IMPLANT FAILURE

Dharshini P
INTRODUCTION
SUCCESS CRITERIA FOR DENTAL IMPLANTS
IMPLANT FAILURE CLASSIFICATION
CLINICAL AND RADIOLOGICAL CONDITIONS
DIAGNOSIS
RISK FACTORS
MANAGEMENT OF AILING AND FAILING IMPLANTS
TREATMENT
CONCLUSION
INTRODUCTION

Implant dentistry has become widely used because of very high success and survival rate,
however implant failure and related complications also have been reported
Dental implants demonstrated peri implant inflammatory reactions which were associated
with crystal bone loss
The inflammation is more pronounced and inflammatory process goes deeper and faster in
implants than in adjacent natural tooth
SUCCESS CRITERIA FOR IMPLANT
The individual implant is immobile when tested clinically
No evidence of peri-implant radiolucency
Bone loss no greater than 0.2 mm annually
Gingival inflammation amenable to treatment
Absence of. Symptoms of infection and pain
Absence of damage to adjacent teeth
Absence of parathesia , anaesthesia, violation of mandibular canal or maxillary sinus
Should provide functional survival for 5 years in 90% of cases and 10 years in 85% of cases
HEALTH SCALE FOR DENTAL IMPLANTS
1. SUCCESS(OPTIMUM HEALTH)
No pain or tenderness upon function
0 mobility
2mm radiographic bone loss from initial surgery
No exudates history
2.SATISFACTORY SURVIVAL
No pain on function
0 mobility
2-4 mm radiographic bone loss
No exudates
3.COMPROMISED SURVIVAL
May have sensitivity on function
No mobility
Radiographic bone loss ( less than 1/2 of implant body)
Probing depth 7 mm
May have exudates history
4.FAILURE( CLINICAL OR ABSOLUTE FAILURE)
Pain on function
Mobility
Radiographic bone loss 1/2 length of implant
Uncontrolled exudate
No longer in mouth
IMPLANT FAILURE CLASSIFICATION
MARCO ESPOSITO, JAN MICHAEL HIRSH, ULF LEKHOLM ET AL HAVE
CLASSIFIED ORAL IMPLANT FAILURES
1)Biological Failure:
Early or primary (Before loading)
Late or secondary (After loading)
2) MECHANICAL FAILURES:
Fracture of implants, connection screws, bridge framework,coating etc
3)IATROGENIC FAILURES:
Improper implant angulation and alignment,nerve damage
4)INADEQUATE PATIENT ADAPTATION
Phonetics, esthetics, psychological problems
According to Abdel Salam el Askary, Roland Meffert and terrence griffin

1) According to etiology :
A)Failures because of host factors
Medical status - Osteoporosis and other bone diseases; uncontrolled diabetes.
Habits - smoking, para-functional habits.
Oral status - poor home care, juvenile, and rapidly progressive periodontitis, irradiation therapy
B) Restorative problems
Excessive cantilever, pier abutments, no passive fit, improper fit of the abutment, improper prosthetic design,
improper occlusal scheme, bending moments, connecting implants to natural dentition, premature loading,
excessivetorquing.
C) Surgical placement
Off axis placement (severe angulation)
Lack of initial stabilization
Impaired healing and infection because of improper flap design or others.
Overheating the bone and exerting too much pressure.
Minimal space between implants
Placing the implant in immature bone grafted sites.
Placement of the implant in an infected socket or a pathologic lesion.
Contamination of the implant body before insertion
 D) Implant selection
Improper implant type in improper bone type.
Length of the implant (too short, crown-implant ratio unfavourable)
Diameter of the implant.

