Misch's Avoiding Complications in Oral Implantology

Carl E. Misch, Randolph Resnik

• Publisher: Mosby
• Year: 2017
• eBook ISBN: 9780323390156
• Topic: Medicine
• Subtopic: Dentistry

See how to effectively manage ALL dental implant complications throughout ALL phases of treatment! Avoiding Complications in Oral Implantology provides evidence-based management protocols for a wide range of implant problems such as placement complications, malpositioning, bleeding, infection, and nerve injuries. Hundreds of high-quality, full-color photos and illustrations clearly demonstrate the complications and their resolution. Edited by Carl Misch and Randolph Resnik — both well-known names in dental implantology and prosthodontics — and with a team of expert contributors, this authoritative guide helps you handle the implant-related complications that can occur as more and more patients choose dental implants.- Expert authors are joined by a panel of recognized leaders in implant dentistry — many of whom are associated with the Misch International Implant Institute — to share their extensive experience with handling complications through all phases of treatment.- Comprehensive approach to complications that occur in the different phases of oral implantology provides the knowledge and skills you need to handle treatment planning, implant placement, post-operative complications, prostheses-related complications, and more.- Over 1, 000 images include full-color clinical photographs, radiographs, line drawings, and diagrams, clearly demonstrating complications, procedures, and outcomes.- Management protocols developed by world-renowned dental implantologists provide a proven system and authoritative guidance in managing complications with dental implants.- Evidence-based solutions make it easier to manage a wide variety of clinical problems associated with dental implants, with state-of-the-art guidance supported by the best available research.

1

Classification of Dental Implant Complications

Randolph R. Resnik

One of the main tenets of dentistry is the restoration of a patient to optimal form, function, and esthetics. In the history of the profession, few advancements have facilitated dentists in this pursuit more than the advent of the dental implant. Though historical evidence reveals humans were attempting to replace missing teeth with foreign materials since ancient times, the science of fully replacing teeth with biologically compatible materials has been a very recent phenomenon. Oral implantology, which encompasses the replacement of missing teeth and their supporting structures with biologically compatible materials, has drastically improved the quality of life for millions of individuals. Patients who were once hopelessly edentulous now have the opportunity to achieve a full restoration to full chewing capability. People who were once destined to undergo radical and continuous loss of the bone that supports esthetically vital facial muscles now have a chance to maintain a youthful appearance. Young patients who were born with congenitally missing teeth now can go through life with a normal esthetic presentation without having to cope with a removable appliance. Though the study of dental implants is a rather recent phenomenon compared to other medical subjects, the impact that the field has had on the quality of life for patients around the world is staggering.

Due to the work of the many pioneers in the field, oral implantology has become a highly successful and viable option for the treatment of edentulous areas. High success rates for implant treatment have been shown through numerous clinical studies. However, as more implants are being placed, the number of complications are increasing. Even with technologic advances in oral implantology, this type of treatment is not void of complications, even many years after completion. These complications appear both surgically and prosthetically, with varying degrees of severity in consequence. Prosthetic complications leave patients without the restorations they ultimately desire, due to functional and esthetic issues stemming from inadequate implant placement, improper diagnosis, or a lack of understanding about the forces acting upon the prosthetic components. Surgical complications can lead to implant failure, neurosensory impairments, infections, significant bleeding episodes, and possibly death. As oral implantology grows as a discipline, the field of dentistry will be confronted with these complications, and knowledge of how to treat them is pivotal to the long-term success of the treatment.

Complication Studies

In review of the literature, many studies have evaluated the prevalence of complications, both surgically and prosthetically. McDermott et al., in a retrospective study, evaluated approximately 2400 implant cases and determined an overall complication frequency of 13.9%.¹ Jung et al. reported a 39% complication rate associated with fixed implant-retained restorations over a 5-year period.² Serrano et al. in a multi-center retrospective study found a 50% complications rate with removable implant prostheses.³ Many other studies have evaluated the specific complications (Table 1.1).

