BDS 11123 Implant Complications and Maintenance PDF

BDS 11123 Implant complications and maintenance Date : / /20 Implant treatment is regarded as a Safe technique for restoring missing teeth, with high rates of Success. Nevertheless, it has, as every surgical procedure, several Complications that can occur and must be known in order to prevent or s...

BDS 11123 Implant complications and maintenance Date : / /20 Implant treatment is regarded as a Safe technique for restoring missing teeth, with high rates of Success. Nevertheless, it has, as every surgical procedure, several Complications that can occur and must be known in order to prevent or solve them. Well-placed implants have a success rate of about 96% B BUT There are failures What is implant failure? Total or partial failure of the implant to fulfill its purpose Functional Esthetic Phonetic Failures can occur at 3 distinct levels: 1- Failure to osseointegrate 2- Failure because of Bone loss >0.2mm / year following 18 months of placement 3- Late failure 1- Failure to osseointegrate Overheating the bone Inability to achieve precise fit Epithelial cell incorporation Bacterial contamination (implant or site) Poor quality of bone Post-operative infection Excessive pressure on tissue overlying the implant Smoking Radiation or Chemotherapy 2- Bone loss > 0.2mm / year following 18 months of placement Excessive loading Compromised peri-implant tissue Poor oral hygiene Tissue hyperplasia 3- Late Failure (more than18 months) Is RARE and may be caused by: Prosthetic problems Excessive forces specially lateral Risk factors in dental implants Failure and Implant Site Failure rate is higher in maxilla - Maxilla have almost 3 times failures than mandible - Posterior maxilla failures are higher than Anterior maxilla Failure and treatment plane Always Remember that Communication among various team members plays a vital role in therapy because many complications are related to communication errors Failure and Smoking Smokers have demonstrated an increase in implant failures 12 % (4.5 % for non-smokers) Smokers are at a higher risk of infection following surgery, and may heal more slowly Nicotine in tobacco reduce the blood flow in the mouth There is a direct link between oral tissue loss (soft & hard) and smoking BUT Smoking should not be an absolute contraindication for implant therapy Patients should be informed that they are at a greater risk of implant failure specially if they smoke during the initial healing phase Failure and Systemic health Similar failure rates between well-controlled diabetics and non-diabetic patients Slightly higher failure rates with Type 2 diabetes (non-insulin dependent) Uncontrolled diabetic patients are poor candidates for any surgical procedure and have higher implant failures Failure and Implant variables Long and wide implants show less failures than short and thin implants Implants restored with angulated abutments show increased failure rates Coating dose not affect the overall success Failure and surgical technique Inadequate irrigation of the surgical site (temperature elevation and bone necrosis ) Using low torque or excessive drill speed Inadequate sterilization protocols Implants performed in bone graft have higher failure rate than other situations Failure and oral hygiene M. ElFar Mechanical and technical complications. Prosthetic related complications. Overload. Caused by: 1. Excessive cantilevers. 2. Premature contacts. 3. Occlusal morphology. 4. Non- passive fit. 1- Cantilevers  Fixed reconstructions with and without cantilever extention : Nedir et al 2006, in an 8 years follow-up, the authors found technical complications in about 30% of the reconstructions with cantilever extensions but in only 8% of the reconstructions without cantilever extensions. Nedir R, Bischof M,Szmukler-Moncler S, Belser UC, Samson J. Prosthetic Complications with dental implants: From an up-to-8year experience in private practice. Int J Oral Maxillofac Implants. 921-28:919. 2006 2- Heavy Or Premature Contacts. 3- Large Occlusal Table, And Steep Cuspal Inclination. 4- Non-Passive fit  Two possible complications of non-passive fitting of the frameworks: Biological complications: Increased transfer of load to the bone, bone loss, and development of microflora at the gap between the implant and the abutment. B. Prosthetic complications: Loosening or fracture of the fastening screw Michalakis, Konstantinos X., Hiroshi Hirayama, and Pavlos D. Garefis. "Cement-retained versus screw-retained implant restorations: a critical review." The International journal of oral & maxillofacial implants 18.5 (2002): 719-728. Biological complications Peri-implant Mucositis Vs Peri-implantitis Peri-implant mucositis.  