2) According to origin of infection –

Peri-implantitis (infective process, bacterial origin)
Retrograde peri-implantitis (traumatic occlusion origin, non-infective, forces off the long axis,
premature, or excessive loading).
3) According to timing of failure –
Before stage II (after surgery)
At stage II (With healing head and or abutment insertion)
After restoration.
4) According to condition of failure (clinical and radiographic status)
Ailing implants
Failing implants
Failed implants
Surviving implants
5) According to responsible personnel –
Dentist (oral surgeon, prosthodontist, periodontist)
Dental hygienist
Laboratory technician
Patient
6) According to failure mode -
Lack of osseointegration (usually mobility)
Unacceptable esthetics
Functional problems
Psychological problems

7) According to supporting tissue type –

Soft tissue problems (lack of keratinized tissues, inflammation, etc.)
Bone loss (Radiographic changes, etc.)
Both soft tissue and bone loss.
 CLINICAL & RADIOGRAPHIC CONDITIONS

Ailing Implant-
The ailing implant expresses radiographic bone loss without inflammation. A deep pocket
around the implant is evident, with absence of bleeding.
Failing implants-
The failing implant presents with constant deterioration at follow up and maintenance
appointments. Inflammation is present and is evident by signs of edema, redness, bleeding, and
suppuration. The implants are immobile, but radiographic bone loss is obvious.
Failed implants-
Failed implants are those with progressive bone loss with clinical mobility and that are not
functioning in the intended sense.
Failed implants are encapsulated in fibrous capsule.
A failed implant is one that is fractured, has been totally refractory to all methods of
treatment, or These implants must be removed immediately, because progressive destruction
of surrounding osseous tissues may occur.
 Surviving implants
Surviving is a term described by Alberktson that applies to implants that are still in function but
have not been tested against success criteria.
Cluster failures of dental implants
multiple implant failures occur in a patient; this is referred to as a “cluster effect.
Cluster failures usually occur soon after implant placement.
Genetic or systemic factors ( Peget’s disease,Osteoporosis,Auto-immune disorder) that
influence the incidence of cluster failures.
Ekfeldt and colleagues suggested that particular issues need to be considered to prevent
cluster implant losses (such as lack of bone support, heavy smoking habits and bruxism)
(Ekfeldt A, Christiansson U, Eriksson T, et al. A retrospective analysis of factors associated with multiple implant failures in
maxillae. Clin Oral Implants Res 2001;12(5):462-467.)
 DIAGNOSIS
Bleeding on probing
There is no correlation between BOP and histologic, microbiologic, or radiographic changes
around implants.
Along with BOP modified gingival index can be used to assess marginal mucosal conditions
around oral implants

SCORE SIGNS
0
Normal mucosa
1
Minimum inflammation with colour change and minor

2
Moderate inflammation with redness

3
Severe inflammation with
redness,edema,ulceration,and spontaneous bleeding
without probing
Probing depth and loss of attachment
Probing should be done in normal probing force .2N- .3N.Probing depth
penetration around teeth has been found to be < 3 mm as opposed to 2 mm to
4 mm around implants.
The so-called platform switch (abutment is located horizontally between
implant and crown) can complicate probing and, thus, hide the true extension
of peri- implantitis
Pus formation
Pus formation is always a sign of infection with active tissue destructive
processes taking place.
Periimplantitis lesions usually yield some pus formation upon provocation by
pressing on the mucosal tissues, while mucositis lesions may not. Hence, pus
formation represents a specific diagnostic sign for the presence of peri-
implantitis.
Radiographic evaluation
The distance from the implant shoulder to the alveolar bone crest represents a reliable
radiographic parameter for long-term monitoring in clinical practice.
A mean bone loss of 1.6 mm for the first year and a mean of 0.13 mm in subsequent years.
 Radiographic features of failed implants-
There can be two well-distinct radiographic pictures: a thin peri-fixtural radiolucency
surrounding the entire implant, suggesting the absence of a direct bone-implant contact and
possibly a loss of stability, and an increased marginal bone loss.(>7 mm).
When an implant fails because of a reason other than infection (such as surgical or prosthetic
trauma), it usually has mobility and peri-implant radiolucency, and there may be an absence of
inflammation.
Failure due to an infection may manifest as progressive bone loss, a peri- implant radiolucency,
overt clinical signs of inflammation.
Pain or sensitivity
Pain or discomfort is often associated with mobility and could be one of the first signs which
indicate an implant failure.
Dull sound at percussion
It has been suggested that a subdued sound upon percussion against the implant carrier is
indicative of soft tissue encapsulation, whereas a clear crystallization sound indicates
successful osseointegration.
Mobility-
Clinically discernible mobility can be present without distinct radiographic bone changes.
Therefore, mobility is the cardinal sign of implant failure.
Several different types of mobility can be seen
Rotation mobility, Lateral or horizontal mobility, Axial or vertical mobility.
it is recommended to remove the prosthetic construction and cheek the implants for stability.
Clinically discernible mobility after bridge removal can confirm the presumptive radiographic
diagnosis of implant failure.
Assessment of implant stability-
Reverse torque test-
Implants that rotate under the applied torque are considered failures and are then removed.
Periotest-
It is a device which is an electrically driven and electronically monitored tapping head that
percusses the implant a total of 16 times. The entire measuring procedure takes about 4 s.
RISK FACTORS

