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International Journal of Advanced Dental Research SUCCESS AND Verma AK et al. / International Journal of Advanced Dental Research , 2016;1(1):01-04. e - ISSN - 2349 - 8005 International Journal of Advanced Dental Research Journal homepage: www.mcmed.us/journal/ijadr SUCCESS AND FAILURE OF DENTAL IMPLANTS Verma AK1, Ali Mariyam2, Katiyar Pratibha3, Gaur Abhishek4, Ahmad Naeem4, Tiwari Arun Kumar 5* 1Professor and HOD, 2Professor, 3Reader, 4Senior Lecturer, 5PG Student, Department of Prosthodontics, CPGIDS, Lucknow, Uttar Pradesh, India. Corresponding Author:- E-mail: [email protected] Article Info ABSTRACT Received 15/01/2016 Implant dentistry is currently being practiced in an atmosphere of enthusiasm and optimism, because Revised 27/01/2016 our knowledge and ability to provide service to our patients has expanded so greatly in such a short Accepted 10/02/2016 period. Complications do arise in implant dentistry. These are more often due to aging, changing health conditions, long-term wear and tear, poor home care and inadequate professional maintenance. Key words: Success cannot be guaranteed, what one can guarantee is to care, to do ones best and to be there to Implants, help in the rare instance that something goes wrong, patient appreciate and benefit from straight talk. Osseointegration, This review article presents a view of the complication that arise in the stages of diagnosis, patient Occlusion, Primary selection, counseling, per-operative procedures, surgical procedures, post insertion and maintenance stability. stages and their prevention and remedies. INTRODUCTION Dental Implant – "A substance that is placed into the jaws Peri-implant mucositis – A term used to describe to support a crown, or fixed or removable denture". Ailing reversible inflammatory reactions in the mucosa adjacent Implant – "An implant that may demonstrate bone loss to an implant [1,2]. with deeper clinical probing depths, but appears to be stable when evaluated at 3-4 months interval. A lamina LITERATURE REVIEW: Egyptian time – used to dura may be present at the borders of osseous defect, implant extracted teeth of poor /slaves who would sell it possibly indicating a static of chronicity". Failing Implant off. When human teeth not available they started using – "An implant that may demonstrate bone loss, increasing animal teeth e.g. goats, dogs and monkeys. Sea shells were clinical probing depth, bleeding on probing and also used. 1886 – Bugnot attempted to use tooth buds and suppuration. This bone loss may be progressive". Failed transplantation of teeth was tried. 1940 – Farmaggini Implant – An implant that demonstrates clinical mobility, a developed screw type of implants. 1952 – Dr. Branemark, peri-implant radiolucency and a dull sound when orthopaedic surgeon, Sweden found that Titanium implant percussed. Early failures – Occurs weeks to few months can be used for bone anchorage (he was doing research of after placement, caused by factors that can interfere with microcirculation in box repair mechanism in rabbits) [3]. normal healing process or an altered host response. Late 1952 – Osseointegration introduced by Branemark. 1962 – failures – Arise from pathological processes that involve a Cr-Co implant, failed. 1967 – Hodosch used acrylic resin previously osseointegrated implant. Peri-implantitis – An in tooth form. 1966 – Linkow introduced blade form inflammatory process that affects the tissue around an implants (Cr-Co-Vanadium). Charles weiss – Fibro- osseointegrated implant in function and results in loss of osseous integration. He claimed that fibrous tissue will act supporting bone. as periodontal ligament. 1980 – Dr. J.P. Branemark 1 Verma AK et al. / International Journal of Advanced Dental Research , 2016;1(1):01-04. brought his research to America. American technology recordings that a hard or rigid object. Recordings range quickly adapted these principles. from 8 to +50 numbers. Teeth with absence of mobility –8 to +9. The bone density around the implant may be Criterias for success of a dental implant; by correlated with these numbers. Alberktsson: Immobile, Per-implant radiolucency, Vertical bone loss Percussion: It is neither an indication of clinical health nor <0.2mm, first year. of rigid fixation. Therefore the ranging sound that occurs Absence of pain, infections, neuropathies, on percussion will be same for both 2 mm of bone and paresthesia, or violation of mandibular canal, Success rate 16mmof bone-implant interface. It can be used to diagnose of 85% - at end of 5 yrs, 80% - at end of 10 yrs[4]. pain, tenderness with an implant, but it is misleading if used to determine the status of rigid fixation. Other Criterias by Misch: Longevity & Pain [5] Unlike the tooth the implant is never temperature Bone Loss: Crestal bone loss in initial