Introduction

Dental Implant failures are often considered roadblocks, which may cause the dentist and the patient to incur additional treatment costs. Implant-supported prostheses are a predictable tooth replacement option for dental patients. Despite their high success rate, dental implant failures are a reality all dentists face in their dental practice.

Implant success or failure can be largely attributed to the following factors:

• Patient-related factors: Overall patient health, oral health status, smoking habit, quality and quantity of bone, oral hygiene maintenance

• Implant characteristics: Dimensions, coating, loading, biomechanical characteristics

Clinician’s experience: Besides patient and implant factors, a clinician’s skill plays a vital role in identifying and management of implant failure. Every implantologist may have faced at least a few cases of implant failure during their practice. But, a skilled clinician is able to spot the cause of failure and make it a learning experience.

Types of Dental Implant Failure

• Early failure can occur due to overheating, contamination, trauma during surgery, poor bone quality, lack of adequate bone quantity, lack of primary implant stability, and incorrect load indication. 

As clinicians, it is important to understand that implant failure is a multifactorial process. Implant failure can be broadly classified into

Early failures can also be further grouped into 

• Biological Failures: When the host’s body is unable to establish or promote osseointegration, it results in biological failure.
• Mechanical Failures: Late implant failures can occur due to occlusal trauma, overloading or periimplantitis.

When Does a Dental Implant Fail to Integrate?

The most common osseointegration-related reasons for implant failure include

• Overheating of the bone at the time of implant placement,
• Contamination of the implant surface
• Systemic problems that may interfere with osseointegration: Few conditions like bisphosphonate necrosis, irradiation of the bone while treating a malignancy, autoimmune disease, or other chronic conditions like diabetes, osteoporosis or immunodeficiency can affect the healing process and decrease the success rate of a dental implant.
• Overloading an implant: Placing excessive force on the implant, such as from bruxism or an improperly designed restoration, can cause the implant to fail to integrate.
• Pre-existing infection from the extracted tooth that was not completely resolved
• Placement of implant in low-quality bone (for example, the posterior maxilla): If the implant is not placed in the correct position in the jaw, it may not be able to integrate with the surrounding bone properly.
• Insufficient natural bone: For an implant to properly integrate with the jawbone, there needs to be enough healthy bone present. If the bone is too thin or weak, the implant may not be able to fuse with it properly.
• Too large an osteotomy

Managing an Implant Integration Failure

Despite the advances in implant procedures, there is still a lack of adequate evidence-based data about the management of failed implants and their replacement. Implant integration failure cases are a challenging task for most dental practitioners. A study stated that meticulously removing granulation tissue at the failed implant site and using wider implants with improved surfaces could improve re-implantation outcomes.

Identifying the cause of implant failure is vital to take corrective measures. This can be done through a combination of clinical examination, radiographic imaging, and laboratory testing. Once the cause of the failure has been identified, the next step is to develop a treatment plan to address the issue.

1. If the failure is caused by a lack of bone density or quality, a bone graft may be necessary to augment the area and provide a suitable foundation for the implant. 
2. If the implant is found to be in the wrong position, it may need to be repositioned or replaced. If the implant has become infected, it will need to be removed and the infection treated before a new implant can be placed.
3. If the failure is caused by poor oral hygiene, the patient will need to be educated on the importance of maintaining good oral hygiene and provided with instructions on how to care for their implant properly. 
4. If the failure is caused by excessive force, a new restoration design may be necessary to reduce the force on the implant.
5. If the failure is caused by a systemic disease, the patient will need to have the disease controlled and stabilised before proceeding with implant treatment. 
6. If the failure is caused by smoking, the patient must be advised to quit before implant treatment.

In cases where the implant itself is found to be of poor quality, the implant should be removed and replaced with a new one. If the implant is removed, the site should be evaluated for bone loss, and if necessary, the site should be grafted before placing a new implant.

Key Takeaway

Dental implant failure treatment requires a multidisciplinary approach involving the diagnosis of the cause of failure, developing a treatment plan, and close follow-up with the patient to ensure proper healing and integration of the new implant. It is important to consider factors such as bone density, implant positioning, infection, smoking, systemic diseases, oral hygiene, force, and implant quality when diagnosing the cause of failure. 

Sometimes, a bone graft, implant repositioning or replacement, and proper oral hygiene education may be necessary. Additionally, close monitoring is necessary to ensure that the new implant is properly integrating with the jawbone.

References:

• Biomechanical implant failures management of an implant failure. Oral Health Group. (2019, October 21). Retrieved January 13, 2023, from https://www.oralhealthgroup.com/features/biomechanical-implant-failures-management-of-an-implant-failure-a-case-report/ 
• Levin, L. (2008). Dealing with dental implant failures. Journal of Applied Oral Science, 16(3), 171–175. https://doi.org/10.1590/s1678-77572008000300002 
• Kochar, S. P., Reche, A., & Paul, P. (2022). The etiology and management of Dental Implant Failure: A Review. Cureus. https://doi.org/10.7759/cureus.30455 
• Dental implant failure: Common causes and how to prevent implants from failing. Dental Implant Failure: Common Causes and How to Prevent Implants from Failing: Saeid Badie, DDS: Cosmetic & General Dentists. (n.d.). Retrieved January 13, 2023, from https://www.badiedental.com/blog/dental-implant-failure-common-causes-and-how-to-prevent-implants-from-failing 

The post How to Appropriately Handle Dental Implant Failure? appeared first on TopDoc.