Host factors-
Systemic diseases-

Osteoporosis, osteomalacia, fibrous dysplasia, diabetes mellitus, thyroid disorders responsible

for poor wound healing and poor osseintegration which causes early failure of implants.
HABITS
Smoking:
Significance
Causes alveolar vasoconstriction and decreased blood flow
Impaired wound healing due to compromised polymorphonuclear leucocytes function,
increased platelet adhesiveness as well as vasoconstriction caused by nicotine.
In case of poor oral hygiene, smokers have 3 times more marginal bone loss
Recommendations:
1.Obtain a smoking history
2.Advice on risks of periodontal breakdown
3.Advice on the prognosis .Smoking cessation
Parafunctional habits-
Most common cause of implant bone loss or lack of rigid fixation
During the first year after implant insertion. Commonly manifests as
connecting screw loosening because of overload.
Fracture of porcelain , progressive bone lose can also be seen
Failures are higher in maxilla because of decrease in bone density.
Increased number of implants to be placed
Avoid cantilevers and occlusal contacts in lateral excursions
Use of wide diameter implant to provide greater surface area. Progressive bone loading and
prosthetic design that improves the distribution of stresses throughout the implant system.
The anterior teeth may be modified to recreate the proper incisal guidance and posterior
interference during excursion.
For maxillary implant restoration hollow night guard is used and in case of mandibular
implant supported prosthesis the occluding surface of maxillary night guard are relieved over
the implant crown.
Quality & quantity presentation-
Patients with low quantity and low density of bone were at highest risk for implant loss.
In type IV bone due to its thin cortex, poor medullary strength, and low trabecular density
implant failure is more.
In division C & D bone chances of failure of implants is more due to less bone support.
Osteoplasty (C–w)
Root form implants (C–h)
Subperiosteal implant (C–h, C–a partial, or completely
edentulous mandible).
Disk design implants (posterior mandible, anterior maxilla)
Ramus frame implant (C–h completely edentulous mandible)
Autogenous iliac crest bone grafts to improve the anterior division
D are strongly recommended.
Endosteal implants of adequate height can rarely be positioned in
the posterior maxilla with division D bone without a sinus graft.
After 6 months post sinus graft, the division DOsteoplasty (C–w)
Root form implants (C–h)
Subperiosteal implant (C–h, C–a partial, or completely edentulous
mandible).
Disk design implants (posterior mandible, anterior maxilla)
Ramus frame implant (C–h completely edentulous mandible)
Autogenous iliac crest bone grafts to improve the anterior division
D are strongly recommended.
Endosteal implants of adequate height can rarely be positioned in
the posterior maxilla with division D bone without a sinus graft.
After 6 months post sinus graft, the division D
Malpositioning of Implants C/F & Diagnosis- Fracture of
Classification prosthesis. Fracture of abutment &
Proximity of implants to each abutment screw.
other Bone loss.
Proximity of implants to adjacent Peri-implantatis.
teeth Implant mobility. IOPAR
Abnormal angulation of the CBCT
implant
Malposition of implant in relation
to position of the missing tooth it
replaces
Mechanical debridement of the affected implant should be done followed by
antiseptic treatment.
Bone grafting is necessary to provide the added bone support.
Implant abutment can be replaced by angled abutment and custom made
abutment.
If it is determined that the implant cannot be functionally or esthetically
restored in its existing location, the implant can be left unexposed beneath the
soft tissue and not uncovered, or it can be uncovered but not placed into
function.

