Dental Implants – What Determines Success and Failure
- March 3, 2022
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Dental implants are promoted to patients as ideal or nearly ideal replacements for lost teeth. They are rarely told of the risks or counselled on failure rates. The procedures might have catastrophic repercussions and are not without flaws. Implants can and frequently do fail. Patients must be well informed about the hazards and be aware that dental implants can fail. Implant placement is relatively predictable, safe, and produces a functional and cosmetic result for patients with careful planning.
Since their introduction in the 1950s, dental implants have come a long way. Dental implant technology is evolving at a breakneck pace. Dental implant success frequently improves as new technology is adopted. Occasionally, a technology enters the market that, while mostly fantastic marketing, either does not improve or actively harms success. Fortunately, this does not happen very frequently.
So, what factors contribute to the failure of dental implants? A number of variables contribute to an increased risk of dental implant failure. Unfortunately, some dangers are unavoidable, which is why, according to numerous studies, dental implants are 90-95 percent successful (the number is actually closer to 95 percent ). As with long bone fractures, certain fractures simply do not heal after the cast is removed, even with the finest approximation of the fracture and significant immobility. Either a non-union (meaning no healing occurred) or a fibrous union occurs (where instead of bone between the two sides of the fracture you have scar tissue). Non-unions and fibrous unions occur about 5% of the time, depending on the form and location of the fracture as well as the patient. This corresponds to the failure rate of dental implants.
The same principles that govern fracture healing apply to implant healing. To achieve a successful osseointegration of the implant, you must have adequate bone approximation to the implant surface and a period of immobility. Osseointegration occurs when the bone accepts the implant and inserts itself around it. As you can see, the failure rate of implants is comparable to the failure rate of fractures that do not heal properly. Failure of the bone to osseointegrate (similar to non-unions) can occur, and instead of bone around an implant, a fibrous encapsulation can form (similar to the fibrous union in bone fractures).
Poorly controlled diabetes, various bone metabolic and congenital abnormalities, and certain drugs such as glucocorticoids (prednisone), immunosuppressants, and bisphosphonate medications all increase the chance of implant failure (Zometa, Fosamax, Actonel, Boniva, etc.) Furthermore, smoking and poor sanitary practises can raise the likelihood of implant failure. People who have these illnesses and/or are taking these medications should notify their implant surgeon so that a treatment plan can be tailored to their specific needs and medical conditions.
Other variables can contribute to an increase in dental implant failure. Implants can fail early or late in the healing process. Early failures would be described as any period before to osseointegration (healing phase) or when the crown is fastened to the implant. Any period after the implant with the tooth is functional is considered late failure.
The following are some of the factors that can lead to early failure:
- overheating the bone at the time of surgery (usually due to lack of good irrigation)
- too much force when they are placed (too tight fitting implants can actually cause bone to resorb)
- not enough force when they are placed (too loose fitting implants don’t stay immobile and don’t heal properly)
- contaminated implant
- contaminated osteotomy
- epithelial cells in osteotomy site (connective tissue or scar tissue fills the socket around the implant instead of bone)
- poor quality of bone
- excessive forces during osseointegration (during healing the implant is under function, is mobile and therefore bone doesn’t affix to the implants)
- poor compliance with post operative medication and/or instructions
- other rare reasons like implant rejection from a titanium alloy allergy.
contaminated osteotomy epithelium cells at the site of the osteotomy (connective tissue or scar tissue fills the socket around the implant instead of bone)
Excessive stresses during osseointegration due to low bone quality (while healing, the implant is in use, mobile, and hence bone does not adhere to the implants)
Poor adherence to post-operative medicines and/or instructions, as well as other uncommon causes such as implant rejection due to a titanium alloy allergy.
Late failures are frequently associated with the patient’s inadequate hygiene. Patients frequently lose teeth as a result of improper maintenance, and for others, the tendency continues even after implant surgery. Occasionally, the implant is just overloaded. Some patients had larger bite forces and may have required more implants to more evenly distribute the forces. Implants can fail late due to lateral stresses. Implants, like teeth, prefer to be loaded axially, or straight up and down. When teeth, particularly implants, are loaded tangentially or laterally, the bone around them weakens and begins to collapse. A poorly planned implant placement, faulty implant placement, and/or a poorly developed prosthetic tooth, teeth, or device are the other factors. As a result, there are numerous reasons why implants can fail. Some are avoidable and controllable, while others are not. So, how can a patient improve their chances and lower their risk of implant failure? The most important thing patients can do is follow the drugs and instructions before and after the treatment. The second step is to use this opportunity to quit smoking.
Finding the correct surgeon and restorative dentist, on the other hand, is the most controllable component in guaranteeing the best likelihood of success. Find a highly successful implant surgeon. This specialist group includes oral surgeons, periodontists, and general dentists with extensive postgraduate study. Implants are typically performed as a group effort. Make certain that not only your implant surgeon is qualified, but that the dentist who will be replacing the implant is likewise qualified (putting the tooth on the the implant). Pose a lot of questions. Inquire about testimonials from previous patients and request to see before and after photos.
Implantology (implant placement) is a highly technical process. The success originates from adequate case planning, and training, skill, and experience are also important components in the procedure’s success. While training is vital, evidence of extensive experience, particularly in your field of interest… can be even more important. Inquire if your surgeon is board qualified, how long they have been placing implants, and if they work or speak with restorative dentists on a regular basis.
The surgeon should go through everything with you before the implant is placed. If you believe you did not obtain appropriate information, wait until you are fully prepared and educated. Find useful information to assist you in your education.
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