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Implant Failure - Prosthodontist’S Eye View

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Implant Failure - Prosthodontist’S Eye View REVIEW ARTICLE Implant Failure - Prosthodontist’s Eye View Reddy Priyadarshini Department of Prosthodontics, GSL Dental College, Lakshmi Puram, Rajahmundry - 533 104, Andhra Pradesh, India Email for correspondence: [email protected] ABSTRACT With the concept of osseointegration, success of implants has drastically increased. This created awareness among the patients who wanted the edentulous site to be replaced with an implant. As said success and failure go hand in hand, failure after successful osseointegration of the implant results in psychological disturbance to the patient as well as the clinician, which adds additional procedures, duration, as well as cost. The present article gives a view over the prosthodontic considerations. Key words: Classifications, evaluation, fractures, implant failures, osseointegration INTRODUCTION tooth replacement using implant. With a predictably Over the decades, dentistry has emerged into a high success rates reported for implant-supported field with various scopes in treatment modalities. restorations, failures that require removal of One among them is implant dentistry, though implants do occur, which affects the clinician and evidence of use and success were reported since AD the patient. 600, the surge in implants for tooth replacement In the present scenario, where implant dentistry increased from middle of the 1900s.[1] is to be practiced through interdisciplinary Dental implant is a prosthetic device made approach, there were cases where implant is placed, of alloplastic material(s) implanted into the oral and after osseointegration, the prosthodontist tissues beneath the mucosal or/and periosteal layer, is called for prosthesis/crown placement. If and on/or within the bone to provide retention and any failure arises, then it is simply called the support for a fixed or removable dental prosthesis; prosthodontic failure. Is it really a failure due to a substance placed into or/and on the jaw bone the prosthesis and the prosthodontist? The present to support a fixed or removable dental prosthesis article briefs the prosthodontic considerations for (glossary of prosthodontic terms - 8).[2] implant failure. Implant failure is the inadequacy of host tissue CLASSIFICATION OF IMPLANT FAILURE to establish or maintain osseointegration. It is the Implant failures are classified based on the failure of the implant due to mechanical or biological time of failure, etiology, origin of infection, condition reasons.[3] Any prosthesis which does not serve the of failure, supporting tissue type, and according to purpose such as function, phonetics, and esthetics osseointegration concept. can be termed a failure.[4] According to Esposito .[5] Awareness regarding implants among the general population has increased to a level where 1. Biological failure: patients directly approach the dentist asking for Early or primary - inadequacy of the host tissue to establish or to maintain osseointegration Quick Response Code Article Info: Late or secondary - failure to maintain the achieved doi: 10.5866/2018.10.100047 osseointegration. Received: 02-01-2018 2. Iatrogenic failure - stable and well osseointegrated Revised: 25-01-2018 but cannot be loaded due to error in positioning Accepted: 07-02-2018 the implant and damage to underlying nerves. Available Online: 15-04-2018, 2017 (www. 3. Mechanical failure - implant fractures, fracture nacd.in)© NAD, 2017 - All rights reserved of the screws, and bridge framework. Journal homepage: www. nacd. in Indian J Dent Adv 2018; 10(1): 47-52 Implant failure - Prosthodontist’s view Priyadarshini According to Truhlar, Tonetti, and Schmid[6] •· At Stage II (With healing head and or abutment · Early failure - failure within 3 months of insertion) implant placement which may be due to altered •· After restoration. healing process. According to condition of failure (clinical · Late failure - after 3 months of implant and radiographic status) placement. •· Ailing implants - bone loss with deeper probing According to Askary[3] depth but stable at 3–4 months. According to aetiology. •· Failing implants - bone loss, increased probing depth, bleeding on probing, and signs of FAILURES BECAUSE OF HOST FACTORS inflammation but no mobility •· Medical status - osteoporosis and any other •· Failed implants - clinical mobility, peri-implant bone diseases; uncontrolled diabetes. radiolucency, and dull sound when percussed. •· Habits - smoking and parafunctional habits. •· Surviving implants. •· Oral status - poor oral hygiene maintenance, According to responsible personnel juvenile, and acute periodontitis, and irradiation •· Dentist (oral surgeon, prosthodontist, and therapy. periodontist) RESTORATIVE