Improper occlusal scheme
C/F & Diagnosis-
Bone loss.
Screw loosening, screw fracture.
Fracture of the prosthesis.
Articulating paper is used (30 μm) for the
initial implant occlusion adjustment in
centric occlusion under light tapping forces.
The implant prosthesis should barely make
contact, and the surrounding teeth in the
arch should exhibit greater initial contact.
Any mobile teeth opposite to the implant
prosthesis should be extracted
Fixed arch Prosthesis-Group function
occlusion or mutually protected occlusion
with shallow anterior guidance when
opposing natural dentition & No working
and balancing contact on cantilever.
For the occlusion on overdentures, it has
been suggested to use bilateral balanced
occlusion & monoplane occlusion in
resorbed ridge can be used.
Such cases are treated by removal of prosthesis followed by regenerative procedure and fabrication of new
prosthesis.
Reduction in cusp inclination can decrease the resultant bending moment with a lever-arm reduction and
improvement of the axial loading force. Reduced cusp inclination, shallow occlusal anatomy, and wide grooves
and fossae may be beneficial when constructing implanted prostheses.
Typically, a 30%-40% reduction in the occlusal table in a molar region has been suggested because any
dimension larger than the implant diameter can cause cantilever effects.
Cusp inclination has been found to produce a high level of For every 10° increase in cusp inclination, there is
an approximately 30% increase in torque.
Improper cantilever
Cantilevers are class-1 levers, which increase the amount of stress on implants.
According to Glantz ; D = F x L / E x W x H ,, D is the amount of deformation, F is the force of occlusion,
L, W, and H are the length, width, and height of the cantilever, respectively, and E is the modulus of
elasticity of the material .
The length of the cantilever should be minimized while maximizing the height and width of the cantilever.
Cantilever length is influenced by type of arch, no of implants , A-P spread, type of prostheses to be used.
At each increment of 5 mm in cantilever length, stress increased by approximately 30% to 37% on
the cortical bone around implant.
According to McAlarney and Stavropoulos ratio of cantilever length and A- P spread should be
between 2-1.5
(McAlarney ME, Stavropoulos DN: Determination of cantilever length anterior-posterior spread
assuming failure criteria to be the compromise of the prosthesis retaining screw-prosthesis joint.
Int J Oral Maxillofac Implants 1996;11:331-319)
English recommended cantilever lengths be 1.5 times the A/P spread, but shorter in poor quality
bone. (English C: Critical A-P spread. Implant Soc 1990;1:2-3)
C/F And Diagnosis :
Progressive bone lose.
Fracture of the framework.
Prosthesis Fracture.
Screw loosening.
Fracture of implant abutment
junction. After regenerative
treatment in ailing/ failing implants
additional implants can be placed
to reduce to cantilever length.
IMPLANT ABUTMENT MISFIT
C/F:
Torque loss.
Progressive bone loss due to
inflammation.
Peri-implantaitis.
Screw loosening.
Regenerative treatment should be done to
reduce the inflammation & to increase
bone level.
Use proper abutment with platform-
switching concept.
CAD/CAM abutment can be used
 SURGICAL ERROR
Excessive Pressure Heat generation Oversized osteotomy

Bone cell damage The critical temperature above

which bone necrosis occurs is 47°C Lack of initial stability.
for 1 minute.
Mobility of implant

No regeneration of the peri implant bone

Presence of an inflammation infiltrate in the gap between bone and implant
No organisation of peri implant bone clot
 Speed must not be above 1200 RPM.
Proper coolant should be used while perform osteotomy.
In case of over sized osteotomy larger diameter implant can be used & loading can be delayed
Injury to the vital structures.

