implants complications and failures.pptx

Implant

1. Implant complications and failures Presented by: Asra Ahmed JR III Dept of Prosthodontics and Crown & Bridge

2. Introduction The success rate of dental implants has increased over a period of years as a treatment option for the rehabilitation of missing teeth. Risks and complications have been identified with dental implant failure though there is continuous innovation in implant systems and various interceptive treatment modalities. 2

3. Diagnosing Between Ailing And Failing Of Dental Implants 3

4. Systemic risk factors 5

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6. I mplant success criteria Schnitman and schulman,1979: Mobility less than 1 mm in any direction. Radilogically observed radilucency graded Gingival inflammation amenable to treatment, absence of symptoms and infection, absence of damage to adjacent teeth, absence of parasthesia and anesthesia or violation of the mandibular canal, maxillary sinus or floor of the nasal passage 7

7. McKinney et al. 1984: 8

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9. I ntra-operative complications 10

10. 11 Mal-positioned initial osteotomy site

11. Bone resorbs from facial to lingual, in some cases after implant placement less than 2.00 mm of facial bone is present. If entire buccal plate is lost, or if mobility exists ideally implant should be removed. Autogenous bone grafting of the osteotomy site. 12 Facial dehiscence after implant placement

12. 13 Early implant failure and bone loss is due to overheating of the bone, due to osteotomy site preparation in dense bone. 47° c should be maintained for 60 seconds. Resultant hyperemia, fibrosis, osteocytic degeneration and increased osteoclast activity may occur leading to necrotic zone around the implant. Overheating the bone

13. Prevention 14

14. Treatment If known excess heat generation occurs during implant placement ideally implant should be removed, regional accelerating phenomenon initiated and the site is grafted for future implant placement. RAP: tissue reaction to a noxious stimulus that increases the healing capacities of the affected tissue such as bone, cartilage but also soft tissue. 15

15. IMPLANT PRESSURE NECROSIS Placing implants in bone with thick cortical components (D1&D2) possibly early implant failure may occur due to pressure necrosis. PREVENTION: Torque value of 35 Ncm is considered safe. 16

16. Poor surgical technique improper angulation insufficient bone quantity placement of implant with incorrect diameter teeth with dilacerated root 17 Injury to adjacent teeth

17. prevention Evaluation through CBCT Using direction indicator Ideally 1.5mm space between implant and root surface is recommended. 18

18. B leeding related complications Careful planning of the location of incisions w.r.t surgical anatomy to maintain hemostasis over host bone. Reflection and elevation of the mucosa and periosteum should be done carefully with full-thickness and atraumatic reflection. Thorough understanding of anatomic structures and variants should be done with the use of CBCT. 19

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20. P ost operative complications 21

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22. 23 Biomechanical complications

23. External Force Factors: These forces greatly risk the screw loosening. Joint-separating forces. External joint separating forces>than the force holding the screw together (clamping force). Cantilever/ increased crown height space: Cantilevers increase the risk of screw loosening because they increase the magnitude of forces on the implant system. 24

24. Presence of parafunctional habits. Key implant positions, sufficient number of implants, passive prosthetic frameworks and adequate occlusal schemes. Crown/ abutment fully seated. 25

25. Crown/ Abutment fully seated: if the abutment is not fully seated because of improper placement. Insufficient/ Excessive Torqueing : the preload stretch of the screw is maintained by frictional force and the tension between the screw and the implant/abutment is termed as clamping force. 26

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27. Screw fracture

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32. 33 E xplantation of dental implants Mobility of the implant Extensive bone loss Chronic pain Advanced peri-implantitis Fractured implant Malpositioned implant

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34. Periodic maintenance After completion of implant treatment, follow up sessions for maintenance and care should be scheduled. Oral hygiene aids for implant maintenance include manual scalers, sonic and ultrasonic scalers, polishing devices, manual and electric tooth brushes, dental floss, interproximal brushes and antimicrobials. 35

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36. conclusion Failure of implant has a multifactor dimension. Often many factors come together to cause the ultimate failure of the implant. One needs to identify the cause not just to treat the present condition but also as a learning experience for future treatments. Proper data collection, patient feedback, and accurate diagnostic tool will help point out the reason for failure. An early intervention is always possible if regular check-up are undertaken 37

37. References Misch’s Contemporary implant dentistry, Randolph R. Rensik , 4 th ed. Complications of Immediate Implant Placement and its Management: A Review Article Seema S. Patil, Arunachaleshwar S. Balkunde , Aditi Samant , Rupali Patil & Pankaj Kadam. Dental Implant Maintenance- “How to Do?” & “What to Do”- A Review Pardeep Bansal , Dhanya , Preetika Bansal , Harvinder Singh , Shanta The Dental Implant Maintenance Gayathri Krishnamoorthy. Maintenance of Full-Arch Implant Restorations , ACP Effect of Schneiderian Membrane Perforation on Posterior Maxillary Implant Survival , Nasser Nooh The role of systemic diseases and local conditions as risk factors, Henning Schliephake 38