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Dental Implant Problems

Non-smokers and patients with good oral hygiene habits put themselves in a much better position for a full and fast recovery after a dental implant procedure.
Non-smokers and patients with good oral hygiene habits put themselves in a much better position for a full and fast recovery after a dental implant procedure.
iStockphoto/Thinkstock

The human body isn't a perfect organism and, by extension, neither is any surgery. That goes for dental implants as well. Designed to replace a lost tooth (or teeth), dental implants have become increasingly popular -- and for good reason. They offer a permanent solution for patients, and the track record for successful dental implant surgery is impressive. Still, there are a number of potential complications that you should be aware of prior to having the work done, or even post-surgery.

While the risk of complications is considered to be very low -- less than 5 percent, according to current statistics -- there's a much greater likelihood that you might be a candidate for dental implants. According to the American Association of Oral and Maxillofacial Surgeons, almost 70 percent of adults between the ages of 35 and 44 have lost "at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay" [source: AAOMS].

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Just two decades ago, the options for a lost tooth were much more restricted. Patients typically would get either removable dentures that rested on the gums (a favorite among old hockey players), or a fixed bridge that anchored to adjacent healthy teeth. Neither were ideal solutions. Dental implants -- where the replacement structure is bolted, often with a titanium screw, directly to the patient's jawbone -- give oral surgeons a promising option to restore teeth permanently. The implant fuses with the jawbone in a process called osseointegration to provide the same solid connection that a natural tooth has (and sometimes stronger). A fitted crown is then attached to the implant to complete the procedure.

But dental implants aren't always the perfect solution. Potential problems include infection, insufficient bone mass, incorrect positioning, fractured implants, damage to surrounding tissue (including gums, nerves and blood vessels) and teeth, overloading and even reaction to anesthesia.

Though the vast majority (more than 95 percent) of all dental implant procedures are completed without complication, it's wise to be aware of what can go wrong, since a rapid response to any problem will enable surgeons to take corrective actions. Most problems are minor and easily rectified. However, if left untreated, even minor problems can threaten the long-term viability of the implant.

Keep in mind that all is not lost if a dental implant fails. Surgeons can usually attempt a second implant, either immediately or within several months after the area has sufficiently healed. Timely assessment is key.

What are the risks of infection with implants?

While modern medicine has greatly reduced the risk of infection during surgery, it still exists, and the risk is higher for your mouth for the simple fact that it's where everything you eat and drink enters your body. This is underscored by the importance of routine oral maintenance, such as brushing, flossing and regular dental check-ups.

To better understand how infection can occur, consider that implant surgery consists of cutting into the gum to reveal the jawbone, where holes are drilled for the dental implant anchor. That anchor is, essentially, the tooth's root, and must be set deep to ensure proper grip. In short, this is not minor surgery.

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After the anchor and surrounding bone fuse, a process that can last from two to six months, the surgeon will then attach an abutment for the crown, or the crown itself, to the anchor. This procedure requires reopening the surrounding gums, so care must be taken to prevent infection. Oral surgery can result in considerable discomfort. Bruising and swelling of your gums and face, pain, and minor bleeding are all common -- and not necessarily indicative of infection. However, it's wise to keep your surgeon apprised of those symptoms.

Infection (the medical term is peri-implantitis) can not only set in during the actual implant procedure, or during the crown restoration, but patients must be vigilant that they don't leave themselves susceptible to post-surgery infection, too. If left untreated, even minor problems can threaten the long-term viability of the implant.

Good dental hygiene is critical in keeping infection at bay. Non-smokers and patients with good oral hygiene habits put themselves in a much better position for a full and fast recovery. Smokers will typically be encouraged to stop smoking beforehand to improve the odds of successful surgery. If properly constructed and cared for, most dental implants should last a lifetime [source: WebMD].

Are you a candidate for "immediate loading?"

Though not common, "immediate loading" is a procedure where the surgeon may opt to build the tooth's crown right away after placing the implant into the jaw, or employing a "fixed prostheses," without the intervening recovery time for osseointegration. The benefits can include shorter treatment times, quicker recovery, less post-surgical care and preservation of the integrity of the patient's gums. Surgeons also report less expense and greater patient satisfaction [source: Leary].

Immediate loading is known as the surgery for the impatient patient, since it promises an "all-in-one" replacement procedure. However, there can be complications. Foremost is faulty or incomplete bone fusion, which can prevent the implant from developing an adequate bond with the jawbone.

