What Can Go Wrong With Dental Implants?

Dental implants have emerged successfully as a treatment for providing replacement of missing teeth functionally, mechanically and esthetically. They do work by attaching prosthetic to the titanium posts that have been pre-inserted into the jaw bone. But as the successful outcome emerges, the negative implications along with the procedure have emerged too.

DURING:

• Failure in placement
• Implant breakage
• Nerve Injury
• Sinus perforation
• Fracture of bone
• Bleeding
• Aspiration

AFTER

• Infection
• Failed Osseointegration
• Loose dental implants
• Nerve damage
• Maxillary sinusitis

Failure In Dental Placement

this may be due to :

• Improper angulation
• Poor spaced implants
• Inadequate bone and tissue coverage for implant

This may lead to certain problems :

• Aesthetic problems
• Chewing issues
• Inability to maintain hygiene
• Difficulty in making restorations

Therefore, for a successful dental implant proper axis, depth, and angle needs to be assured.

Fracture Of Dental Implants

• This may be due to overloading of implants.
• May ne due to defect in Implant design
• Implants with smaller diameter are more prone to fracture.
• Tightening of implants more than the recommended torque.

Sinus Perforation

• The sinus membrane serves as a biological barrier from the oral cavity protecting the sinus from infection.
• If sinus lining is in proximation with the dental implant, during implant insertion or tapping the sinus lining may perforate and the implant may go inside the sinus.
• If it happens the immediate removal of the implant lodged in the maxillary sinus has to be done otherwise maxillary sinusitis or foreign body reaction may occur.

Nerve Injury

• Nerves most commonly affected – inferior alveolar nerve, infraorbital nerve, mental nerve
• Nerve damage can occur either during implant placement or during injecting anesthesia , while raising a flap.
• Three types of nerve injury occurs :
  
  • 1. Neurapraxia – There is no loss of continuity of the nerve; it has been stretched or has undergone blunt trauma. The paresthesia will subside, and feeling will return in days to weeks.
    2. Axonotmesis – Nerve is damaged but not severed; senation returns within 2 to 6 months.
    3. Neurotmesis – Severed nerve; poor prognosis for resolution of paresthesia.

Intra-operative Bleeding

• In patients who already have prolonged bleeding time like diabetic patients, patient on oral anti-coagulants, bleeding disorders
• Injury to inferior alveolar canal during drilling, tapping of implant when the implant is in close proximity to the canal.
• Control of the hemorrhage can be ensured by compressing the area with the implant or an abutment.

Fracture

• Although it is more common in atrophic mandibles as they are associated with diminished blood supply.
• May occur during implant insertion or during tightening of implants when adequate mandibular support is not provided.
• Radiological examination should be thoroughly evaluated for height and labial-lingual width of mandible.

Aspiration

Instruments like screw driver , healing caps, abutments are to be carried into their surgical site with extreme precaution because if they slip there are chances that patient might apirate/ swallow them and it will be a case of extreme emergency as airway patency can get compromised and these patient require immediate hospitalization.

Devitalization Of Adjacent Tooth

When there is not enough space in between adjacent tooth and implants.

Loose Dental Implants

The normal healing period of an implant is 3-6 months during which osseointegration occurs. If the implant is loose, it means it has lost integration with bone and is no longer in contact with it. It may be due to many reasons :

• Infection post-surgery
• Inadequate amount of bone available
  Micro-motion during loading the implant
• Poor surgical technique during placement
• Over preparation of the site
• Traumatic surgery
• Smoking after the procedure
• Poor oral hygiene

Peri- Implatitis

It is the inflammatory change that takes place in the soft and hard tissues surrounding an osseointegrated implant.
The causes may be :

• Contamination of implant via accidental contact with the implants or indirectly from gloves or instruments.
• Improper soft tissue closure can lead to bacterial contamination around the bone resulting in destruction of the tissues surrounding the implant.
• Unequal occlusal load distribution, which may lead to loosening of the implant and chances of infection in the surrounding area increases.
• Patient unable to maintain oral hygiene
• If a patient is chronic smoker or alcohol consumer

Post – Operative Bleeding

Laceration of tissues caused by tight or sharp suture material or by incorrect suturing technique

Masticatory trauma

Secondary hemorrhage can occur due to loosening of sutures.

Maxillary Sinusitis

• Close approximation of Sinus to the dental implants and wound dehiscence in that area can lead to bacterial contamination and inflammation of maxillary sinus.
• Displacement of implant into the sinus may cause a foreign body reaction.
• Use of decongestants with antibiotics and clearing off the etiologic factor is essential along with sinus drains.

Failed Osseointegration

One of the worst complications as it result in total retrieval of implants.

• Failure to follow complete sterilization protocols
• Contamination of implants either accidently or with gloves or fingers during placement
• Overheating during drilling above 47 degree celcius in 1 minutes
• Decreased healing potential due to underlying systemic disease

Dental implant placement procedure is not easy as it may seem. The procedure is always associated with a series of complication that can