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avoid dental implant complications with dialogue

Complications

What are complications with implants?

Complications associated with a dental implant treatment are unanticipated problems that arise during or following the treatment. Even if your dentist identifies most of the risks and mitigates them, there is still the possibility that unforeseen events could occur.


Complications with implants

How common are complications with implants?

Complications with dental implants are part of routine dental implant treatment. In fact, an estimated 17% of people undergoing single dental implant treatments will experience complications, however, their overall success rate still remains at 97% [1]. The overall high success rate means that a complication is not something to fear. Still, this is where your dentist’s expertise and resources play an important role in making sure that the complications you may experience do not impact your treatment outcome negatively.

“There is a trade-off between more complex procedures that can yield optimal aesthetic results and an increased risk of complications.”[2].

The risks associated with a dental implant procedure also varies depending on the level of difficulty. You can choose a dental implant treatment involving a higher risk of potential complications to occur or you can choose a more conservative approach including a lower risk of complications. Just remember to think carefully about the outcome you wish to have and to set your expectations accordingly.


Example of complication with implant: peri-implantitis
Fig 1: Peri-implantitis illustrated on the left side of the implant

What are the most common complications with implants?

There are many different causes of complications with implants during and following dental implant treatment[15]. Some of the more common complications include:

Peri-implant Diseases: Mucositis and Peri-implantitis

One of the most frequent complications with implants is mucositis, which if left untreated evolves into peri-implantitis (Fig. 1)[3]. It is the infection of the gum and structure surrounding the implant (i.e. the peri-implant gingiva) and is caused by an accumulation of bacteria (e.g. biofilm, plaque) [4,5,6].

When the disease is diagnosed at its early stage (mucositis) nonsurgical options can stop it. Typically your dentist or dental hygenist would then schedule you in for a set of interventions where they clean your teeth and remove plaque as well as disinfect and seal the pocket. This together with a good dental hygiene program should normally make your infection disappear.

However, if left untreated, the mucositis could transform into peri-implantitis. This means that the infection has spread towards the implant, where it attacks and resorbs the bone. It is not clear how common peri-implantitis is but it is very serious [7,8,9]. In a worst-case scenario, the resorption of bone could result in implant failure, meaning you would lose the affected implant. In order to prevent further bone resorption, you would undergo surgical or non-surgical removal of the bacterial plaque. Then, if needed, you might require a regenerative procedure [10, 11,12,13], such as bone grafting.

It is frequent to experience a relapse after once having had peri-implantitis. However, regular follow-ups will help to ensure early detection and the use of biomaterials to enhance your healing could limit the risk of relapsing [14].

Treatment Plan Related Complications

For example, selecting the correct sized dental implant with the right connection to the dental prosthesis as well as embedding the implants at the correct angle, in the right position, with a solid foundation of bone is integral to the successful outcome of your implant treatment.

Anatomy-Related Complications

Injuries to the nerves, adjacent teeth and sinus perforation are examples of anatomy-related complications.

Chewing Forces (e.g. bruxism)

Teeth grinding and constant pressure on an implant can lead to it becoming unstable and loosening.

Lifestyle Habits (e.g. smoking)

For example, smoking is a major risk factor for dental implant failure.

Medical Conditions (e.g. diabetes)

Chronic health conditions such as uncontrolled diabetes, or conditions that interfere with the body’s ability to heal, can influence your risk of dental implant complications.

Ongoing Medical Treatments

Certain treatments you may be undergoing (e.g. radiation, bisphosphonate, chemotherapy) may influence your likelihood of dental implant complications.

The Dentist’s Approach

Different types of surgery (e.g. one-stage surgery, bone augmentation, guided surgery) carry different degrees of risk.

What can you do to limit complications?

Select a good dentist whom you trust and have good communication with. This will help you to be open and share important details with your dentists and give them the best understanding possible of your medical history, physical state, dental condition, and expectations for getting treated. The more details you share with your dentist, the better they will be able to anticipate your risk of complications[15].

Another important element in selecting a dentist is to find a dentist with expertise in treating dental indications similar to yours. A dentist who regularly performs the same type of treatment will know what complications to look out for, what questions to ask you, and is often well-equipped.

One point to discuss with your dentist is how your lifestyle habits could affect your risk of complications. For example, smoking has been associated with a higher risk of complications. Therefore, ideally, if you are interested in a dental implant treatment you should quit smoking to improve your chances of a successful treatment outcome [15].

Another important point to discuss with your dentist is the risks versus benefits of different treatment options available to you. You want to make sure that the benefits of your treatment outweigh the potential risks. This will help you select a dental implant treatment you feel comfortable with.

complications with implants

Maintaining good dental hygiene will also help to minimize your risk of complications. In fact, your dental implants should be taken care of with as much care as your natural teeth. The build-up of plaque and bacteria around the implant could result in an infection. An infection requires either manual or surgical treatment.

Another important point is to comply with your dental practitioner’s after-care instructions [15]. For example, there are stages of recovery from your dental implant surgery that need to be taken very seriously. During each stage of your healing period, you often have different types of food restrictions put on you and things for you to consider. Eating foods that are too hard could lead to excessive pressure put on your implant and cause the implant to shift. This can impact the outcome or mean that you would need to undergo surgery once more to fix the problem.