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That situation can lead to another potential pitfall with immediate loading. A phenomenon known as "overloading" -- or applying undue stress -- where the forces on the implant can potentially disrupt the bone fusion process, can lead to premature implant failure or rejection. As a result of this higher risk of implant failure, there is a greater likelihood that the patient will need more implants. In some respects, this is the dental implant version of "haste makes waste."

For this reason, patients with insufficient or inadequate bone mass may not be eligible for the immediate loading technique. Instead, surgeons will typically counsel patience, in order to develop a sound foundation for the implant.

Also keep in mind that the immediate loading procedure is often more expensive than conventional staged implants, which allow for more complete osseointegration [source: Dental Implant]. Since implants are not often covered by standard insurance policies, the additional cost could become an overriding factor.

Another major concern for dental implants along the upper row of teeth is the impact these implants can have on sinuses. Essentially, the upper back jaw is a very difficult area for dental implant procedures, due not only to insufficient bone quality and quantity, but also the presence of the sinuses.

Like other areas of the mouth, lack of quality bone foundation may require a bone graft to provide sufficient purchase. In the case of the upper teeth, surgeons may opt for a procedure known as "sinus augmentation." This technique involves lifting the existing bone into the sinus cavity, creating more space to accommodate a bone graft, which can also help regenerate new tissue to support an implant.

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A typical bone graph during a sinus augmentation procedure requires four months to a year to fully develop. However, patients ought to consider that time as an investment, as implant surgery following complete augmentation procedures often have a lifespan similar to normal implant work [source: AAP].

Problems can also arise if the implants actually protrude into the sinus and are inflamed or infected. This condition should be readily detected by X-ray or CT scan. Once detected, the repair is relatively commonplace, though it should not be considered "minor" surgery.

Implant patients with prior sinus issues are also encouraged to be forthright with their oral surgeons during discussions about possible implant surgery, since that procedure can exacerbate existing problems. A simple percussion test on the teeth can reveal an existing sinus infection.

Also, some research indicates that dental implants may need additional treatment compared to traditional root canal surgery. In general, dental experts recommend continued adherence to a sound oral hygiene program and avoidance of hard items, such as ice and hard candy, which can break both article crowns and natural teeth. People who grind their teeth ought to get treatment to avoid damaging their implants.

Ready to sink your teeth into some more information? Visit the links and resources on the next page.

Related Articles

Sources

  • American Academy of Periodontology. "Dental Implant Placement Options." Perio.org. (Dec. 2, 2011) http://www.perio.org/consumer/2mb.htm
  • American Association of Oral and Maxillofacial Surgeons. "Dental Implants." (Dec. 1, 2011) http://www.aaoms.org/dental_implants.php
  • Dental Health Magazine. "Top 7 Myths About Dental Implants." WorldDental.org. (Dec. 2, 2011) http://worldental.org/teeth/top-7-myths-dental-implants/3497/
  • Dental Implant. "Immediate Loading Implant." DentalImplat.co.uk. (Dec. 1, 2011) http://www.dentalimplant.co.uk/dental-implant/immediate-loading.html
  • Dental Implant 411. "Why Dental Implants." DentalImplant411.com. (Dec. 3, 2011) http://dentalimplant411.com/dental_implant_overview
  • Dental Implants Guide. "Dental Implant Problems." (Dec. 2, 2011) http://www.dental-implants-guide.com/dental-implant-problems.html
  • Hitti, Miranda. "Root Canal or Dental Implant." WebMD.com. Nov. 19, 2008. (Dec. 3, 2011) http://www.webmd.com/oral-health/news/20081119/root-canal-or-dental-implant
  • Leary, Joseph and Hirayama, Muneki. "Extraction, immediate-load implants, impressions and final restorations in two patient visits." The Journal of the American Dental Association. June 1, 2003. (Dec. 1, 2011) http://jada.ada.org/content/134/6/715.abstract
  • Mayo Clinic. "Dental Implant Surgery." Mayo Clinic. (Dec. 1, 2011) http://www.mayoclinic.com/health/dental-implant-surgery/MY00084
  • Ranft, Lesley. "The Correlation between Tooth Pain and the Sinuses." Consumer Guide to Dentistry. Sept. 13, 2011. (Dec. 1, 2011) http://www.yourdentistryguide.com/tooth-pain/
  • WebMD. "Dental Implants." Feb. 8, 2009. (Dec. 3, 2011) http://www.webmd.com/oral-health/dental-implants

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