implants complications and failures.pptx

Implant complications and failures
Presented by:
Asra Ahmed
JR III
Dept of Prosthodontics and
Crown & Bridge

Introduction
▸ The success rate of dental implants has increased over a period of years as a
treatment option for the rehabilitation of missing teeth.
▸ Risks and complications have been identified with dental implant failure though
there is continuous innovation in implant systems and various interceptive
treatment modalities.
2

Diagnosing Between Ailing And Failing Of Dental
Implants
3
Failed
Failing
Ailing

Systemic
diseases
Smoking
Maxillary
implant
location
Statistically
analyzed
factors
Quantity
and
Quality
of bone
Genetic
diseases.
Immunological

Implant success criteria
Schnitman and schulman,1979:
1. Mobility less than 1 mm in any direction.
2. Radilogically observed radilucency graded
3. Gingival inflammation amenable to treatment, absence of symptoms and infection, absence of
damage to adjacent teeth, absence of parasthesia and anesthesia or violation of the mandibular
canal, maxillary sinus or floor of the nasal passage
7

McKinney et al. 1984:
8
Objective 1.Good occlusal balance and vertical
dimension.
Mobility of less than 1 mm
buccolingually, mesiodistally, and
vertically
1.Absence of symptoms and infection
associated with the dental implant.
Absence of damage to adjacent tooth
or teeth and their supporting
structures
1.Gingival inflammation vulnerable to
treatment.

9
Intraoperative
complications
Bleeding
related
complications
Postoperative
complications
Biomechanical
complications
Fractured
implant
Explantation of
implant

Intra-operative complications
10
Mal-positioned
initial osteotomy
site
Facial dehiscence
after implant
placement
Loss of facial plate
when placing an
implant
Overheating the
bone
Implant pressure
necrosis
Injury to adjacent
teeth
Swallowing/
Aspiration of
implant
components

11
Mal-positioned
initial osteotomy
site
• Use of surgical templates
• Use of Linderman bur (i.e side
cutting fissure bur)
Prevention

Bone resorbs from facial to lingual, in
some cases afterimplant placement
less than 2.00 mm of facial bone is
present.
▸ If entire buccal plate is lost,
or if mobility exists ideally
implant should be removed.
▸ Autogenous bone grafting of
the osteotomy site.
12
Facial dehiscence
after implant
placement

13
▸ Early implant failure and bone loss is due to
overheating of the bone, due to osteotomy
site preparation in dense bone.
▸ 47° c should be maintained for 60 seconds.
▸ Resultant hyperemia, fibrosis,
osteocytic degeneration and increased
osteoclast activity may occur leading to
necrotic zone around the implant.
Overheating the
bone

Prevention
14
Intermediate
bur
Use of
saline
Bone dance
Use of sharp
new drills
Surgical
templates

Treatment
▸ If known excess heat generation occurs during implant
placement ideally implant should be removed, regional
accelerating phenomenon initiated and the site is grafted for
future implant placement.
▸ RAP: tissue reaction to a noxious stimulus that increases the healing
capacities of the affected tissue such as bone, cartilage but also soft
tissue.
15

IMPLANT PRESSURE NECROSIS
▸ Placing implants in bone with thick cortical components (D1&D2)
possibly early implant failure may occur due to pressure necrosis.
▸ PREVENTION:
▹ Torque value of 35 Ncm is considered safe.
16

Poor surgical technique
improper angulation
insufficient bone quantity
placement of implant with incorrectdiameter
teethwith dilaceratedroot
17
Injury to adjacent
teeth

prevention
▸ Evaluation through CBCT
▸ Using direction indicator
▸ Ideally 1.5mm space between implant and root surface
is recommended.
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Bleeding related complications
 Careful planning of the location of incisions w.r.t surgical anatomy to maintain
hemostasis over host bone.
 Reflection and elevation of the mucosa and periosteum should be done carefully with
full-thickness and atraumatic reflection.
 Thorough understanding of anatomic structures and variants should be done with the
use of CBCT.
19

Post operative complications
21
Edema (post
operative
surgical
swelling)
Ecchymosis
Retrograde peri-
implantitis
Titanium allergy/
Hypersenstivity
Incision line
opening

23
Biomechanical complications
Screw
loosening
External force
factors
Cantilevers/
increased
crown height
Insufficient
torque
Splinted vs
non splinted
crowns

▸ External Force Factors:
▹ These forces greatly risk the screw loosening.
▹ Joint-separating forces.
▹ External joint separating forces>than the force holding the
screw together (clamping force).
▸ Cantilever/ increased crown height space:
▹ Cantilevers increase the risk of screw loosening because they increase
the magnitude of forces on the implant system.
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Uneven
occlusal
loads
Repeated
cycles of
compression
and tension
Inclined
plane of
implant
vibrations
Screw
loosening

▸ Presence of parafunctional habits.
▸ Key implant positions, sufficient number of implants, passive
prosthetic frameworks and adequate occlusal schemes.
▸ Crown/ abutment fully seated.
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▸ Crown/ Abutment fully seated:
▹ if the abutment is not fully
seated because of improper
placement.
▸ Insufficient/ Excessive Torqueing:
▹ the preload stretch of the screw is
maintained by frictional force and
the tension between the screw
and the implant/abutment is
termed as clamping force.
26

27
Screw Diameter
• The greater the screw diameter, the
higher the pre-load that may be
applied which results in greater
clamping force on screw joint.
Screw Material
• The composition of the metal may
influence the amount of strain in
the screw from the preload and the
point of fracture, directly affecting
the amount of preload that can be
safely applied.

29
Ultra sonic/
cavitron
device
Round bur
(205LN)
Inverted cone
bur
Slot the top of
the screw
Manufactured
retrieval
instruments

33
Explantation of dental implants
▸ Mobility of the implant
▸ Extensive bone loss
▸ Chronic pain
▸ Advanced peri-implantitis
▸ Fractured implant
▸ Malpositioned implant

Periodic maintenance
▸ After completion of implant treatment, follow up sessions for
maintenance and care should be scheduled.
▸ Oral hygiene aids for implant maintenance include manual
scalers, sonic and ultrasonic scalers, polishing devices, manual
and electric tooth brushes, dental floss, interproximal brushes
and antimicrobials.
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conclusion
▸ Failure of implant has a multifactor dimension.
▸ Often many factors come together to cause the ultimate failure of the
implant.
▸ One needs to identify the cause not just to treat the present condition
but also as a learning experience for future treatments.
▸ Proper data collection, patient feedback, and accurate diagnostic tool
will help point out the reason for failure.
▸ An early intervention is always possible if regular check-up are
undertaken
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References
▸ Misch’s Contemporary implant dentistry, Randolph R. Rensik, 4th ed.
▸ Complications of Immediate Implant Placement and its Management: A Review Article Seema S. Patil,
Arunachaleshwar S. Balkunde, Aditi Samant, Rupali Patil & Pankaj Kadam.
▸ Dental Implant Maintenance- “How to Do?” & “What to Do”- A Review Pardeep Bansal , Dhanya ,
Preetika Bansal , Harvinder Singh , Shanta
▸ The Dental Implant Maintenance Gayathri Krishnamoorthy.
▸ Maintenance of Full-Arch Implant Restorations , ACP
▸ Effect of Schneiderian Membrane Perforation on Posterior Maxillary Implant Survival, Nasser Nooh
▸ The role of systemic diseases and local conditions as risk factors, Henning Schliephake
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