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Dental implants have evolved over time and become an ideal replacement for a lost tooth or teeth. The long term success rate of dental implants is well over 95%. What once was a product offered to very few has now become a mainstream dental care service available to most.

Options For Dental Implants

Depending on each, unique, individual person, each dental implants case will be personalized. Depending on how many teeth are missing as well as the available quantity and quality of bone present. Below are some of the situations where dental implants can replace lost teeth:

-Loss Of A Single Tooth. At one time, this meant wearing a removable appliance (commonly called a “flipper”) or removing natural tooth structure from surrounding teeth to create a fixed bridge of dental crowns. The flipper tends to be uncomfortable to wear and may affect speech. The 3 unit bridge compromises the support teeth by having them do the work of the lost tooth, and by making them more susceptible to decay. The long term success rate is lowered due to difficulties in cleaning under and around the bridge. A single tooth dental implant, when completed properly, will last a lifetime and function just like a natural tooth.

-Loss Of Multiple Teeth. When missing multiple teeth in a single area, dental implants can be used to form a fixed bridge. The beauty of this arrangement is stability and the ability not to affect the natural teeth in any way.

-Replacing All Teeth. In the past, the only way to restore function was to fabricate a removable denture. With dental implants, dentists have the ability to restore natural function and esthetics.

Complementary Procedures To Dental Implants

There are times when other dental procedures are necessary to successfully complete the placement of dental implants. These include:

-Sinus Lift. When you have a large sinus area that impinges on available bone depth, the sinus lift is a common surgical procedure. Sinus lifts are needed to elevate the sinus membrane and thicken a part of the upper jaw with a bone graft. This helps give  a dental implant enough bone depth to place it properly in the area you need it. Dental implants need a good quantity of bone along with good, dense quality of bone to succeed. The upper jaw is known to have poorer quantity and quality bone structure as opposed to the lower jaw. The maxillary sinus also plays a role in increasing difficulty in this area. Sinus augmentation can remedy these issues by raising the sinus floor and placing bone grafts in the area to aid in dental implant placement.

-Bone Grafting. When the bone is not 100% adequate for dental implant placement, dentists are able to add to it by performing a dental bone graft. A bone graft is the placement of bone or bone-like materials in the jaw to to build it up. This gives an excellent platform for dental implants. Modification of the bone in this fashion has been shown to improve both appearance and long term success of dental implants. Typically, dentists try to place implants at least as deeply into bone as the crown or tooth will be above the bone. This is called a 1:1 crown to root ratio. This ratio serves as a guide for bone grafting in most situations.

Can A Dental Implant Fail?

It is quite rare for a dental implant to fail but when it does the dental implant must be removed. Then re evaluated as to why the failure occurred and to see if a new dental implant may be placed. Some of the common reasons for dental implant failure include:

-Failed Integration of Dental Implants - This occurs when the bone does not grow and fuse between the threads of the implant. This fusion of bone to dental implant is called osseointegration. If this does not occur, the dental implants will not function properly,will become uncomfortable, become loose, or come out completely. To reduce this risk, your dental surgeon will evaluate the quality and density of the jaw bone prior to surgery. This will help to only place dental implants in areas where there is a highly predictable success rate. If osseointegration does not take place, the dental implants can be removed, and surgery can be attempted again once the area has fully healed.

-Infection –  This is the most common complication of dental implant surgery. The surrounding bone and gums can get infected during the surgical procedure. This can happen due to non-sterile technique, a contaminated implant, poor healing ability(diabetic, smoker, osteoporosis medications), or pre-existing infection. The most likely time for this to occur would be during the surgical placement of the dental implant into the bone. Implant infection can occur after placement as well. Poor hygiene, too much force placed on the implant, or excess cement can cause the support tissue to breakdown. Implant infection is a condition referred to as peri-implantitis. Peri-implantitis is characterized by inflammation or swelling of the tissues surrounding the implant area. Peri-implantitis can also present as a secondary infection later on is a form of periodontal disease that can lead to inflammation, bone loss and implant failure if not treated quickly and properly. Although implant infections are usually caused by the presence of bacteria during or immediately after the oral surgery for the placement of the dental implants, an implant infection can occur months or years after surgery.

-Post Surgical Bleeding - Some bleeding following surgery is normal and should be expected for about 1-2 days. Biting gently on a gauze pad placed over the surgery area for 30 minutes should normally stop the bleeding. Excessive bleeding is not normal and you should notify your dentist immediately if you have concerns about your dental implants.

-Damage To Surrounding Tissues - Dental implant complications related with surgical errors affecting adjacent teeth, nerves or sinus are directly correlated with the experience and skills of the dentist or surgeon. An experienced and skilled implant dentist is able to identify potential problems by examining x-rays or CT scan (computer tomography), design the proper surgical plan for ideal location and angle, and execute it successfully without complications. Even with the most skilled implant dentist there is always a possibility of dental implant complications. The complications can be limited by choosing an implant dentist with the skills and experience necessary to handle any complications if they arise.

-Rejection – An extremely rare complication for dental implants but it has been noted in the research literature. The dental implants can sometimes be viewed as a foreign body.

