Dental Implants are booming in dentistry with continual research and development with successful results. It has established a belief among patients that is close to their natural teeth.
The basis for a successful implant lasting for years is from proper diagnosis and treatment planning. As inferred from this journal there is no absolute contraindication for dental implants but some high-risk associated factors are to be noted for successful and long-lasting implants.
PRECAUTIONS BEFORE DENTAL IMPLANT:
- Take note of the chief complaint / the presenting illness of the patient.
- Obtain a complete medical and dental history of the patient.
- Obtain any history of recent medication/surgery within 6 months.
- Take note of the patients need, demands and economical constraints.
- Have a thorough examination of the hard tissue and soft tissue.
- Radiographical investigation with 3-dimensional imaging systems like CBCT to evaluate the bone width & density.
- Evaluation of the vital anatomical structures like Inferior Alveolar nerve, maxillary sinus, incisive canal, and mental foramen and their closeness to the site of implant placement.
- Multidisciplinary approach in assessing the patient for proper diagnosis and treatment planning.
- Bone/tissue augmentation is planned prior to the placement of the implant if necessary.
- Explanation of the complete procedure including its pros and cons. As patient co-operation plays a major role in the effectiveness and success of dental implants.
- Selection of the form and type of implant that is best suited for the patient.
HIGH-RISK FACTORS ASSOCIATED WITH FAILURE OF DENTAL IMPLANTS:
- Periodontal Diseases: Patients with a history of periodontal disease or the presence of periodontal disease while planning for the dental implant is considered as a well-recognized risk factor for failure of implants. They exhibit compromised bone-level, decreased bone volume and quality with immune dysfunction. Both aggressive and chronic Periodontitis are considered as a risk factor for the failure of implants. A systematic review on Periodontitis associated implant failure states that patients with aggressive Periodontitis are at greater risk for implant failure when compared to a patient with Chronic Periodontitis.
- Smoking: This habit promotes an anaerobic environment for the multiplication of the periodontal pathogen causing detachment of the periodontal ligament. They possess a high risk of postoperative infection and marginal bone loss.
- Bruxism: Patients with Bruxism tend to have implant failure due to abnormal physical forces.
- Increased proton pump inhibitors consumption: Most of the population consumes proton pump inhibitors as antacids for gastric issues. Increased consumption of PPI can result in hypochlorhydria i.e. malabsorption of calcium thereby decreasing the calcium levels and disturbing the mechanism of bone formation. They decrease the bone turnover by directly acting on the H+ / K+ ATPase of gastric cells. This action has a negative effect on bone cells by stimulating bone resorption.
- Increased consumption of serotonin selective receptor inhibitor: This drug is used to treat patients with depressive disorders with or without psychiatric conditions. They increase the rate of bone loss and decrease bone mineral density.
- Bleeding disorders: Patients with bleeding disorders like hemophilia and clotting factor viii deficiency and those who are under antiplatelet therapy are considered high-risk patients. Elective surgery is contraindicated if hemostasis cannot be achieved.
- Bone diseases: Bone diseases like osteoporosis result in decreased bone mass and imbalance in bone metabolism resulting in decreased bone volume & bone quality. Women are generally affected by this disease with fragile or brittle bones.
- Diabetes mellitus: Poor wound healing and a reduced immune response are observed in hyperglycemic conditions which may contribute to implant failure.
- Antiresorptive medications: These medications are prescribed for various diseases like osteoporosis, Paget’s disease and hypercalcemia, bone metastasis of prostate, lung and breast cancers. They tend to increase the bone quality and metabolism of bone formation. They are available as bisphosphonates & RANKL inhibitors. They are not considered as high risk for implant failure. Bisphosphonates cause bone necrosis in a few patients with the implant but also showed 95% to 100% survival of implants. Other drugs don’t have any systematic review associating their hand in implant failure.
- Radiation therapy: Radiation therapy is advised for 5 to 7 weeks in patients suffering from cancer. Higher doses of radiation to treat oral cancer patients result in reduced blood supply to the bone, bone sclerosis and reduced ability of osseous regeneration. The failure of implants occurs as a result of decreased vascularization and regeneration of the bone. The failure rates are decreased when the implant is located in areas that are not irradiated.
The above-mentioned risk factors can be avoided by following proper precautions before planning a dental implant. All the factors have a role in the failure of implants.
The survival of the implants with any one of the above-mentioned factors is noted and proved with systematic reviews conducted with periodic follow-ups. The survival of implants in patients with periodontal diseases is 83% with frequent follow up from 12 – 120 months.
The risk of failure of implants in patients with diabetes mellitus, smoking and Bruxism was two times higher than their normal counterparts. No systematic review states that patients with bleeding disorders are absolutely contraindicated dental implants or any association of implant failure in patients with bleeding disorders.
Patients with bone diseases survived dental implants without failure. A systematic review conducted by evaluating more than 20000 dental implants from 2001-2017 holds 96% survival with increased signs of peri-implantitis in a few cases.
There is no absolute contraindication for dental implants but a combination of any of the above or increased occurrences is considered as a potential risk for the survival of the implants. Hence the clinician has to make note of the above while evaluating a patient.
The right diagnosis and right treatment plan considering the associated risk can reduce the failure of implants. Education of the patient about the do’s and don’ts after the implant placement with proper follow-up and maintenance also plays a major role in successful and long-lasting implants.