Implants are commonplace in many dental practices as patients seek tooth replacement options. But implants are not foolproof and complications can occur which can ultimately in some cases lead to implant failure.
It is therefore important to know the top 3 reasons why implants fail. In understanding these reasons, this will prepare you when planning and placing implants on your own patients so that you are setting yourself up for success!
Why do implants fail and how can this be prevented?
1. Lack of osseointegration
For implants to be successful, they must osseointegrate. Osseointegration is when a connection is formed between the living bone and the surface of the artificial titanium implant. This essentially weaves the implant in with the bone so it is solid. In order to ensure this happens, patients must be assessed properly. There needs to be a sufficient amount of bone for this, otherwise grafting might be required. Patients with certain medical conditions, or on certain medications such as bisphosphonates, will also have higher risk of failure of osseointegration.
Dentists also need to ensure implants are placed properly. There must not be overheating of the bone at the time of implant placement - therefore appropriate speeds of placement using the correct sequence of implant drills with effective irrigation are needed. Implant surfaces are treated to ensure they are sterile and clinicians should take care that these are not contaminated with inappropriate handling.
2. Overloading
If implants are incorrectly loaded, this can lead to the implant failing. In pre-operative planning, dentists should plan with the end in mind i.e. plan for the final restoration and work backwards from there.
The implant is the focal point of the dental restoration and to ensure this, there needs to be good communication between the dentist, surgeon and dental technician. This can be done via a wax up on a study cast, and this can be used later for a surgical template or a temporary restoration. You can then ensure that implant abutments are loaded axially as recommended by suppliers. In designing the occlusal load for your implants, you should ideally also:
Ensure the long axis of the implant is aligned with cusps of the opposing teeth.
Avoid extreme cusp formation.
Consider individual implant position alongside existing anatomy and available space.
Follow dimension recommendations according to implant supplier.
- Consider delayed loading of implants where primary stability is inadequate.
3. Lack of maintenance
Implants can fail if they are not maintained well - similar to any treatment in dentistry. If oral hygiene is not maintained, peri-implantitis can occur where the tissues around the implant become inflamed and there is loss of the connective tissue and supporting bone. This leads to implant mobility, infection and ultimately loss of the implant.
Some patients will be more at risk for this complication, such as those who have had periodontal disease and smokers. Dentists should therefore educate patients on this risk and the importance of maintaining their implants. Individual advice should be given so patients are able to clean effectively around their implants - for example the use of interdental aids. They should return for regular hygienist visits to help continue maintaining their investment.
By understanding these top 3 reasons for implant failure, dentists can safely plan and deliver this treatment in the reassurance that the treatment they provide for their patients has the highest chance of success.
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