Introduction

Welcome to Magadh Oro Dental’s blog, where we provide insights into dental care procedures. In this post, we’ll focuses on the common complications in treatments involving the use of implants and also considers the modalities for its management. The Implantologist should be fully aware of any possible complications prior to treatment and inform the patient accordingly. In most cases it is possible to avoid complications by careful attention to diagnosis, treatment planning and good surgical and prosthodontic planning

Abstract

Proper case selection and treatment planning are the keys to success of implants. The focus of implant research is shifting to the identification of factors associated with failure. Implantologist must have detailed knowledge regarding the complications and failures . Prompt management of these complications holds the key to the success of the implants. This article reviews the various complications that implantologist faces during implant surgery, It also throws light on the management of the complication. It is necessary to have knowledge regarding the complication as it is the Implant Surgeon to be blamed in case of implant failure.

Dental Implant Complications

Common Complications and Their Management:

1. Surgical Complications:

Nerve Damage:

Improper drilling in bone during implant placement can damage the inferior alveolar nerve, leading to numbness, tingling, or pain. Management involves proper planning, Taking OPG X-Rays and CBCT before doing procedure, observation, and in severe cases, nerve regeneration may be necessary.

Maxillary Sinus Issues:

Improper drilling in bone during Implant placement in the upper jaw can lead to sinus infections, pain, or pressure if the implant is placed too close to the sinus or if there's sinus perforation. Management may include antibiotics, surgical intervention (e.g., sinus lift), or implant removal.

Bleeding:

Surgical bleeding is a common occurrence. Initial control involves biting on gauze for 30 minutes. If bleeding persists, additional gauze, tea bags, or even further surgical intervention might be needed.

Infection:

Post-surgical infection is a serious concern. Management involves antibiotics, wound care, and in severe cases, implant removal.

Implant Failure:

Implant failure, including malpositioning, can occur due to various factors like inadequate bone quantity or poor technique. Management depends on the cause and may involve removal and re-implantation, bone grafting, or other procedures.

2. Long-Term Complications:

Peri-Implantitis:

This is an inflammatory process around the implant, leading to bone loss and potential implant failure. Early detection and management are crucial. Initial management may involve non-surgical debridement, while advanced cases may require surgical intervention and bone grafting.

Peri-Implant Mucositis:

This is a reversible inflammatory reaction in the tissues around the implant. It's important to manage it promptly to prevent it from progressing to peri-implantitis.

Implant Fracture:

Implant fracture can occur due to excessive occlusal forces or material fatigue. Management may involve removal and replacement with a new implant.

Cosmetic Issues:

Malpositioned implants can lead to esthetic issues like gingival recession or unacceptable aesthetics. Management may involve adjustments to the implant or abutment, or even removal and re-implantation.

Management Strategies:

Prevention:

Thorough patient evaluation, proper surgical technique, careful treatment planning, and patient education on oral hygiene are crucial for preventing complications.

Early Detection:

Regular follow-up appointments, clinical assessments (probing depth, bleeding on probing, mobility), and radiographic evaluation are essential for detecting complications early.

Prompt Management:

Aggressively managing complications as they arise is crucial to prevent further complications and maintain implant success.

Long-Term Care:

Ongoing maintenance, including professional cleanings, and patient education on oral hygiene and lifestyle habits, are important for long-term implant success.

Factors Affecting Complications:

Patient Factors:

Medical conditions like diabetes or uncontrolled periodontal disease can increase the risk of complications.

Surgical Technique:

Improper implant placement, excessive force during surgery, or improper handling of the implant can lead to complications.

Material and Design:

Implant material quality, design, and abutment selection can influence implant success.

By understanding the potential complications of implant dentistry and implementing effective management strategies, dental professionals can significantly improve the success and longevity of dental implants. 

A complication is a secondary condition that developed during or after implant surgery or prosthesis placement. It does not indicate that a substandard treatment was provided and also that an implant has failed. Prompt management of the complications is the key to implant success.

Implant Complication associated with Systemic Disorders and Medications 

The disease often leading to implant complications are:

Myocardial infarction

Alteration in blood and oxygen supply interferes with the process of osseointegration.

Smoking

Smoking increases the rate of implant complications.

Osteoporosis

The impaired bone metabolism as it occurs in osteoporosis may affect osseointegration of implants.

Diabetes

Studies of implants in the anterior mandible have shown 5-year survival rates of 88 to 94% in subjects with type II diabetes.

Paget’s disease

Paget’s disease has compromised bone density and may be contraindicated for dental implant surgery.

Parkinson’s disease

Poor motor control, often a cause of improper oral hygiene maintenance.

Cancer therapy – radiation

When implants are placed following irradiation, the failure rate may be higher.

Immunodeficiency: 

Long-term systemic steroids can induce osteoporosis, which should be considered in the risk–benefit assessment for implant therapy.