Is a inflammatory reaction of the mucosa adjacent to an implant without bone loss.  Reversible.  It is generally accepted that mucositis will eventually give rise to periimplantitis. Peri-implantitis:  It is an inflammatory process which affects the tissues around an implant in function, resulting in the loss of the supporting bone, which is often associated with bleeding, suppuration, increased probing depth, mobility and radiographical bone loss.  Irreversible. Etiology and Risk Factors It has been accepted that the bacterial contamination (PLAQUE) is the main etiological factor in development of peri-implant disease. There are many risk factors that increase a likelihood of disease development and promote for disease progression Patient Restoration Risk factors Systemic Local 1. Factors Related To the Patient a) Smoking b) Poor oral hygiene and compliance c) Parafunction and bruxism 2. Local factors A. Soft tissue quality. B. C. D. E. History of periodontitis. Poor bone quality. Poor angulation and bodily positioning of the implants. Excess cement 3. Systemic a) Diabetes especially uncontrolled DIABETIC. b) Systemic conditions or medications that can affect bone turnover, salivary output and natural body defenses are likely to increase the risk to peri-implant infection. c) Genetic. Maintenance and Recall Maintenance and Recall  Annually – periapical radiographs should be taken to monitor the crestal bone levels. (crestal bone can be at the level of the first thread in one year with 0.1mm continued loss to approximately 1. 5 mm total bone loss) – remove and reinsert screw retained implant prostheses every 2 years unless indicated otherwise. Replace prosthesis with new retaining screws if removed. – Cemented restorations are usually permanent (nonretrievable). – Recall focus Occlusion - verify there are no excursive contacts. Should not hold shimstock. Better to be out of occlusion Oral hygiene - same requirements as for natural teeth. Soft tissue health - periodontal probing for evidence of disease. Screw joint torque - check for loosened screws (most common problem). Integrity of attachments - applies to overdenture / overpartials. Stability of implants - must be stable (non mobile) to be successful  Screw retained prosthesis – Remove prosthetic retention screws Screw access holes are usually sealed with a layer of cotton pellet, silicone plug or gutta percha the acrylic or composite resin. Expose the screw by drilling carefully through the resin. Remove the screw (slot or hex) with the appropriate screw driver. Throat drapes are highly recommended. – Check for implant mobility and retorque abutments to 20 Ncm. (hand tighten as much as possible with finger abutment driver if no torque control device is available) – Clean and polish abutments (Do not remove) – Reseat restoration using new gold retaining screws. Tighten screws as if doing nuts on the lugs of an automobile - place all screws back with minimal torque. Then work back and forth across the arch until all are tightened to 10 Ncm. (hand torque with appropriate hand screw driver if no torque controller is available)  Screw retained prosthesis (cont.) – Temporary reinsertion fill access holes with small cotton pellet and polyvinylsiloxane impression material or putty. – Long-term reinsertion fill access hole with small cotton pellet over the head of the screw, followed by warm gutta percha and only 1-2 mm of acrylic or composite resin. Cemented restorations – Single unit usually nonretrievable and not removed for maintenance. – Multiple unit (usually not indicated) carefully tap off with crown remover, check for mobile implants and retorque abutment screws. Replace restoration with provisional luting media, and recheck occlusion. Hygiene Aids Super - floss End tufted brushes Proxy brushes Tarter control dentrifices Mechanical instruments Peridex Super - Floss - Excellent for all types of implant restorations Butler Post Care Floss Aid - Excellent for implant bars and fixed hybrid prostheses. Fixed Hybrid Prosthesis - Hygiene care with a proxy brush Plastic scalers are appropriate for cleaning around standard abutments supporting implant bar substructures, hybrid prostheses and implant supported splinted restorations. Plastic scaler tips are also available for metal handle scalers.