Implant-Related

Complications and Failures

1. Understand the diagnosis and treatment of periimplant
complications
2. Types and etiology of periimplant complications
3. Understand the diagnosis of periimplant tissue
breakdown.
 Implant Complications and Failures
• Implant success:-
Is simply determined by the implant presence at the time of the
last patient examination.
• This is affected by:-
• The patient
• The dentist
• The procedure
• Implant design
• Implant material
• The operator knowledge and experience.
So implant success is defined as the outcome of dental implants without any
adverse effects
It is any implant – retained restoration in
which ( Criteria of Implant success):-
• The original treatment plane is performed
as intended and maintained without
complication.
• All placed implants remains stable and
functioning without problems.
• Peri-implant soft and hard tissues are
healthy.
• Both the patient and the clinician are pleased
with the results.
• Implant survival is defined as any implant
that remains in place at the time of evaluation
regardless of any problem present at the time
of evaluation or history of any problem.

• Functioning implants are implants that carry

restorations in function
• Sleeper implants are those implants inserted
and maintained osseo-integrated without
bearing any restoration and did not share in
any function.

• Sleepers are not considered as successful

surviving implants but it is counted as
implants failures because they failed to
fulfill the originally intended treatment.
Etiology of complications
1- Surgical complications:-
• Hemorrhage and hematoma.
• Neurosensory Disturbances.
• Damage to adjacent teeth.

2. Biologic complications
• Inflammation and Proliferation
• Dehiscence and Recession
• Periimplantitis and Bone Loss
• Implant Loss or Failure
3- Technical or Mechanical Complications:-
• Screw Loosening and Fracture.
• Implant fracture.
• Fracture of restorative Materials.
5. Esthetic and phonetic complications
• Esthetic Complications
• Phonetic Problems
Hemorrhage and Hematoma
 Bleeding during surgery is common and easily
controlled
 If large vessel is incised or injured during surgical
procedure, the hemorrhage can be difficult to control
 Smaller vessels will naturally constrict or retract to slow
the hemorrhage
 Most difficult situation when the point of bleeding is
inaccessible and internal (within the connective tissues
and soft tissue spaces).
Implant Malposition
• Dental implant being placed in an undesired or
unintended position
• Malpositioning of dental implants is usually the
result of poor treatment planning before the implant
surgery, lack of surgical skill by the implant
surgeon, and/or poor communication between
implant surgeon and restorative dentist
• Apicocoronally, the implant should be placed
so the dental implant platform is 2 to 3 mm
apical to the gingival margin of the anticipated
restoration
• If the platform is placed at or above the level of
the gingival margin, a metal collar or implant
exposure can occur yielding an unaesthetic
result
• Mesiodistal implants should be placed at a
distance of 1.5 to 2 mm from a natural tooth
and 2 to 3 mm from an adjacent implant to
maintain an adequate biologic dimension.
 2-3 mm

1.5 – 2 mm
• During surgical procedures and placement of
implants adjacent to teeth can injure the teeth
either by directly cutting into the tooth
structure or by damaging nearby supporting
tissues and nerves
• During drilling, directed at or near the
adjacent tooth may cause injury to the
periodontal ligament, tooth structure, and
nerve of the tooth
The 2-mm guide pin is used to determine After angle correction, the osteotomy sites
direction of the osteotomy site and its are completed to length with the final
proximity to the adjacent root Drill, usin 3 mm guide pin
Neurosensory Disturbances

• One of the more problematic surgical

complications is an injury to nerves
• Neurosensory alterations caused by damage to
a nerve may be temporary or permanent
• Neuropathy can be caused by a drilling injury
– Cut, tear, puncture of the nerve
– Implant compression to the nerve
Biologic Complications:-

A- Inflammation and Proliferation.

B- Dehiscence and gingival Recession.

C- Periimplantitis and bone loss.

D- Implant loss or Failure.