PROBLEMS •· Dental hygienist •· Excessive cantilever, pier abutments, no •· Laboratory technician passive fit, improper fit of the abutment, improper •· Patient. prosthetic design, and improper occlusal scheme, According to failure mode bending moments, connecting implants to natural •· Lack of osseointegration (usually mobility) dentition, premature loading, and excessive torquing •· Unacceptable esthetics are restorative problems that may lead to the implant •· Psychological problems. failures. According to supporting tissue type SURGICAL PLACEMENT •· Soft tissue problems (lack of keratinized tissues, •· Off-axis placement (severe angulation) inflammation, etc.) •· Lack of initial stabilization •· Bone loss (radiographic changes, etc.) •· Impaired healing and infection because of •· Both soft tissue and bone loss. improper flap design or others •· Excess heat generated during bone drills Heydenrijik .[4] - occurrence in time •· Inadequate irrigation •· Early failures - Osseointegration has never been •· Minimal space between implants established, thus representing an interference •· Placing the implant in immature bone-grafted sites with healing process. •· Contamination of the fixture before placement • Late failures - Osseointegration not maintained IMPLANT SELECTION implying processes involving loss of osseointegration •· Improper implant type in improper bone type. •· Soon late failures - Implants failing during the •· Length of the implant (too short, crown-implant 1st year of loading. ratio unfavorable) •· Delayed late - Failure’s implants failing in •· Diameter of the implant subsequent years. According to origin of infection CRITERIA TO EVALUATE THE FAILURE OF •· Peri-implantitis - infective process and bacterial AN IMPLANT[7] origin Schnitman and Schulman criteria (1979) •· Retrograde peri-implantitis - traumatic occlusion origin, non-infective, forces off the long axis, •· Mobility <1 mm in any direction premature, or excessive loading. •· Radiologically observed radiolucency graded, but no success criterion defined According to timing of failure •· Bone loss no greater than one-third of the •· Before Stage II (after surgery) vertical height of the bone Indian J Dent Adv 2018; 10(1): 47-52 Journal homepage: www. nacd. in Implant failure - Prosthodontist’s view Priyadarshini •· Gingival inflammation amenable to treatment; •· Radiograph that does not demonstrate evidence absence of symptoms and infection, absence of peri-implant radiolucency of damage to adjacent teeth, absence of •· Bone loss that is <0.2 mm annually after the paresthesia and anesthesia or violation of the implant’s 1st year of service mandibular canal, maxillary sinus, or floor of •· Individual implant performance that is the nasal passage characterized by an absence of persistent • Functional service for 5 years in 75% of patients. and/or irreversible signs and symptoms of Crainin, Silverbranch, Sher, and Salter pain, infections, necropathies, paresthesia, or Criteria (1982) violation of the mandibular canal •· In context of criteria mentioned a success rate •· In place 60 months or more of 85% at the end of a 5-year observation period •· Lack of significant evidence of cervical and 80% at the end of a 10-year observation as saucerization on radiographs a minimum criterion for success. •· Freedom from hemorrhage according to Muhleman’s index Esposito M, Hirish JM, and Lekholm Criteria [5] •· Lack of mobility (1998) •· Absence of pain or percussive tenderness •· Absence of mobility •· No pericervical granulomatosis or gingival •· Radiographic marginal bone loss of <1.5 mm hyperplasia during the 1st year •· No evidence of a widening peri-implant space •· <0.2 mm annually after the 1st year on radiograph •· Absence of pain or paresthesia. McKinney, Koth, and Steflik Criteria (1984) According to time period of failure - Jividen [8] Subjective criteria and Misch •· Adequate function •· Surgical failure •· Absence of discomfort •· Osseous healing failure •· Patient belief that esthetics and emotional and •· Early loading failure psychological attitudes is improved. •· Late implant failure Objective criteria •· Long-term implant failure. •· Good occlusal balance and vertical dimension EVALUATION OF IMPLANT FAILURE •· Bone loss no greater than one-third of the Clinical signs of failure vertical height of the implant, absence of symptoms, and functionally stable after 5 years •· During the early phase of healing, complications •· Gingival inflammation vulnerable to treatment such as swelling, fistulas, suppuration, early/ •· Mobility of <1 mm buccolingually, mesiodistally, late mucosal dehiscence’s, and osteomyelitis and vertically can occasionally be present which can lead to •· Absence of symptoms and infection associated disturbance in osseointegration process. The with the dental implant first sign of failure
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