Dental Implant Complications

Etiology, Prevention, and Treatment

Stuart J. Froum

• Publisher: Wiley-Blackwell
• Year: 2015
• Print ISBN: 9781118976456
• eBook ISBN: 9781118976463
• Edition: 2
• Topic: Medicine
• Subtopic: Dentistry

Dental implants have become one of the most popular and rapidly growing techniques for replacing missing teeth. While their predictability, functionality, and durability make them an attractive option for patients and clinicians alike, complications can arise at any stage from patient assessment to maintenance therapy. Dental Implant Complications: Etiology, Prevention, and Treatment, Second Edition, updates and expands the hallmark first edition, which was the first comprehensive reference designed to provide clinicians of all skill levels with practical instruction grounded in evidence-based research. Featuring cases from a variety of dental specialties, the book covers the most commonly occurring implant complications as well as the unique.

Dental Implant Complications: Etiology, Prevention, and Treatment, Second Edition, is organized sequentially, guiding the reader through complications associated with the diagnosis, treatment planning, placement, restoration, and maintenance of implants at any stage. Complications associated with various bone augmentation and sinus lift procedures are also discussed in detail with emphasis on their etiology and prevention. Each chapter utilizes a highly illustrated and user-friendly format to showcase key pedagogical features, including a list of "take home tips" summarizing the fundamental points of each chapter. New chapters include discussions of complications from drug prescribing, implant naturalization, cemented restorations, loose implant restoration syndrome, and craniofacial growth. Readers will also find more case presentations to see how complications have been managed in real-world situations.

Dental Implant Complications: Etiology, Prevention, and Treatment, Second Edition, brings together contributions from leading experts in the field under the superior editorship of Dr. Stuart Froum. With its pragmatic approach to preventing and managing implant complications, this expertly crafted text continues to serve as an indispensable clinical reference and guide for all dentists placing or restoring implants.

Chapter 1
Implant complications: scope of the problem

Stuart J. Froum DDS

Introduction

The introduction of endosseous dental implants as an option for restoring partially and fully edentulous patients has revolutionized dental treatment. High survival rates reported for single and multiple missing tooth replacements have validated the use of implant-supported restorations as a predictable method for oral rehabilitation [1–9]. In fact, owing to the improved function provided by implants, the Toronto Consensus Conference concluded that a two-implant-supported overdenture should be considered the standard of care (replacing the full denture) for mandibular edentulous patients [10].

Implants enable a single missing tooth to be replaced without restoring adjacent teeth. In addition, implants allow fixed restorations to be fabricated in patients who are fully or partially edentulous. Thus, the National Institutes of Health, Consensus Development Conference Statement in 1978 on Dental Implant: Benefits and Risk concluded that, “clinically, thousands of patients have been treated with dental implants for years and there is no question that many received long-term benefits.” However, the report further stated that, “some implants fail in patients within six months; and some have resulted in extensive bone loss and produced irreversible defects and complications” [11]. Although this report is more than 35 years old, and refers to different types of implant systems than those that are currently being used, problems with implant complications have grown in number and complexity. This is reflected in the increased number of articles, journals, and continuing education conferences that have recently been devoted to the topic of implant complications [12–31].

Two literature reviews reported that when implant success was defined as an implant-retained restoration free of complications, only 61% of patients after 5 years with implant-supported fixed partial dentures (FPDs) [28] and 50% of patients after 10 years with combined tooth/implant FPDs [20, 29] reported no complications.

Moreover, the prevalence of complications increased dramatically in some categories. In the 10-year study, for example, in terms of technical complications, the incidence of connection-related complications (screw loosening or fracture) rose from 4.3% after 5 years to 26.4% after 10 years. Of the 9% of restorations that were cemented, loss of retention of the restorations occurred in 6.2% within 5 years and 24.9% within 10 years [20]. Obviously, implant complications increase with the length of time an implant-supported restoration is in place.

The second edition of dental implant complications continues with the same format as first edition, where the various complications are discussed with respect to their etiology, prevention, and treatment. Since the publication of the first edition, five chapters have been added, covering newly recognized complications. Moreover, every chapter has been updated to encompass new knowledge and techniques that have been recognized and evolved since the publication of the first edition. Following a similar “Etiology, Prevention, and Treatment” format, this chapter addresses the scope of the problem regarding implant complications.