Injury of inferior alveolar nerve Maxillary sinus perforation. soft tissue injury

Paresthesia of lips Nasal bleeding Maxillary sinusitis Flap dehiscence. Presence of

large edema or hematomas.
Exposure of implant site
Proper flap design to prevent soft tissue injury .
Large dehiscence can be treated by removal of granulation tissue and resuturing
if sinus perforation occurs loading should be delayed by 6 months.
Transantral endoscopic surgery can be done in case of maxillary sinusitis or losing implant in
maxillary sinus.
Detailed initial treatment planning and careful surgery to unroof the canal and move the
neurovascular bundle inferiorly prior to fixture installation can be done to prevent inferior
alveolar nerve injury.
MANAGEMENT OF AILING AND FAILING IMPLANTS

Identification of the cause

Peri-implantaitis
Prophylactic procedures
The patient should be motivated to perform an adequate level of plaque control on a regular
basis.
Overcontoured and sub-gingivally placed prosthesis, particularly in the proximal region, will
prevent the patient from attaining optimal oral hygiene, thereby jeopardizing the health of
abutment teeth and their surrounding tissues.
Therapeutic strategies
Cumulative interceptive supportive therapy (CIST)
This protocol is cumulative in nature and includes four steps which should not be used as
single procedures, but rather as a sequence of therapeutic procedures with increasing
antibacterial potential, depending on the severity and extent of the lesion. In 2004 it was
modified and called AKUT-concept by Lang et al. (Smeets R, Henningsen A, Jung O, Heiland
M, Hammächer C, Stein JM, et al. Definition, etiology, prevention and treatment of peri-
implantitis – A review. Head Face Med 2014;10:34)
 A. Mechanical debridement (supportive therapy protocol A)
Oral implants with evident plaque or calculus deposits adjacent to only slightly inflamed peri-
implant tissues), but lacking suppuration and having a probing depth not exceeding 3 mm.
While calculus may be chipped off using carbon-fiber curettes, plastic hand instruments or
ultrasonic instruments with a plastic tip.
The use of a high pressure air powder abrasive (mixture of sodium bicarbonate and sterile
water), has been advocated, as this removes the microbial deposits, does not alter the surface
topography and has no adverse effect on cell adhesion.
 CO2, Diode-, Er:YAG- and Er,Cr:YSGG- lasers are used in the treatment of peri-implant
diseases with increasing frequency
Most of these lasers, function through vaporization mode. High temperatures could alter or
damage the implant surface making them inappropriate for use in treating the implant defect.
They could also result in charring or coagulation of tissue, delaying the reparative cascade.
The Er, Cr: YSGG laser, operating at 2780 nm, blates tissue by a hydrokinetic process that
prevents temperature rise.
(El-Askary AS, Meffert RM, Griffin T. Why do implants fail? Part II. Implant Dentistry. 1999;
8:265– 276.)
B. Antiseptic treatment (supportive therapy protocol B)
The type of implant surface will determine the method of decontamination
1. critic acid (40% concentration; pH 1)
2. chlorhexidine gluconate (.1%)
3. Stannous fluoride 4. tetracycline
contact with a supersaturated solution of are antimicrobials and/or
antibiotics, for 30-60 seconds have been used for the preparation of the
implant surfaces, as they have the highest potential for the removal of
endotoxins from both the hydroxyapatite and the titanium implant
surfaces.
In general, 3–4 weeks of regular administration are necessary to achieve
positive treatment results.
 Machined titanium surfaces are the easiest to decontaminate and that topical tetratcyclines.
Tetracycline stimulates fibroblast growth in the affected area.
(Buser D, Merickske-Stern R, Dula K, et al. Clinical experience with one-stage, non-submerged
dental implants. Advances Dental Res. 1999; 13:153–161.)
Prolonged application time of citric acid solution are not recommended for use on HA
surfaces, since this would alter the quality and impair its ability to bond to the titanium body
of the implant.
