Implant Complications: Prevention and Management

What is the role of the GDP for implants?

• Patient assessment & advice on tooth replacement

• Establishing oral health

• Referral

• Monitoring implant health & function, providing supportive care

What criteria suggests the 'success' of dental implants?

Albrektsson et al. 1986

• Clinical immobility

• No peri-implant radiolucency

• Vertical BL <0.2mm annually after first year

• Absence of pain, infection, neuropathy etc.

• In the context of the above, min success rates of 85% after 5yrs & 80% after 10yrs.

What are the types of implant complications? (4)

- biological

- mechanical

- aesthetic

- multi-factorial

How should implant health be monitored?

• Symptoms

• Visual inspection of peri-implant soft tissues

• Probing Depth

• Bleeding

• Suppuration

• Mobility

Probing dental implants:

How should clinical signs be interpreted when monitoring aspects of implant health? Probing depths

• "Normal" probing depths around anterior implants can be deeper than expected around teeth.

• Increasing probing depth is signif

How should clinical signs be interpreted when monitoring aspects of implant health? BoP

Small amounts of BOP are not uncommon, however brisk BOP should be regarded as a sign of inflammation

How should clinical signs be interpreted when monitoring aspects of implant health? Suppuration

always significant

How should clinical signs be interpreted when monitoring aspects of implant health? Mobility

• Implants should be immobile

• Clinical mobility may be due to loss of implant integration or a prosthetic failure

What are the different biological complications of implants?

- peri-implant mucositis (inflammation, no BL)

- peri-implantitis (inflammation, BL)

- biofilm related diseases

> These conditions result from the presence of biofilm adjacent to the peri-implant mucosa

Peri-implant mucositis:

- Inflammation in the peri-implant soft tissues

- Plaque-induced gingivitis w/ oedema

- No BL

Peri-implantitis:

- Inflammation in the peri-implant soft tissues

- Chronic periodontitis in tissues surrounding osseointegrated implant

- BL

'saucering'

How could peri-implant disease be prevented?

• Control of risk factors: oral hygiene, periodontal disease, smoking

• Regular supportive visits

• Prosthesis design: facilitates OH

• Cement

• Sufficient keratinised tissue: facilitates OH

How should peri-implant mucositis be managed?

• Pt-performed plaque control

• Professional debridement

• Restoration modification

Instrument...

How should peri-implantitis be managed?

• Surgical Access

• Granulation tissue removal

• Implant surface decontamination

• Implant surface modification?

• Bone Regeneration?

• Implant removal

Implant surface decontamination:

Implantoplasty

- Adjunct to surgery in peri-implantitis treatment

- Removal of the windings & rough surface of the contaminated implant & a subsequent polishing

- Aim to obtain smooth implant surface for better pt biofilm control

Mechanical complications:

- breakage of screw &/or abutment

- can usually be managed

What aesthetic complications may present?

• Prosthetic Errors

• Soft tissue deficiencies:

> Pre-existing

> Labial recession/uneven contour

> Lack of papillae

3D implant position

Failure of integration:

• Rapid & complete loss of integration

• Early (before loading) - Intra-operative trauma?

• Later: overload?? host factors?

>1.5mm between implant and adjacent tooth:

- Bone remodelling cannot extend all way through whole bone

- Needed for stability of interdental papilla