therapy is an sensitive, hence early warning signs and symptoms are indicator of the need for initial preventive therapy. absent. Percussion with forces of 500gm is clinically used Whenever possible implant should be placed at above the to evaluate tooth/implant pain/discomfort. Presence of pain level of bone crest to avoid an increase in sulcus depth requires removal of implant pain from rigid implant is subsequent to abutment placement. early problem, where pain from mobile implant can occur early /late in treatment. Tenderness to percussion Initial bone loss – is due to occlusal traumatic stress, usually implies healing proximal to nerve /bone stress parafunction. beyond physiologic limits. If implant tenderness immediately post-surgery occurs in proximity of inferior Secondary bone loss – due to bacteria and increased alveolar canal – implant unthreaded for few mm and re- stress. evaluated after 3/more wks for symptoms. If tenderness is In threaded implant – the distance between each thread after stage-I healing and not due to surgical encroachment (thread pitch) is usually 0.6mm and can be used as on an anatomic landmark, stress may be the causative radiographic marker. element. In general if bone loss is more than the one-half of implant height is said to be failure regardless of original Rigid Fixations: It means absence of observed clinical amount of implant-bone contact. mobility. A normal tooth moves 56 to 73 m. The healthy implant moves <75 m that means it has '0' clinical Radiographic Evaluation: One of the easiest clinical mobility. Lack of mobility does not always indicate direct tools to assess the implant crestal bone loss. It only bone-implant interface. It means at least a portion of an illustrates mesial and distal crestal levels clearly however, implant is in direct contact with the bone, although early bone loss is more on facial aspects. Parallel IOPA is percentage of bone contact cannot be predicted. Mobile very difficult to take with implant therefore apex of implant indicates presence of connective tissue between implant will be apical to tooth and muscle attachment. implant and bone. Mobility may be due to trauma/ bone Bitewing and periapical radiograph without apex are best loss. to assess the crestal bone loss. Both the region the thread area must be very clear, if these borders are fuzzy then Technique: To assess mobility is almost same to natural radiograph is not said to be diagnostic for crestal bone loss teeth. Two rigid instruments apply labio-lingual force of assessment. Peri-implant radiolucency-indication of failure approximately 500gm. This can be graded as; may be due to bacteria infection, non-rigid fixation, local 0 – Absence bone healing disorders, dehiscence, contamination of drill, 1 – Detectable horizontal movement overheating of bone. 2 – Visible mobility up to 0.5mm horizontally 3 – Severe horizontal movement >0.5mm Classification of Complications: 4 – Visible moderate to severe horizontal and any visible Swedish team (Branemark et al) vertical movement. I. Loss of bone anchorage Tooth with mobility of 0.5mm, which was due to Mucoperiosteal perforation occlusal trauma may revert back to normal rigid fixation Surgical trauma by removing the cause, but this rarely occurs in implants. II. Gingival problems An implant with >0.5 mm mobility should be removed. Proliferative gingivitis. Fistula formation Periotest: Periotest (Siemens Corporation) is a computer III. Mechanical complications mechanical device developed by Schulte that measures the Fixture fractures dampening effect of objects. It develops a force of 12 to 18 Fracture of prostheses, gold screws, abutment gm/n. The soft surface or mobile object will give higher screws [6]. 2 Verma AK et al. / International Journal of Advanced Dental Research , 2016;1(1):01-04. UCLA team (Beumer. Moy) Occlusal design: Narrow occlusal table, Centric contacts 1. Complications in stage I surgery over implants, Lingualised occlusion Mental nerve damage Strategic Extractions: Periodontaly compromised Penetration into a sinus, nasal cavity or through inferior abutments should be extracted. border of the mandible. Excess counter sink Single implant restorations: Problems include loose Thread exposure screws, Fracture of screws, Loss of osseo-integration, Eccentric drills, taps Fracture of implants. Stripping of threads Jaw fracture Soft Tissue Complications: Exposure of cover screws Ecchymosis, more common in older patients because of Open wound, Residual suture material, poorly Wound dehiscence adjusted denture so a Sore spot. Facial space abscess, submental, submandibular abscess, Ludwig’s angina Mechanical complications and management: Suture abscess i) Fixture fracture: Remaining portion should be Loss cover screw. surgically removed with trephine bur. Fractured
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