-Unusable Dental Implants – An implant that has successfully integrated with bone, but the area or extreme angle of placement deem it unrestorable.

Dental Implants Conclusion

Dental implants have been the solution for many. They come with risks but with proper treatment planning from a well qualified dentist they can be a successful tooth replacement for a lifetime of smiles.

 

 

Peri-implantitis - is a destructive  process affecting the gums and bone surrounding dental implants. The various periodontal bacteria found surrounding failing dental implants (those affected by peri-implantitis) are very similar to those found in association with various forms of periodontal disease.

Peri-implantitis is a unique complication when dealing with dental implants. Dental implants have a very high success rate but do fail for various reasons. These can include failure to integrate with bone, poor oral hygiene by patient, rejection by the body, trauma, or peri-implantitis. Peri-implantitis becomes a factor in patients with poor oral hygiene, diabetes, smoking, and when there is residual cement stuck to the implant surface.  Peri-implantitis will cause the destruction of bone and gum tissue exposing part of the dental implant to the outside. This will cause the possibility for the dental implant to become less stable and cause the patient to lose the implant and restoration if not treated in a timely manner.

How Is It Diagnosed?

A dentist will use x-rays and measuring instruments to determine the level of the bone surrounding the dental implant. If it is found there is some level of bone loss beyond normal surrounding the dental implant, then the diagnosis becomes that of peri-implantitis. It is normal to see some minor bone loss 1-2 years out following placement of the dental implants. It should be no more than 1-1.5 mm in the first year and no more than 0.2 mm in each subsequent year. As stated earlier peri-implantitis of a  dental implant that goes undiagnosed will lead to complete failure and have to be removed.

Peri-implantitis can be diagnosed early or once clear clinical evidence has developed. The most common signs and symptoms are:

- Color changes of the gum tissue around the implant.

- Bleeding during brushing, probing or measuring.

- Increased pocket depth around the implant.

- Pus drainage from around the dental implant.

- Thinning of the tissue causing transparency around the implant..

- Progressive loss of bone height around the implant.

-X-rays showing loss of bone around the implant.

Peri-Implantitis Treatment Options

The course and success of treatment revolves around when the peri-implantitis is diagnosed. If the initial bone loss is limited there will be a higher chance of success in saving the dental implant. However, the later treatment begins the lower the chance of saving the dental implants. There are various methods used to treat peri-implantitis. All have varying degrees of success. These include the following:

-Mechanical Debridement (professional cleaning using instruments). A patient with dental implants must follow normal treatment schedules to maintain his/her dental implants. This includes regular dental visits. At these visits radiographs will be taken to ensure the dental implant and surrounding tissues are in a  healthy state. At these visits the patient will also undergo a professional cleaning for the dental implants and/or natural teeth. Dental implants require special tools for cleanings. The standard dental implant instruments used for cleaning include plastic, graphite, or gold tipped instruments. Ultrasonic tips may be used. The goal in cleaning the implant is to remove debris and bacteria without damaging the exterior coating of the dental implant.

-Perioscope. A microscope guided cleaning deep below the tissues to remove debris and otherwise  undetectable cement residue.

-Localized Drug Delivery. Since dental implants by nature have rough surfaces (to allow better integration with surrounding bone), removing infection tends to be quite a challenge using just hand instruments. It is recommended that a chemical anti microbial agent be used along side hand instrumentation. Recent studies have shown the combination of hand instruments and chemical agents have proven effective in eliminating peri-implantitis in its earliest stages. Drugs used can include chlorhexidine rinse, oral antibiotics such as tetracycline, minocycline, doxycycline hyclate, or Arestin, an antibiotic placed directly into the pocket.

-Bone regrowth factors. Emdogain can be placed along with bone grafting material to help stimulate new bone growth.

Conclusion

The primary goal once peri-implantitis has been diagnosed is to stop the disease process from progressing. If untreated, it will ultimately lead to loss of the dental implants. The #1 goal should be to see your dentist regularly to avoid the complication of peri-implantitis. It is important to note any signs that may be occurring so you can be proactive about your dental health.

Dental implants in dentistry have become a highly successful dental procedure. Most studies show that dental implants have a success rate of around 96-98% when placed properly. Dental implants have become a highly reliable procedure for the replacement of lost teeth. This means, almost all patients who undergo the procedure for dental

Dental Implants Marielaina Perrone DDS

implants with a highly competent surgeon, will have success. What about the other 2-4%? What can go wrong with dental implants?

Success of dental implants is related to the dentist or surgeons skill, quality and quantity of the bone available at the site, quality of materials used, the patient’s healing ability, and maintenance of good oral hygiene.

Possible Dental Implants Complications

-Failed Integration of Dental Implants - This occurs when the bone does not grow and fuse between the threads of the implant. This fusion of bone to dental implant is called osseointegration. If this does not occur, the dental implants will not function properly,will become uncomfortable, become loose, or come out completely. To reduce this risk, your dental surgeon will evaluate the quality and density of the jaw bone prior to surgery. This will help to only place dental implants in areas where there is a highly predictable success rate. If osseointegration does not take place, the dental implants can be removed, and surgery can be attempted again once the area has fully healed.