Complication associated with Implant Planning

Lack of proper diagnosis, patient history especially of the systemic conditions is often responsible for the complications of implants. Using too few implants can lead to occlusal overload and ultimate failure of the prosthesis. Patient’s motivation for cleanliness and implant maintenance also plays a vital role as poor oral hygiene can often result in peri-implantitis.

Tooth or root proximity to a planned implant site can cause adjacent tooth devitalization

 
Implant fenestration or dehiscence may occur due to improper placement of implant.

An adjacent tooth with an undiagnosed periapical lesion could lead to implant failure, when the infection spreads and reaches the implant surface.

Another factor of prime importance concerns vital anatomic structures. Structures of importance to note before beginning treatment are the proximity of the inferior alveolar canal, mental foramen, sinus, nasal
floor, and incisive canal. Anatomic variations can lead to perforations of the alveolar bone during treatment. This could lead to soft tissue and/or artery damage, with the ensuing complications 
 

Implant Complications related to Immediate Implant Placement into Extraction Sites

Most common complications that occur with immediate implant placement after extraction of the natural tooth include:

Poor implant positioning

Gingival recession

Membrane exposure during healing

Inadequate bands of keratinized tissue after healing
 

Classification of implant failure: 

There are two commonly used periods to assess an implant failure tharelate to the time of occurrence:

Early implant failures

Failures before osseointegration, primarily the result of surgical and/or postoperative complications.

Late implant failures

Failures after the osseointegration period, usually arising during and after the restorative phase.

Etiology and risk factors: Implant failure can be caused by several factors, including:

Infection

Tissue trauma

overheating of bone, pressure necrosis

Overload

transmucosal loading, occlusal trauma, Iatrogenic and improper angulations

Management of Complication of Implants

A detailed knowledge of the complication is essential. This will enable its prompt management and thereby ensuring implant success. Management of the stated complication is as follows:

Management of Systemic Disorder and Medication-related Complications

Proper case history and systemic evaluation
Stop the procedure, in case of complication, during surgery and seek medical help. It is wise to have nitroglycerine, adrenaline and oxygen handy
Proper postoperative antibiotic course
Regular recalls
Abstaining from habits – smoking.

Management of Complication associated with Implant Planning

Proper diagnosis, evaluation of patient and treatment planning
Necessary investigations should be thoroughly performed

Patient instructions should be given prior to surgery

Manufacturing instructions regarding implant placement should be followed.

Management of Implant Fractures

Three management options have been described in the event of implant fracture.

1.Complete removal of the fractured implant using explantation trephines.
2. Removal of the coronal portion of the fractured implant with the purpose of placing a new prosthetic post.
3. Removal of the coronal portion of the fractured implant, leaving the remaining apical part integrated in the bone.

Management of Peri-implantitis

Cumulative interceptive supportive therapy (CIST): Four-step procedure, along with antibiotics.

1. Mechanical debridement
2. Antiseptic treatment
3. Antibiotic treatment
4. Regenerative or resective therapy.

Removal of implant if mobile, entire length and circumference of implant involved.

Proper plaque control measures.

Management of Improper Angulations of Implants

Correct any implant malposition at the time of implant placement
Removal of implant if necessary (if angulation is not possible to correct)
Proper oral hygiene
In case of recession or membrane exposure, adequate bands of keratinized tissue can be created by flap positioning or connective tissue grafting at the time of or after implant placement.

Implant Complications related to Immediate Implant Placement into Extraction Sites

Correct any implant malposition at the time of implant placement
Removal of implant if necessary (if angulation is not possible to correct)
Proper oral hygiene
In case of recession or membrane exposure, adequate bands of keratinized tissue can be created by flap positioning or connective tis

Management of Complications related to Immediately loaded Dental Implants

If immediately restored implants are found to be mobile within a short time after placement, it may be possible to save them by eliminating or minimizing forces on them.
Regular recall appointments.

Implant Failures

Diagnose and identify the failed implant.
Note the clinical signs: Mobility, edema, pain, pus,
bleeding and radiographic signs of peri-implant bone loss.
In any case of implant failure where mobility is apparent, the implant should be removed immediately.
Replacement of failed implant.

Implant Maintenance

One of the key factors for long term success of implants is the maintenance of the healthy tissues around it. Implant should have accessible embrasure widths for maintenance with polished collars for prevention of plaque formations. Scaling is to be done delicately to avoid scratches with a plastic scaler. Chlorhexidine gluconate may be used as an irrigant. Patient must be asked to maintain plaque control. A soft or extrasoft toothbrush must be used. Use of floss and interdental aids may be encouraged

Bone loss and Survival of Implants

Bone loss around dental implants   - 0.1 mm bone loss 1 year following implant loading and 0.2 mm annually

Survival Rate                                     -  Functional survival for 5 years in 90% and 10 years in 85%, of cases respectively.

Conclusion

The ultimate success of implants is not only based on diagnosis, evaluation, treatment planning but also on having a knowledge regarding the complications of implants and their fruitful management. In short it is always better to remember: ‘Prevention is better than cure’ and ‘a stitch in time saves nine.’