If the HA is already damaged due to the virulence of the infection surrounding the implant. It
is eliminated completely by drilling and then proceed to apply air abrasion or ultrasound and
subsequently decontaminate the area with.
C.Antibiotic treatment (supportive therapy protocol C)
Before starting the antibiotic treatment the mechanical
(A) and the antiseptic
(B) treatment protocols have to be applied.
During the last 10 days of of the antiseptic treatment antibiotic treatment should be used.
D.Regenerative and resective therapy (supportive therapy protocol D)
Only if infection is controlled successfully, as evidenced by an absence of suppuration and
reduced edema, further treatment to restore the bony support of the implant by means of
regenerative techniques or to reshape the peri-implant soft tissues and/or bony architecture
should be done
It is recommended to remove the prosthesis 8 weeks prior to surgical treatment in order to
ensure optimal results of oral hygiene practices and allow the soft tissue to heal and collapse
around the implant sites
The first step in surgical therapy is to degranulate the defect. It is followed by exposing and
treating the bacterially contaminated implant surface
If the surface is clean and detoxified, with all exposed areas of the implant visualized and
instrumented, it is possible to graft with an allograft material such as DFDBA to achieve
biologic healing.
If the implant surface cannot be cleaned and detoxified due to vents, holes in the implant
fixture, it is advisable to graft with an alloplast material such as HA or Bioactive Glass.
The resective osseous surgery is indicated to reduce pockets and bone recontouring to correct
negative architecture of bone . This include Resection techniques including ostectomy, with
the raising of an apical repositioning flap, and implantoplasty.
 CALCIUM HYDROXIDE PASTE AS A SURFACE DETOXIFYING AGENT FOR
INFECTED DENTAL IMPLANTS: CASE REPORT
Dennis Flanagan.
Journal of Oral Implantology, 2009.
A 44-year-old woman with failing endodontically treated maxillary central incisors presented
for treatment and after extraction of two incisors two implants were placed.
After4 months of healing, 1 implant was placed in site #11 and Site #21 had poor bone quality
for initial stabilization, therefore, the osteotomy was compressed with an osteotome and a
larger implant was installed
At the eighth postoperative week, the patient presented with a small facial swelling at site
#21. A drainage tract was seen and a radiograph was made with a #40 gutta percha point
placed into the tract to act as an indicator to the source.
The site was locally anesthetized and surgically opened. The area was debrided with a
periodontal curet, treated with calcium hydroxide paste(30 sec).
An allograft material was then placed in the defect (Puros), and a barrier membrane was
placed
THE TREATMENT OPTIONS FOR MANAGING IMPLANT FAILURE
Removal of failed implant.
The techniques of removal of failed implants include use of a counter- torque ratchet, Piezo
tips, high-speed burs, elevators, forceps, reverse screw and trephine burs and combinations of
these tools.
Use of the counter-torque ratchet is the least invasive technique for removing an implant. It is
screwed into a failed implant and reverse torqued. It works well in the maxilla.
In the mandible, where the bone is denser, it is advisable to use a bur 360 degrees around an
implant to remove bone at least one-half its length before counter torquing.
Removal of failed implant.  The techniques of removal of failed implants include use of a counter- torque ratchet, Piezo tips, high-speed burs, elevators, forceps, reverse screw and trephine burs and combinations of these tools.  Use of the counter-torque ratchet is the least
invasive technique for removing an implant. It is screwed into a failed implant and reverse torqued. It works well in the maxilla.  In the mandible, where the bone is denser, it is advisable to use a bur 360 degrees around an implant to remove bone at least one-half its length before
counter torquing.
DENTAL IMPLANT REIMPLANTATIONS

Delayed Reimplantation after loss of an implant.

