Professional Documents
Culture Documents
FAILURES
Dept. of Periodontology & Implantology
GUIDED BY
PROF. DR. VARSHA RATHOD
DEAN & HOD
Contents
1. Introduction
2. Definitions
3. Predictors of implant success or failure
4. Warning signs of implant failure
5. Criteria for implant success
6. Implant quality scale
7. Classifications of implant failures
8. Conclusion
9. References
Introductio
n
Definition
IMPLANT FAILURE :
It is defined as total failure of the implant to fulfill
its purpose (functional, esthetic or phonetic) because
of mechanical or biological reasons.
1. Askary et al. Why do dental implants fail : part I ID 1999 vol8 no2 173-183
Definition
Ailing implants:
Those that show radiographic bone loss without
inflammatory signs or mobility.
Failing Implant:
Characterized by progressive bone loss, signs of
inflammation and no mobility.
Definition
Failed Implants:
Those with progressive bone loss, with clinical
mobility and that which are not functioning in the
intended sense.
Surviving Implants:
Described by Albrektsson, that applies to implants
that are still in function but have been tested against
the success criteria.
Predictors of implant
success or failures
Bone type (type 1and 2)
Patient less than 60yrs old
Experienced Clinician
Mandibular placement
Implant length > 8mm
FPD with more than two implants
Axial loading of implant
Regular postoperative recalls
Good oral hygiene
Predictors of implant
success or failures
Bone type (type 3 and 4)
Low bone volume
Patient more than 60yrs old
Limited clinician experience
Systemic diseases
Auto-immune disease
Chronic periodontitis
Predictors of implant
success or failures
Smoking and tobacco use
Unresolved caries, endodontic lesions, frank
pathology
Maxillary, particularly posterior region
Short implants (<7mm)
Eccentric loading
Inappropriate early clinical loading
Bruxism and other parafunctional habits
1. Askary et al. Why do dental implants fail : part I ID 1999 vol8 no2 173-183
Classification
1. E.S Rosenberg, J.P. Torosian and J. Slots.
2. Kees Heydenrijik, Henny JA Meijer, Wil A Van der et
al.
3. Marco Esposito, Jan Michael Hirsh, Ulf Lekholm et al.
4. Sumiya Hobo, Eiji Ichida, Lily T Garcia.
5. Abdel Salam El Askary, Roland Mefert and Terrence
Griffin.
2. Traumatic
Failures
Radiographic periimplant
radiolucency.
Mobility
Pockets.
Presence of granulomatous
tissue upon removal
Late Failures:
Soon late failures:
Overloading in relation to poor bone quality and
insufficient bone volume.
Delayed late failures:
Progressive changes of the loading conditions in relation
to bone quality, volume and peri -implantitis.
Mechanical Failures:
Fracture of implants, connecting screws, bridge framework,
coatings etc
Iatrogenic Failures:
Improper implant angulation and alignment, nerve damage
U.C.L.A team
( Branemark et al)
(Beumer, Moy)
1.
1.
Complications in Stage I
surgery.
2.
Gingival problems:
a. Proliferative gingivitis
b. Fistula formation
2.
Complications in Stage II
surgery.
3.
Mechanical complications:
a. Fracture of prosthesis,
gold screws, abutment
screws.
3.
Prosthetic complications
Surgical
factor
Implant
selection factor
Restorative
factor
After stage II
After restoration
Retrograde peri-implantitis
(Traumatic occlusion origin,
non infective, forces off the long
axis, premature or excessive
loading)
Unacceptable
aesthetics
Functional
problems
Psychological
Problems
Failing Implant
Bone loss
Combined
According to etiology
Host
factor
Surgical
factor
Implant
selection factor
Restorative
factor
Host Factor
Medical status
Habits
Oral status
Host Factor
Medical Status
1. Bone diseases
Osteoporosis
Osteomalacia
? Hyperparathyroidism
? Osteomyelitis
Fibrous dysplasia
Paget disease
Multiple myeloma
Host Factor
Medical Status
2. Autoimmune Conditions
Sjogrens syndrome
? HIV
? SLE
3. Pregnancy
Should be Avoided
Host Factor
Medical Status
4. Endocrine Conditions
Diabetes Mellitus
Thyroid Disorders
Host Factor
Habits
1. Smoking
Causes alveolar vasoconstriction and decreased
blood flow.
Impaired wound healing due to compromised
polymorphonuclear leucocytes function.
Poor bone quality in case of poor oral hygiene,
smokers have 3 times more marginal bone loss
then non-smokers.
Host Factor
Habits
1. Bruxism
Increased physiologic load upto 1000 psi
Most common cause of implant failure
Manifests as screw loosening
More in maxilla
Host Factor
Habits
1. Bruxism
Prevention:
1. Increased number of implants
2. Avoid cantilevers
3. Use of occlusal splints
4. Wide diameter implants
5. Progressive bone loading and prosthetic design that
improves the distribution of stresses throughout the
implant system (By Misch)
Host Factor
Oral Status
Suprabony connective tissue fibers are
oriented parallel to the implant surface
Susceptible to plaque accumulation and
bacterial ingress
Host Factor
Oral Status
Prevention
1. It is recommended that the patient be recalled frequently,
preferably at a minimum of 3 months intervals. Periodontal
indices, bleeding on probing and radiographic evaluation
should be performed, using plastic tipped probes for checking
pocket depths.
2. Soft tissue debridement should be performed by means of
plastic curettes and plastic tips for ultrasonic scalers, and
topical and systematic antimicrobial drugs should be used
3. Provide space beneath the superstructure to allow cleansing
aids
2
According to etiology
Host
factor
Surgical
factor
Implant
selection factor
Restorative
factor
Surgical Factor
1.
2.
3.
4.
5.
6.
7.
Surgical Factor
1. Impaired Healing
No single flap design is optimal for implant surgery.
But improper flap design - infection & bacterial ingress chances of failure increases.
Basic principles of flap designing should be followed.
3
1
Surgical Factor
2. Bone overheating
Excessive pressure
Inverse relationship
between speed & heat
production
Failure increases
Connective tissue
interface formed
3
2
Surgical Factor
3. Implant contamination
By autoclaving the
contaminated implant
Non-titanium instrument
By glove powder
No close adaptation to
the bone
3
3
Surgical Factor
4. Off-axis placement (Severe angulation)
Occlusal load lie at an
angle
Chances of failure
increases
3
4
Surgical Factor
5. Lack of primary stability
Due to oversized
osteotomy
Gap develop
between implant &
bone
Lack of
osseointegration
the
3
5
According to etiology
Host
factor
Surgical
factor
Implant
selection factor
Restorative
factor
3
7
3
8
3
9
According to etiology
Host
factor
Surgical
factor
Implant
selection factor
Restorative
factor
Restorative Factor
1.
2.
3.
4.
5.
6.
7.
Excessive Cantilever
Pier abutments
No passive fit
Improper fit of the abutment
Bending moments
Connecting implants to natural teeth
Improper occlusal scheme
4
1
4
2
Bone loss
4
3
Contents Part
B
1. According to timing
2. According to infection - peri implantitis
3. According to tissue type
4. Mechanical Failures
5. Inhalation or swallowing of implant components
6. Conclusion
4
4
References
1.
2.
3.
4.
5.
6.
7.
8.
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2.DR. NIMISHA