 Biologic Complications
A- Inflammation and Proliferation:-

• Soft tissue problems around dental implants are due to

bacterial accumulation around implants, the causes of
bacterial accumulation around implants are;
• Ill-fitting implant – abutment
• Abutment-crown connection
• Rough surfaces of the implants as titanium plasma-
spray (TPS) or hydroxylapatite (HA) coated implants.
• Inflammation of the periimplant soft tissues has
been found to be similar to but with more profound
and dramatic inflammatory proliferation than the
inflammatory response around roots of the teeth.
• Inflammations appear with erythema, edema, and
swelling.
• If inflammation is confined to the soft tissues only
it is termed periimplant mucositis but if it affects
soft and hard tissues it is termed periimplantitis.
• Periimplant mucositis is mainly caused by:-
• Loose-fitting implant to abutment connection
• Trapped excess cement that remains within the soft
tissue space or pocket
– This will leads to infection of the soft tissues with bacteria
leading to:-
– Mucosal hypertrophy or proliferation
– Abscess formation.
– Fistula formation.
• Correction of the causative factors will effectively
resolves the lesion.
Inflammatory proliferation caused by a loose-fitting connection
between the abutment and the implant.
Abscess caused by excess cement
trapped within the soft tissues
Fistula caused by loose implant-abutment connection
 Dehiscence and Recession
• Recession is a common finding after implant
restoration and should be anticipated especially
when the soft tissues are thin and not well
supported.
• It constitutes a big problem with patients with
high smile line or patients with esthetic
demands if it occurs in the anterior region and
it is considered as failure of the implant.
• In normal dentition the presence of
dentogingival and transceptal fibers
provides support for the gingival tissues far
above the level of the crestal bone in absence
of inflammation.
• The gingival margins and interdental
papillae are supported and maintained
around teeth even when the periodontal
tissues are very thin.
• On the other hand , periimplant soft tissues are
entirely dependant on the surrounding bone for
support.
• Absence of the supracrestal fibers will limit the
support of the soft tissues around the implant.
• The soft tissue height around dental implant is 3-4
mm and bone loss around implants often leads to
recession.
Periimplantitis and bone Loss
• Periimplantitis is defined as an
inflammatory process affecting the tissues
around an ossoeointegrated implant in
function, resulting in loss of supporting
bone.
 Diagnosis of Periimplantitis
• To diagnose a compromised implant site , soft
tissue measurements by using manual or
automated probes & standardized radiography,
both with and without computerized analysis.
• 1- Periodic clinical evaluation of tissue appearance,
• 2- Probing depth changes &
• 3- Radiographic assessment
• are the best means of detecting changes in bone
support.
 Causes of periimplantitis
1- Bacterial infection & contaminated
rough surface
2- Impaired healing.
3- Excessive biomechanical forces
(affected by; number of implants,
implants distribution and the
occlusion relationship).
• Severely reduced bone support extending into
the apical half of the implant.

• In this case implant removal should be

considered; after the implant removal, the
ridge defects can be reconstructed using bone
graft and membrane techniques, this will
enables the clinician to place implants in
previously compromised situation.
Implant loss or failure

Implant loss or failure is generally considered

relative to the time of placement or restoration.

Early implant failures occur before implant

restoration.

Late implant failures occur after the implant

has been restorated.
• When an implant fails before restoration (early), it
probably did not achieve osseointegration, or the
integration was weak or jeopardized by:-
– Infection
– Movement (overload)
– Impaired wound healing
• Late implant failures occur after delivery of
prosthesis for many reasons, including implant
overload & infection.
PROSTHETIC OR MECHANICAL
COMPLICATIONS

• Screw Loosening and Fracture

• Implant Fracture

• Fracture of Restorative Materials

Screw Loosening and Fracture
• Found most frequently in
screw-retained FPDs.
• Screw-retained single crowns attached to externally
hexed implants (i.e., those with narrow- or
standarddiameter restorative interface connection
surfaces) are particularly prone to this
type of mechanical complication
• Abutment or prosthesis screw loosening is
often corrected by retightening the screws.

• Over time, however, if screws continue to be

stretched, they become fatigued and
eventually fracture
 Fracture of Restorative Materials

• Fracture or failure of materials used for

implant-retained restorations can be a
significant problem. This is particularly true
for veneers (acrylic, composite, or ceramic)
that are attached to superstructures
ESTHETIC AND PHONETIC
COMPLICATIONS
• Esthetic complications arise when patient
expectations are not met.

• Patient satisfaction with the esthetic outcome

of the implant prosthesis vary from patient to
patient, depending on a number of factors.
– high smile line, thin periodontal soft tissues, or
inadequate bone quantity and quality
• Result from poor implant position and deficiencies
in the existing anatomy of the edentulous sites that
were reconstructed with implants.
• An important prerequisite for achieving optimal
gingival tissue contour is sufficient periimplant bone
to support the soft tissues.
• Hard tissue defects can be treated by a variety of
bone augmentation procedures.
• Available amount of bone does not allow for
ideal implant placement.

• Implant is positioned too apical, buccal, or

in the proximal space, an unesthetic
prosthetic profile will be developed
• If crown contours and dimensions are not
ideal or if gingival harmony around the
implant restoration is unesthetic, outcome
does not represent a natural appearance
• Implant prostheses that are fabricated
with unusual palatal contours
– Restricted or narrow palatal space
– Spaces under and around the superstructure

• Can create phonetic problems for the

patient.
(creating spaces that allow air to escape during speech).
NEWMAN, M. G., TAKEI, H.,
KLOKKEVOLD, P. R. & CARRANZA, F. A.
2011. Carranza's clinical periodontology,
Elsevier health sciences.
THANK YOU