Boota Uhbi discusses some of the issues clinicians need to be aware of.
As dental implants have become incredibly popular over the last two decades, the procedure is now something that the everyday patient could expect to encounter at some point in their lives. Advanced implant surgery, however, can be complex and complications can arise post-surgery.
Potential issues with bone grafting
Bone grafting is a great way to prepare the mouth for an implant if there has been some deterioration after tooth loss or trauma. However, like many surgical procedures it does not come without possible complications and risks. Some issues that a patient can incur after the procedure include infection, bleeding, swelling, nerve damage, and more. The risks of these problems occurring will vary depending on things such as whether or not you’re using donor tissue for autogenous grafts, the patient’s age, and other medical conditions. Smoking or diabetes can affect the healing time of a patient and increase the risk of unforeseen complications.
Although potential difficulties with bone grafting procedures have decreased as technology, education and techniques have developed there are still instances where the treatments are not successful. A study examining the success of bone grafts in 112 patients found that 17.6 per cent experienced complications regardless of the final outcome of the implant procedure and smoking was associated with a high rate of complications and graft failure. This indicates that smoking can have a significant impact on the outcome of a procedure and therefore implies that other unhealthy habits could have an impact; highlighting the modifiable risk factors that a dentist cannot control.
Sinus augmentation and possible complications
Sinus augmentation can sometimes be carried out to support a patient with an implant procedure even if the bone demonstrates significant resorption with newer techniques such as osseodensification. The complications that can occur include pain, swelling, infection of the surgical site, sinusitis, further bone resorption, bleeding, and more. In a clinical study, involving 70 people, the complications of sinus augmentation were investigated and it was discovered that the most common was the perforation of the sinus membrane, which presented in 25 per cent of sinuses. As well as this, 5.6 per cent exhibited suppuration of the maxillary sinus and five of those patients were smokers; this indicated a prevalence of complications significantly greater in smokers compared to non-smokers. Out of the entire cohort two of the patients showed signs of persistent infection and needed further treatment. Although dentists can do everything possible to minimise things like infection, the study demonstrates there will be at least some patients who experience continuous complications.
The challenges of soft tissue graft
Soft tissue grafting is used to build up supportive structures to ensure successful installation of implants and improve the appearance of a patient’s smile – periodontitis, for example, may cause gums to deteriorate and result in tooth loss. This may result in both hard/ soft tissue volume loss and the patient may want to undergo a soft tissue graft alongside implant placement in order to improve the appearance of their smile. This type of procedure generally has a high success rate but there are still some risk factors involved.
Postoperative pain, swelling, and bleeding are the most common issues that patients experience. In a study that compared the frequency of postop complications after free soft tissue grafting (FSTG) and subepithelial connective tissue grafting (SCTG), it was revealed that current smokers were three times more likely to experience post-surgical swelling. As well as this, patients who underwent FSTG were three times more likely to develop pain or bleeding after surgery compared to those who had SCTG. This indicated that smokers were at a higher risk of post-op complications but the methods used in surgery also appear to have an impact.
There is a plethora of complications that patients can endure when it comes to implant surgery, especially regarding more advanced procedures. Each case is different depending on whether the patient smokes or has health issues, for instance. Although dentists are capable of treating patients with complex needs it can be in their best interest to refer to a clinic that handles advanced implant procedures on a daily basis.
References available on request.