Dental Implants constitute today the most stable form of rehabilitation of partially and completely edentulous jaws. Although scientifically and clinically proven to have a high success rate of around 90-95%, dental implant failures also are not uncommon in dental practice. These dental implants when inserted into jawbones are retained for a long time because of the intimacy of bone growth on their surface. Biological failure occurs when osseointegration is not established or is not maintained.
The dental implant failures can be early when the osseointegration fails before or at the time of abutment correction or late depending failure happens post osseointegration at any time after abutment connection. In case of failed osseointegration, clinically the implant will be mobile and radiographically a peri-implant radiolucency can be seen. In any case, the prospect of failures related to a dental implant is frightening for both dentists and patients. Such failures jeopardize clinician’s efforts to accomplish satisfactory function and esthetics. On the other hand, for patients results in further expenses and additional treatments. Therefore, adequate preparation to promote the establishment of osseointegration and its long-term preservation is obviously necessary to avoid implant failure. Adoption of some key measures both on the dental clinicians and patient part could lead to the prevention of such dental implant failures.
This blog will discuss some key measures which if taken into consideration will prevent dental implant failures.
10 Strategies to prevent dental implant failures:
1. General Health
Careful patient selection during the planning phase of dental implant placement is paramount to foresee the success of the dental implant. Careful consideration should be given to patients suffering from a systemic disease like diabetes mellites or conditions which interfere with the bone formation or wound healing. Also, patients who are on steroid therapy or immunosuppressive drugs which have been associated with impaired wound healing should be properly evaluated as they can lead to implant failure.
Several published scientific literatures have vouched for the fact that smokers have almost two times the chance of dental implant failure as compared to non-smokers. Also, the chances of failure in the upper jaw are more as compared to the lower jaw. Therefore, abstinence from smoking is imperative to prevent dental implant failure in the future.
3. Assessment of bone quality and anatomical factor
The success of dental implant is highly related to the bone quality where it’s inserted and site has been proven as a key factor irrespective of implant loading. Studies have shown that implants placed in the maxillary bone as compared to the mandibular have drawn more failures. Also, failure rates are high if placed in the posterior part of jaws as the bone volume is restricted due to the presence of neurovascular bundles. Therefore, the selection of amicable site is important to prevent dental implant failures.
4. Oral Hygiene
Meticulous oral hygiene is of paramount importance whether any prosthesis placed or not. In fact, in case of any the prosthesis its role even increases. Most often the main cause of implant failure is due to non-maintenance of adequate oral hygiene. This causes accumulation of microorganisms leading to peri-implantitis and implant failure. This can be prevented by brushing teeth at least twice daily with soft the tooth brush and flossing every night before going to bed. Also, additional attention should be given towards the cleaning of abutments so that trapped biofilm can be removed. In some cases, antibacterial mouth rinses could also help in reducing bacterial load.
Scientific literature has mentioned patient undergoing therapy as having a high risk of dental implant failure as such treatment impairs the vascularity of jaw bone. The rate of such failures is high in the upper jaw as compared to the lower jaw. Therefore, careful patient history is important to prevent failure of the dental implant if placed in such patients.
6. The surgical technique used
Dental implant failure can also be prevented by adopting as possible an atraumatic technique during implant placement. Proper use of drilling machine and profuse use of irritant is crucial during its placement. In case of non-compliance of such technique lead to increase of temperature over 47 degree celsius, which can lead to a zone of the necrotic bone surrounding the implant which ultimately impairs osseointegration leading to implant failure.
7. Number of Implants placed
As part of the loading consideration, a sufficient number of correctly placed implants should be designed. Excess loading may cause undue stress to the supporting bone leading to a biological failure (osseointegration) and mechanical failure. Studies have shown a better success rate of three or more implants than two in case of rehabilitation of a patient who is partially dentate as they share the load which prevents their failure.
8. Type of implant used
The surface characteristics of dental implants like surface roughness and the type of coatings used also influence the failure pattern. Various surface modifications have been introduced which has led to improved osseointegration and thus has reduced the failure rates of dental implants.
9. Microbial contamination and antibiotic prophylaxis
Often it has been seen that failure to maintain a high standard of cross-infection control mechanism led to implant failure. In the patient with high plaque score, such a situation led to enhance contamination and accumulation of micro-organisms which ultimately drive to peri-implantitis and dental implant failure. Therefore, every attempt should made to minimize such cross-infection like use of antibiotic prophylaxis prior to dental implant placement, shorted length of surgery, use of solid implants instead of hollow ones, etc.
10. Implant loading
Timing of loading of implants is also a key factor in determining the success of dental implants. It has been suggested that to prevent dental implant failure there should be no loading during the healing phase of 3-4 months in the lower jaw and 6-8 months in the upper jaw. Also, immediate loading has been seen resulting in high failure. Therefore, these considerations should be kept in mind when planning about dental implants.
Overall, dental implant failure happens in less than 5 % of cases of which most of them preventable. Careful planning from the dental Implantologists, proper placement of dental implants in due considerations of patient factors, and optimal maintenance of oral hygiene on patient part is essential in the prevention of failure of dental implants.