Following on from my last article on treatment failures in periodontal therapy, I now want to look at dental implants.
My opinion is that, out of these two fields of dentistry, implant therapy throws up many more potential complications – particularly where patient expectations and emotions are running high.
Unlike periodontics, failures in dental implant therapy are, in my opinion, better defined. Successful implants integrate and the supra-structure solves the patient’s problems in the areas of function, aesthetics and self-confidence. Failed implant therapy may sit in one or all of these areas.
Most failures in dental implant therapy arise from poor planning, but for the sake of this article we will break potential failures into a number of areas:
Determining patient expectations is paramount. If their problem is purely aesthetic then dental implants may not be the best solution. Do not forget the other forms of dental restorations that may more appropriately solve the problem.
If the issue is functional then make sure the patient understands the new level of function that is achievable. If the problem is psychological do we really want to be treating this patient?
It is also important to determine the number of and ideal position for the implants and make clear to the patient the time, financial investment and degree of hassle that might be involved. Under-promise (realistically) and over-deliver.
There is a low but possible risk of failure of a bone graft or the implant/implants to integrate. The patient must be aware of this and no matter how low the real and perceived risk they must be prepared psychologically.
Surgical failure may also be related to implant positioning which can have a significant impact on the aesthetic result in the front parts of the mouth. This is the ideal stage for failure of the implant to integrate if it is to occur.
Early failure of a dental implant can be resolved more easily by removing it and placing another one after an appropriate wait. After the supra-structure is fitted it becomes more of an issue.
This can present in a number of ways. There may be fracture of the supra-structure (particularly removable upper over-dentures where the acrylic can be thin and has to bear more load than simple acrylic full dentures). Porcelain may chip, although rare dental implants may fracture. Another problem is that of screw loosening. Better mechanical understanding of the prosthetic implant interface is helping to make this less of a challenge.
Dental implants are not always the first choice for solving cosmetic problems. Loss of soft and hard tissues, poor implant positioning and high smile and laugh lines can result in poor cosmetic results.
Often the aesthetic result is in the eyes of the patient. Beware of unrealistic expectations. Failure can come in many guises. Plan, consent and execute carefully. Get to know the patient in front of you – then you are in a position to cover most of your bases.