Complication with implants
Procedure related; you can have a lack of primary stability, mechanical complications, mandibular fracture, ingestion/aspiration
Anatomy: Neuro injury , bleeding, cortical plate perfortion, sinus perforation, devitalization of adjacent teeth
Treatment Pla
Surgical complications during and after implant placement are not uncommon
Overall complication rate of 14%
Insertion of implants into fresh extraction sites can affect implant failure rates
No consensus on whether radiation therapy will hider implant success or not.
Complications: Early vs Late:
Early: infection, edema eccymosis and hematoma, emphysema, bleeding, dehiscence of the area and neuro-sensation altered, also rotary instrumentation not done properly and burnign bone if greater than 47 degrees.
Late: Mucoperiosteal flap perforations/dihi
Complications: Intraoperative
Bleeding: Administration of local anesthesia and vasoconstrictor agents, as well as the application of gauzes soaked in bovine thrombin to help in the last coagulation process transforming fibrinogen into fibrin. (Debate about whther to do a nerve block o
Intraoperative Complications: Lesions of adjacent teeth
non-integration of the implant because of the inflammation. It is of the utmost interest to study the axis of those teeth delimiting the edentulous space before surgery, reduce/curb its convergence and this prevent this type of dental istrogenic lesions.
Intraoperative Complications: Lack of primary stability
Primary stability is determined by bone density and cortical bone thickness; a better stability in mandibular implants than maxillary implants. Rough surfaces, a cone design of implants, and the use of osteotomies in the management of the implant bed can
Intraoperative Complications: Dihiscence and Fenestrations
Osseous dehiscence and fenestrations in the vestibular cortical bone during the placement of implants constitute a risk factor for the healing process of peri-implant tissues. (Try to apply bone at the time of implant placement) Bone regeneration in paral
Intraoperative Complications: Implant Displacement
Implants could go into the sinus, nasal cavity. Any implant could undergo a displacement at any time after having been fixed with a cover screw (osseointegration period) , or even afterwards, at the time of connecting the healing abutment. Implant displac
Intraoperative Complications: Mandibular Fractures
Not an uncommon occurrence due to implant bone interaction based on bone quality. Type 1 bone, most commonly seen in the ant mandible can be at risk for fracture during implant placement. This is associated with atrophic mandibles. The central area of the
Intraoperative Complications: Neurosensory impairment
Neurosensory impairment may occur at any time during implant surgery, including anesthesia administration, incision, raising a flap, as well separating it too lightly, during osteotomy preparation, bone augmentation, implant placement, suturing or any sof
Intraoperative Complications: Aspiration or Swallowing of Instruments
Aspiration or swallowing of instruments is not an uncommon occurrence. A vital emergency if the instrument has entered the airways. If the object has bot been discharged from the respiratory tract, it should then be necessary to perform a bronchoscopy. Ti
Complications--Early; Edema
Avoid with the use of analgesic and anti-inflammatory drugs, as well as flapless surgery. Swelling can appear after a surgical intervention, 24 hours after: trismus, lack of hygiene in the wound and discomfort to the patient, decreases with time. Wide fla
Complications--Early; Emphysema
Air emphysema. Tissue emphysema: inadvertent insufflation propulsion of air into tissues under skin/mucous membranes from a high speed handpeice, an air/water syringe, an air polishing unit or an air abrasive device can be projected into a sulcus, surgica
Complications--Early; Mucosal Dihiscence
A soft tissue complication that can develop infections in the surgical area and implant and/or graft failures with poor esthetic results. Patients that have scarring problems due to a poor quality mucosa (thin biotype, traumatized or cicatricial type), he
Complications--Early; Implant Fracture
Fracture of prosthetic retaining crews is more common than implant fracture; a metal fatigue following an overload of materials. Defects in the implant design or materials used in their construction, a non-passive union between the implant and the prothes
Complications--Early; Genetics
immunologic markers TNF alpha-1, IL-6 indicates greater implant failure. Can happen with patients with osteoporosis or diabetes
Complications--Early; Radiation Therapy
87.6% success rate with HBO therapy. Jury is out on whether radiation is a no-no for implants
Complications: Early/Late;
Infection: Infection of the implant is a common cause of failure but the efficacy of prophylactic antibiotics for dental implant placement seems to not influence risk of implant failure and other complications. A single perioperative dose is enough
Peri-i
Microbiota of implant infections
Biofilm: Surface of the implant colonized by bacteria in the form of a biofilm which poses a barrier of bacterial challenges due to mucopolysaccharide morphology of organisms: Staphylococcous sp
Peri-implant mucositis: 40-48% of implants placed over 10 ye
Implants placed at site of infection:
The extraction site with a history of periapical, endodontic or periodontal infection have traditional healing periods of several months before being treated definitively with implants
Immediate placement contraindicated in site due to effect of bacteria
Plan for Case
Consult with ENT about: Endoscopic sinus exploration
Debridement, Remove diseased tissue, Implant removal
Primary advancement buccal flap closure
Future Options: Possible sinus grafting with bone based upon resolution of disease, Sinus health to be monito
Conclusions:
Proper tx planning: CBCT, occlusion/angluation, surgical guides, adjacent anatomy, medically compromised patient
Presence of zones of keritinized tissue
Pre-prosthetic surgical consideration
Antibiotic prophylaxis: antibiotics and rinses
Follow up at 1 we