TABLE 1.1

Summary of Complication Journal Articles

	Category	Study Findings
CBCT COMPLICATIONS
Schneider (2009)^1	Computer Generated Guide Accuracy	• Meta-regression analysis reported a mean deviation of 1.07 mm at entry point and 1.63 mm at the apex
D’haese (2012)^2	Immediate Loading Guided Surgery	• Reviewed six papers with an average complication rate to 42% when stereolithographic guided surgery was combined with immediate loading
Arisan (2010)^3	Guide Accuracy	• Bone-supported guides had the highest mean deviations (5.0° ± 1.66° angular, and 1.70 ± 0.52 mm and 1.99 ± 0.64 mm for implant shoulder and tip, respectively
Valente (2009)^4	Template Guided Flapless Surgery	• Mean lateral deviations coronal (1.4 mm) and apical (1.6 mm). Mean depth deviation was 1.1 mm and mean angular deviation was 7.9 degrees
BLEEDING COMPLICATIONS
Hong (2012)^5	Coumadin	• Frequency of persistent bleeding (2%) with patients on Coumadin • Extractions + implant placement = bleeding increases to 4.8%
Balaguer Martí (2015)^6	Mandibular Bleeding	• Most common area for heavy bleeding after implant surgery is in the mandible (canine > incisor > first premolar) • Most common artery is Sublingual artery, usually from lingual perforation
Zijderveld (2008)^7	Lateral Window Bleeding	• 2% significant bleeding complications after lateral window preparation
Goodacre (2003)^8	Postoperative Ecchymosis	• 24% of all dental implant sites manifest noticeable ecchymosis. The location of the ecchymosis is influenced by gravity
NERVE COMPLICATONS
Burstein (2008)^9	Mandibular Nerve Impairment	• Meta-analysis of implant placement nerve injury studies show a range of incidence from 0% to 13%
Bartling (1999)^10	Mandibular Nerve Impairment	• An incidence of 8.5% nerve impairment was found at the first postoperative appointment
Libersa (2007)^11	Temporary vs. Permanent Nerve Injury	• Evaluated transient vs. permanent implant-related nerve injuries with 75% of injuries being permanent
Pogrel (2000)^12	Inferior Alveolar Block Nerve Impairment	• 1 : 26,762 inferior alveolar nerve blocks result in nerve impairment with 36% causing a dysesthesia
INFECTION COMPLICATIONS
Powell (2005)^13	Dental Implant Infection	• 1.14% infection rate after stage I and stage II surgery
Gynther (1998)^14	Dental Implant Infection	• 0.7% infection rate after surgery
Greenstein (2008)^15	Wound Dehiscence	• Incision line opening prevalence ranging from 4.6%–13.7%
Lekovic (1997)^16	Wound Dehiscence with Membrane	• 30% prevalence of soft tissue dehiscence's was noted when barriers were placed as part of guided bone regeneration procedures
Urban (2012)^17	Sinus Graft Infections	• 2.3% developed a sinus graft infection post-surgery
Sicilia (2008)^18	Titanium Alloy Sensitivity	• Type IV hypersensitivity reaction (titanium alloy sensitivity) Ti allergy was reported with a 0.6% prevalence
Davies (1990)^19	Air Embolism	• Report of three fatal cases of air emboli after implant placement
SURGICAL COMPLICATIONS
Hämmerle (2002)^20	Guided Bone Regeneration	• Retrospective studies reporting success or survival rates for implants in regenerated bone ranging from 79.4%–100% after 5 years
Levin (2007)^21	Autogenous Onlay Grafts Complications	• Survival rate was 96.9%, marginal bone loss around implants ranged from 0 to 3.3 mm only 5% of the implants presented marginal bone loss 1.5 mm over the follow-up time
Chiapasco (2009)^22	Allograft and Membrane	• In the postoperative period, 20% of the nonresorbable membranes and ...

Table of contents

• Cover image
• Title Page
• Table of Contents
• Copyright
• Contributors
• Foreword
• Preface
• Acknowledgments
• In Memoriam
• Dedication
• 1 Classification of Dental Implant Complications
• 2 Medical/Medication Complications in Oral Implantology
• 3 Treatment Planning Complications
• 4 Radiographic Complications and Evaluation
• 5 Dental Implant Intraoperative Complications
• 6 Ideal Implant Positioning
• 7 Intraoperative Complications
• 8 Intraoperative Complications
• 9 Neurosensory Deficit Complications in Implant Dentistry
• 10 Postoperative Complications
• 11 Wound Dehiscence
• 12 Bone Grafting Complications
• 13 Posterior Maxilla Complications
• 14 Complications Associated With Immediate Implant Placement
• 15 Removable Implant Complications
• 16 Fixed Prosthodontics Complications
• 17 Occlusion Complications
• 18 Periodontal and Maintenance Complications
• 19 Medicolegal Aspects of Implant Dentistry
• Index