Dental implants are an increasingly popular, high-quality treatment option for patients with partial or complete edentulism. As a premium solution, patients have high expectations and want their investment to last. In the overwhelming majority of cases, dental implants are highly successful and long-lasting. However, as with any procedure there is the potential for failure and complications.
Early failures are usually related to the osseointegration process not going as planned. The hallmark of this is excessive mobility of the implant, which indicates that secondary stability from osseointegration is not being sufficiently achieved. Early implant failures are associated with poor or insufficient bone quality and/or volume, inadequate primary stability and overloading the implant. Other factors can complicate healing around the implant, causing fibrous scar tissue around it instead of reliable osseointegration. These risk factors include: active infection, smoking, and using implants with design features not suited to host conditions (too narrow, too long, the surface, the thread design, etc.). With these factors known, good case selection and treatment planning can largely help to avoid early failure, and this is born out in the very high success rate of dental implants.
Provided that early failure is avoided, the most prominent late failure risk is peri-implantitis. Peri-implantitis is a destructive inflammatory disease that erodes the hard tissue around the implant, which can lead to its loss. Peri-implantitis is preceded by peri-implant mucositis in the soft tissue around the implant, much as gingivitis precedes periodontitis. Bleeding on probing long after the initial healing period remains the best diagnostic indicator of the condition. Patients should be advised to get in touch with the dental team if they repeatedly notice blood while brushing, after the initial healing process has concluded.
Peri-implantitis progresses in a non-linear fashion, which makes disease progression difficult to predict. Bone loss can occur in a rapid, alarming burst then appear to almost halt, then resume again at a later date. Other cases may see a slow but steady erosion of the bone, or anywhere in between; as with periodontitis it is a highly variable condition.
As with most things, prevention is better than cure, and peri-implantitis is highly preventable. Patients should be strongly advised to continue to attend regular check-ups, maintain their oral hygiene, and quit smoking if applicable. Diabetes promotes inflammation and consequently poorly controlled diabetes is also a significant risk factor, however, when controlled success rates are broadly similar (conversely prediabetes appears to have no effect on implant survival at all). Catching and arresting peri-implant mucositis before it develops into peri-implantitis makes a huge difference to patient’s outcomes. It has been reported that after 5-years of complying to supportive therapy for peri-implant mucositis, less than a fifth of patients (18%) went on to develop peri-implantitis, whereas 44% of patients who did not adhere to supportive therapy developed the disease.2 So while peri-implantitis is not totally preventable in all cases, we can greatly improve the patient’s prognosis.
The inherent unpredictability of peri-implantitis and its destructive nature make it sensible to weigh the odds in the patient’s favour as much as possible. In addition to careful case selection and on-going follow-up care, choosing the best possible implant for the patient can also help shift the odds in their favour. Great advances have been made in material science, allowing modern designs to be more favourable to initial osseointegration, less vulnerable to bacterial colonisation, less invasive, and so on.
Straumann® offers a range of implant systems tailored to general and specific patient requirements. The StraumannÒ BLX implant system was engineered to provide a minimally invasive, highly reliable implant solution. It is ideal for immediate placement boasting a better than 98% survival rate after 10 years and has numerous features that reduce healing time. It has been designed with dynamic chip flutes, which collect and condense native bone chips and distributes them around the implant body. BLX features the SLActive® surface – demonstrated to have a 100% implant survival rate in irradiated patients even with compromised bone after 5 years, – and the Roxolid® body is composed of a high-performance zirconium-titanium designed with a reduced neck diameter, and a slim, fully tapered core for smaller osteotomies.
With good case selection, treatment planning and on-going maintenance, dental implant recipients can enjoy the benefits of their prosthesis for many years. Choosing the right implant system for a given patient can make a real difference, and the technology has branched, developed and diversified considerably since the landmark studies in the early 1980s. Advances in material science and osseointegration theory, have given rise to implants with surfaces featuring more favourable characteristics for success in the short- and long-term. Provided patients maintain their oral hygiene and attend follow-up care, the vast majority should be able to avoid peri-implantitis.
For more information on the StraumannÒ BLX implant system click here