survival: A systematic review and sensitivity meta-analysis. J Dent. 2019 May;84:9-21. doi: 10.1016/j.jdent.2019.03.008. Epub 2019 Mar 20. PMID: 30904559.

[v] Chappuis V, Buser R, Brägger U, Bornstein MM, Salvi GE, Buser D. (2013). Long-term outcomes of dental implants with a titanium plasma-sprayed surface: a 20-year prospective case series study in partially edentulous patients. Clin Implant Dent Relat Res [Epub ahead of print 3/18/2013] (in press)

[vi] Kochar SP, Reche A, Paul P. The Etiology and Management of Dental Implant Failure: A Review. Cureus. 2022 Oct 19;14(10):e30455. doi: 10.7759/cureus.30455. PMID: 36415394; PMCID: PMC9674049.

[vii] Mustapha AD, Salame Z, Chrcanovic BR. Smoking and Dental Implants: A Systematic Review and Meta-Analysis. Medicina. 2022; 58(1):39. https://doi.org/10.3390/medicina58010039

[viii] Hanif A, Qureshi S, Sheikh Z, Rashid H. Complications in implant dentistry. Eur J Dent. 2017 Jan-Mar;11(1):135-140. doi: 10.4103/ejd.ejd_340_16. PMID: 28435381; PMCID: PMC5379828.

[ix] Rokaya D, Srimaneepong V, Wisitrasameewon W, Humagain M, Thunyakitpisal P. Peri-implantitis Update: Risk Indicators, Diagnosis, and Treatment. Eur J Dent. 2020 Oct;14(4):672-682. doi: 10.1055/s-0040-1715779. Epub 2020 Sep 3. PMID: 32882741; PMCID: PMC7536094.

[x] Al-Haj Husain A, De Cicco O, Stadlinger B, Bosshard FA, Schmidt V, Özcan M, Valdec S. A Survey on Attitude, Awareness, and Knowledge of Patients Regarding the Use of Dental Implants at a Swiss University Clinic. Dent J (Basel). 2023 Jul 5;11(7):165. doi: 10.3390/dj11070165. PMID: 37504231; PMCID: PMC10378414.

[xi] Alani A. Bishop K. Peri-implantitis. Part 2: Prevention and maintenance of peri-implant health. British Dental Journal. September 2014; 217 (6); 289-297

[xii] Corbella S, Del Fabbro M, Taschieri S, De Siena F, Francetti L. Clinical evaluation of an implant maintenance protocol for the prevention of peri-implant diseases in patients treated with immediately loaded full-arch rehabilitations. Int J Dent Hyg. 2011 Aug;9(3):216-22. doi: 10.1111/j.1601-5037.2010.00489.x. Epub 2010 Oct 14. PMID: 21356024.

[xiii] Cheung MC, Hopcraft MS, Darby IB. Patient-reported oral hygiene and implant outcomes in general dental practice. Aust Dent J. 2021 Mar;66(1):49-60. doi: 10.1111/adj.12806. Epub 2020 Dec 5. PMID: 33174206.

[xiv] Derks J, Ichioka Y, Dionigi C, Trullenque-Eriksson A, Berglundh J, Tomasi C, Graziani F. Prevention and management of peri-implant mucositis and peri-implantitis: A systematic review of outcome measures used in clinical studies in the last 10 years. J Clin Periodontol. 2023 May;50 Suppl 25:55-66. doi: 10.1111/jcpe.13608. Epub 2022 Jul 11. PMID: 35246865.

[xv] McCrea SJJ. An Analysis of Patient Perceptions and Expectations to Dental Implants: Is There a Significant Effect on Long-Term Satisfaction Levels? Int J Dent. 2017;2017:8230618. doi: 10.1155/2017/8230618. Epub 2017 Aug 8. PMID: 28928771; PMCID: PMC5591937.

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