If you suspect to have an infection or experience discomfort, then go to see your dentist as soon as possible. Many complications can be mitigated without the need for additional surgery if detected early. Also, the earlier you address a complication the more likely it is not to have a long-term impact on your treatment outcome. For example, if you detect an infection at the implant site early enough this can often be managed with excellent dental hygiene whereas if detected late you could risk losing your dental implant and have a higher risk of recurring infections.

What can your dentist do to limit complications?

The more time the dentist spends on diagnosis and planning, the lower the risk of complications with dental implants. For example, some dentists only take 30 minutes for your first consultation whereas others take up to an hour.

During the planning phase, your dentist envisions your best possible treatment outcome and the way to reach this goal. Another important aspect is for the dentist to minimize your risk of unexpected events and having contingency plans in case of unforeseen events. You will see in the discussion with your dentist how well prepared they are when explaining to you the possible complications they foresee and how they would address them if they were to occur.

In addition, the equipment used to plan your treatment can impact the level of information a dentist gets. For example, a CBCT (3D scanner) can help your dentist discover a lack of bone volume, which would impact their treatment plan.

The material used can also affect the risk of complications. When receiving the treatment offer you will also be able to see what brand and type of dental implant your dentist will use. It is important for your dentist to select the correct sized implant, with the right connection to your dental prosthesis. Learn more about the importance of a good dental implant here.

Finally, the experience of your dentist plays a big role. A successful outcome is dependent on your dentist being able to embed the implant at the correct angle, in the correct position, and making sure that there is enough bone volume present to provide a good foundation for the implant.

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[2] Jemt T, Olsson M, Franke Stenport V. Incidence of First Implant Failure: A Retroprospective Study of 27 Years of Implant Operations at One Specialist Clinic. Clin Implant Dent Relat Res. 2015 Oct;17 Suppl 2:e501–10. doi: 10.1111/cid.12277. Epub 2014 Dec 23.sr

[3] Costa FO, Takenaka-Martinez S, Miranda Cota LO, Diniz Ferreira S, Magalhães Silva GL, Costa JE. Peri-implant Disease in Subjects With and Without Preventive Maintenance: A 5-year Follow-Up. J Clin Periodontol. 2012 Feb;39(2):173-81. doi: 10.1111/j.1600-051X.2011.01819.x. Epub 2011 Nov 23.

[4] Pontoriero R, Tonelli MP, Carnevale G, Mombelli A, Nyman SR, Lang NP. Experimentally Induced Peri-Implant Mucositis. A Clinical Study in Humans. Clin Oral Implants Res. 1994 Dec;5(4):254-9. doi: 10.1034/j.1600-0501.1994.050409.x.

[5] Augthun M, ConradsG. Microbial Findings of Deep Peri-Implant Bone Defects. Int J Oral Maxillofac Implants. Jan-Feb 1997;12(1):106-12.

[6] Quirynen M, Vogels R, Peeters W, van Steenberghe D, Naert I, Haffajee a. Dynamics of Initial Subgingival Colonization of ‘Pristine’ Peri-Implant Pockets. Clin Oral Implants Res. 2006 Feb;17(1):25-37. doi: 10.1111/j.1600-0501.2005.01194.x.

[7] Saaby M, Schou S. Factors influencing severity of peri-implantitis. Clin Oral Implants Res. 2016 ; 27: 7-12

[8] Stefan RENVERT, Marc QUIRYNEN: Risk indicators for peri-implantitis – A narrative review. Clin Oral Implants Res. 2015; 26, S11: 15-44

[9] Andrea Mombelli, Nada Muller, Norbert Cionca. The epidemiology of peri-implantitis – Literature review. Clin Oral Implants Res. 2012 Oct; 23 Suppl 6: 67-76.

[10] Schwarz F & Becker J, Peri-implant Infection: Etiology, Diagnosis and Treatment. Quintessence Publishing 2007 (Book).

[11] Jepsen S, Berglundh T, Genco R, Aass AM, Demirel K, Derks J, Figuero E, Giovannoli JL, Goldstein M, Lambert F, Ortiz-Vigon. Primary Prevention of Peri-Implantitis: Managing Peri-Implant Mucositis. J Clin Periodontol. 2015 Apr;42 Suppl 16:S152-7. doi: 10.1111/jcpe.12369.

[12] Polyzois A I, Salvi GE, Schwarz F, Serino G, Tomasi C, Zitzmann NU. Primary prevention of periimplantitis: managing periimplant mucositis. J Clin Periodontol 2015; 42 (Suppl. 16): S152–S157. doi: 10.1111/jcpe.12369.

[13] Costa FO, Takenaka-Martinez S, Cota LO, Ferreira SD, Silva, GL, Costa JE ‘Peri-implant disease in subjects with and without
preventive maintenance: a 5-year followup.’ Journal of Clinical Periodontology 2012; 39, 173– 183.

[14] Pirnazar P, Wolinsky L, Nachnani S, Haake S, Pilloni A, Bernard GW. ‘Bacteriostatic effects of hyaluronic acid.’ J Periodontol 1999;70:370–4

[15] Curtis DA, Lin GH, Fishman A, Sadowsky SJ, Daubert DM, Kapila Y, Sharma AB, Conte GJ, Yonemura CY, Marinello CP, Kao R. Patient-Centered Risk Assessment in Implant Treatment Planning. Int J Oral Maxillofac Implants. 2019 March/April;34(2):506–520. doi: 10.11607/jomi.7025. Epub 2019 Feb 4. PMID: 30716143.