-Infection –  This is the most common complication of dental implant surgery. The surrounding bone and gums can get infected during the surgical procedure. This can happen due to non-sterile technique, a contaminated implant, poor healing ability(diabetic, smoker, osteoporosis medications), pre-existing infection. The most likely time for this to occur would be during the surgical placement of the dental implant into the bone. Implant infection is a condition referred to as peri-implantitis. Peri-implantitis is characterized by inflammation or swelling of the tissues surrounding the implant area. Peri-implantitis can also present as a secondary infection later on is a form of periodontal disease that can lead to inflammation, bone loss and implant failure if not treated quickly and properly. Although implant infections are usually caused by the presence of bacteria during or immediately after the oral surgery for the placement of the dental implants, an implant infection can occur months or years after surgery.

-Post Surgical Bleeding - Some bleeding following surgery is normal and should be expected for about 1-2 days. Biting gently on a gauze pad placed over the surgery area for 30 minutes should normally stop the bleeding. Excessive bleeding is not normal and you should notify your dentist immediately if you have concerns about your dental implants.

-Damage To Surrounding Tissues - Dental implant complications related with surgical errors affecting adjacent teeth, nerves or sinus are directly correlated with the experience and skills of the dentist or surgeon. An experienced and skilled implant dentist is able to identify potential problems by examining x-rays or CT scan (computer tomography), design the proper surgical plan for ideal location and angle, and execute it successfully without complications. Even with the most skilled implant dentist there is always a possibility of dental implant complications. The complications can be limited by choosing an implant dentist with the skills and experience necessary to handle any complications if they arise.

The following areas could be damaged:

1Surrounding Teeth - During the placement of dental implants, the dentist may damage the crown or the roots of adjacent teeth. Root canal therapy may be needed to repair the injured teeth. The dentist must carefully review the x-rays or CT-scan

Dental Implants Marielaina Perrone DDSbefore drilling because the teeth are not always in ideal positions. A skilled implant dentist will be prepared for any changes necessary.

2. Nerve Damage - While rare, this is a complication of implant surgery in the lower jaw (mandible). There is a nerve (inferior alveolar nerve) that runs through the lower jawbone that can be injured during dental implants placement. Nerve injury may cause pain, numbness or painful tingling in teeth, gums, lips, tongue or chin. Similar symptoms may occur if the implant is placed right on top of the nerve, causing severe pain when chewing down. If the nerve fails to heal and the symptoms persist, the dental implant will likely need to be removed. X-rays and CT scans can help the implant dentist to identify the exact location of the nerve and minimize the possibility of nerve damage.

3. Perforation into Sinus - This occurs during placement of dental implants in the upper jaw. This occurs during implant placement, when an implant is placed into the sinus cavity. With proper planning, the bone around the sinus can be grafted and lifted (sinus augmentation) to allow for the necessary length of the dental implants. To prevent this implant complication, the dentist must check carefully the CT scans and proceed with ‘sinus augmentation’ if needed to provide sufficient bone for successful implant placement.

4. Bone Fracture - Jaw fracture is another possible complication of dental implants placement. If there is not enough bone or bone density, the jaw can fracture under the pressure during the surgical placement of the dental implants (during drilling or implant insertion).

5. Inflammation - Inflammation and swelling of the surrounding tissues is the immediate symptom of implant infection. Improper placement or size of the abutment and crown restoration, that puts under pressure and traumatizes the soft tissues around or beneath it, may also cause dental implants complications. Dental implant inflammation triggers an inflammatory response from the body’s immune system that attacks gum tissues and surrounding bone. This can result in bone loss around the dental implant and if left untreated the dental implants will become loose and will need to be removed. The dentist has to eliminate the inflammation as soon as possible to prevent further bone loss that can cause dental implants failure. The inflammation can be treated by antibiotics and cleaning if caused by implant infection, or by removing or adjusting the defective restoration if caused by trauma.

Other reasons for failure of Dental Implants

-Rejection – An extremely rare complication but it has been noted in the research literature. The dental implants can sometimes be viewed as a foreign body.

-Unusable Dental Implants – An implant that has successfully integrated with bone, but the area or extreme angle of placement deem it unrestorable.

Dental Implants Conclusion

Implant dentistry has come a long way. It has become an almost routine procedure. Understand, that just because it is done often does not make it a simple procedure thatDental Implants Marielaina Perrone DDS anyone can do. Implant surgery is an intricate and comprehensive process that involves several stages. Treatment consults, treatment planning, and treatment procedures (which can include multiple surgeries) need to be undertaken with extreme care. General dentists DO NOT have the same training as surgeons, and are generally better at restoring the implants after surgical placement. As with all types of surgery, there are risks involved during both the actual dental implants procedure as well as during the recovery period. While most dental implant complications are quite minor, it is important to be aware of them prior to surgery. These complications can be minimized by choosing an implant dentist with the skill and knowledge to overcome any challenges that may come your way before, during, or after surgery. Choose your surgeon based on skill level and not price, and you will be much more likely to have a long term success.

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