Etiology

There are several reasons for the increased numbers of implant complications being experienced by clinicians in recent years. First, the total number of implants being placed has increased significantly over the past 10–15 years. The 2000 Survey of Current Issues in Dentistry, published by the American Dental Association, noted that over a 4-year span (1995–1999) the average number of implants placed by all dentists increased annually from 37.7 to 56.2 [32]. A dental implant overview evaluating the implant market by the Millennium Research Group in 2006 reported that from 2002 to 2006 the number of professionally active general practitioners rose from 125 230 to 130 830. During the same period the percentage of general practitioners rose from 5.0% to 19.0% [33]. As the number of general practitioners was increasing, the actual number of general practitioners placing implants in 2006 was four times higher than the number placing implants in 2002. In the years 2003, 2004, 2005, and 2006 the growth in the number of implants placed by general practitioners was 82%, 46.0%, 24.4%, and 20.1%, respectively. The Millennium Research Group reported that, “Global sales of dental implant systems ‥ are expected to maintain double digit growth over the next five years soaring to more than 4.5 billion dollars” [33]. In fact an independent survey reported that the number of dental implants sold in the United States alone will be over 2.7 million by 2017 [34]. Therefore, the increased numbers of implants and implant-related procedures being performed would have in itself resulted in a greater number of complications even if the percentage of adverse event occurrences remained the same [35].

The second reason is related to the fact that the increased number of implants being placed also reflects an increased number of dentists, varying in their clinical experience, placing and restoring implants. When first introduced to the profession, endosseous dental implants were primarily placed by oral surgeons and periodontists who had prior experience and training in bone and soft tissue surgery. However, as the number of dentists placing implants increased, more dentists, who did not routinely perform oral or periodontal surgery, began performing additional procedures as part of implant therapy. A recently published survey concluded that by 2015 more general dentists will be placing implants than all specialties combined [36]. Regrettably, in some cases this has resulted in an increased rate of implant-related complications. A recent article in the July 2014 issue of the Journal of the American Dental Association reporting on outcomes of implants and restoratio...

Table of contents

• Cover
• Title page
• Copyright
• List of Contributors
• Foreword
• Introduction
• Chapter 1 Implant complications: scope of the problem
• Chapter 2 Implant complications associated with systemic disorders and medications
• Chapter 3 Complications of drug prescribing in implant therapy
• Chapter 4 Complications associated with implant planning: etiology, prevention, and treatment
• Chapter 5 Implant complications associated with two- and three-dimensional diagnostic imaging technologies
• Chapter 6 Implant fractures: etiology, prevention, and treatment
• Chapter 7 Implant naturalization: restoring osseointegrated dental implants with damaged platforms and connections
• Chapter 8 Implant failure: prevalence, risk factors, management, and prevention
• Chapter 9 Peri-implantitis: etiology, pathogenesis, prevention, and therapy
• Chapter 10 Complications related to cemented implant restoration
• Chapter 11 Esthetic complications due to implant malpositions: etiology, prevention, and treatment
• Chapter 12 Prosthetic-related dental implant complications: etiology, prevention, and treatment
• Chapter 13 The loose implant restoration syndrome
• Chapter 14 Management of complications associated with single-implant esthetics
• Chapter 15 Esthetic complications with adjacent implant restorations
• Chapter 16 Complications of autogenous bone grafting
• Chapter 17 Complications in guided bone regeneration
• Chapter 18 Avoiding complications of alveolar segmental osteoperiosteal flaps
• Chapter 19 Complications in lateral window sinus elevation surgery
• Chapter 20 Complications with transcrestal sinus floor elevation: etiology, prevention, and treatment
• Chapter 21 Implant complications related to immediate implant placement into extraction sites
• Chapter 22 Complications associated with flapless surgery
• Chapter 23 Complications related to immediately loaded dental implants
• Chapter 24 Prosthodontic complications related to non-optimal dental implant placement
• Chapter 25 Prosthodontic management of malpositioned implants and implant occlusion complications
• Chapter 26 Craniofacial growth in adults and its implications for implant reconstruction
• Chapter 27 Implant complications encountered during maintenance therapy
• Chapter 28 Medicolegal issues related to implant complications
• Chapter 29 Management of implant complications by the experts (part 1)
• Chapter 30 Management of implant complications by the experts (part 2)
• Index
• EULA