When an implant is lost, a flap should primarily cover the entrance to the site and after 9-12
months, a new implant can be replaced at that site.
New implants are larger in length and diameter than the implants placed first.
Immediate Reimplantation after loss of an implant
Failure rates after implant removal were not significantly different between delayed and
immediate reimplantations.
If there is adequate bone to achieve primary stability, delayed placement does not appear to
provide any advantages.
Treatment of peri-implantitis using an Er:YAG laser or an air-abrasive device: a randomized clinical trial.

Renvert S, Lindahl C, Roos Jansa˚ker A-M, Persson GR. J Clin Periodontol 2011; 38: 65–73.
Aim- The aim of the present study was to assess the clinical outcomes following treatment with
either a non-surgical debridement using an air- abrasive device or an Er:YAG laser in subjects with
implants and a diagnosis of periimplantitis.
Materials and Method
42 Subjects were selected which are presented with at least one dental implant with bone loss. and
having a PPD >5 mm with bleeding on probing.
 Twenty-one subjects in each group were randomly assigned to one time intervention by an
air-abrasive device or an Er:YAG laser. Clinical data were collected before treatment and at 6
months.
Results-
No baseline subject characteristic differences were found. Bleeding on probing and
suppuration decreased in both the groups.
25% of the subjects in the laser group had an average PPD reduction more than or equal to 1.0
mm whereas 38% of the subjects in the air-abrasive group had an average PPD reduction
more than or equal to 1.0 mm.
The average change in the bone level was a loss of 0.3 mm for the laser group and a loss of
0.1 mm bone height for the air-abrasive group.
Conclusion- Air- abrasive group shows better clinical out come than laser group.
 Prognosis of the implants replaced after removal of failed dental implants.
Young-Kyun Kim, Jin-Young Park, Su-Gwan Kim Int J Oral Maxillofac Implants ;2016.
Aim- This study was carried out to evaluate the survival rate and condition of tissue
surrounding the replaced implants after removal of failed implants.
Materials And Methods-
This study examined 60 implants ( 39 implants in men, 21 implants in women) in 49 of these
patients (35 men, 14 women).
The following parameters associated with the implants were measured and analyzed: the area
in which the implant failed, the surgical methods performed in the first placement, the
surgical methods performed in the second placement, the biomaterials used in the first
placement, the biomaterials used in the second placement.
Results-
The most frequent site of implant failure was the maxillary first molar area.
The percentages of cases of immediate and delayed replacement were 48.3% and 51.7%,
respectively. The average healing time for patients undergoing delayed replacement was 2-
3months.
No significant difference in the failure rate of the second implant was observed between the
immediate and delayed replacement groups.
The marginal bone loss at the final follow-up (22-24) months after implantation) was 0.33-0.49
mm, the width of attached gingiva was 1.68- 2.11 mm, the plaque index was 0.81-1.05, the
gingival index was 0.56- 0.63, and the pocket depth was 3.33-1.21 mm.
Conclusion- Implant failure occurred most frequently in the maxillary first molar area. We can
improve the survival rate of replaced dental implants after removing the initial failed implant
using various bone grafting techniques and/or additional implant fixture.
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CONCLUSION

Failure of implant can be multi-factorial. Often many factors come together to cause the
ultimate failure of the implant. One needs to identify the cause not just to treat the
present condition but also as a learning experience for future treatments. Proper data
collection, patient feedback, and accurate diagnostic tool will help point out the reason
for failure. An early intervention is always possible if regular check-up are undertaken.
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