Reducing implant complications

14 May 2024

Loven Ganeswaran advises clinicians on ways to improve patient behaviours.

Dental implants are widely considered a safe, effective and patient-preferred solution for missing teeth. In appropriate situations, when delivered by suitably trained and skilful clinicians, implant therapies can transform a patient’s life. However, it is essential that patients understand what the surgery entails, as well as the role they will need to play post-operatively to maintain oral hygiene and facilitate the best results. Not only does this ensure informed consent, but it will also lead to more satisfied patients.

Changing lives

Traditionally, dentures have been the go-to solution for missing teeth. However, changing societal trends and pressures have created negative attitudes towards removable restorations.

For partially or fully edentulous patients, dental implants have become the gold-standard solution. They can restore a person’s ability to eat and speak properly while improving their smile aesthetics and boosting their self-confidence. Quality of life has been shown to increase for patients who receive implants, especially with regard to their social interactions, emotional health and self-esteem.

Modern products, techniques and technologies have facilitated significant success in the implantology field. The literature shows implant survival rates of 95.5 per cent at one-year post-placement, 93.2-96.4 per cent at 10 years, and 89.5 per cent after 20 years. This means that many patients can enjoy the benefits of treatment for decades or even for the rest of their lives – when they properly care for their implant and restoration, of course.

Bumps in the road

Despite the exceptional survival rates recorded, dental implants are not without their potential complications. Several factors can affect their success, including the patient’s age, gender and systemic health. Lifestyle factors must also be considered. Smoking, for example, may not be a contraindication for treatment, but it has been shown to increase the risk of implant failure by 140 per cent.

When it comes to the implants themselves, mechanical, biological and technical complications can occur, such as biomechanical overloading and fractures in the framework or prosthetic. One of the most common issues is peri-implantitis. This can develop from residual cement on the restoration but is more often associated with plaque accumulation and biofilm formation.

Preventing the preventable

As is true for periodontitis, peri-implantitis is very often preventable. A Swiss study found that, while most patients were aware of dental implants (almost 80 per cent of participants), they possessed poor knowledge regarding the post-operative care that is required for the long-term success of treatment. Preventive measures should, therefore, be put in place even before treatment has begun. For example, patients must be educated on the risk of infection and its impact on their implants well in advance. The importance of long-term maintenance must also be emphasised.

The implementation of an effective and systematic oral hygiene routine – which minimises plaque and biofilm – is integral to reducing the risk of peri-implant diseases. Evidence also suggests that a lack of interproximal cleaning, in particular, increases the chance of peri-implantitis. That’s why professional advice should cover oral hygiene techniques and products, tailoring guidance to ensure that individuals understand exactly what they should do at home to look after their implants.

From a professional perspective, during review appointments and check-ups, regular probing pocket depth and bleeding on probing scores are important for monitoring post-implant placement and identifying early signs of disease. They can also be utilised to manage any peri-implant mucositis or peri-implantitis that does occur to reduce symptoms before more damage is caused.

Encouraging positive patient behaviour  

Ensuring patients really understand the importance of oral hygiene around an implant is critical for the success of treatment and for obtaining informed consent. A fully informed patient must have realistic expectations of their implant treatment from the outset, which will increase their satisfaction with the outcome achieved. So, how can this be consistently achieved?

The way that treatment is discussed with the patient from the beginning is key. If they truly appreciate the role they must play and the impact their actions have on their implants, they are far more likely to implement necessary changes to their routine or maintain a high standard of oral hygiene.

For the best outcomes, dental professionals can utilise Chairsyde – a state-of-the-art patient consultation platform. Containing a comprehensive library of animations, the system can be used to explain a patient’s current oral health status, their need for treatment and the procedure itself (benefits and risks included) in a way that they will understand clearly. There are also videos to demonstrate oral hygiene techniques and how disease progression can be prevented, supporting informed consent and patient compliance.

With tools like this, the benefits and risks of dental implants can be more accurately and concisely communicated with patients. With their cooperation, the risk of complications can be minimised, and treatment outcomes can be optimised.


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References available on request.