Early Dental Implant

Failure: Risk Factors

ZAID H. BAQAIN, WAEL YOUSEF MOQBEL, FALEH A. SAWAIR
D E PA R T M E N T O F O R A L A N D M A X I L L O FA C I A L S U R G E R Y , O R A L M E D I C I N E , O R A L PA T H O L O G Y A N D
P E R I O D O N T O L O G Y, FA C U L T Y O F D E N T I S T R Y , U N I V E R S I T Y O F J O R D A N , A M M A N , J O R D A N
O R A L A N D M A X I L L O FA C I A L S U R G E R Y D I V I S I O N , U N I V E R S I T Y O F J O R D A N H O S P I TA L , A M M A N , J O R D A N
© 2 0 1 1 T H E B R I T I S H A S S O C I AT I O N O F O R A L A N D M A X I L L O FA C I A L S U R G E O N S . P U B L I S H E D B Y E L S E V I E R LT D .
A L L R I G H T S R E S E RV E D .
Abstract
Objective: estimate the
incidence of early loss
of dental implants and
potential risk factors.
Predictive variables: Outcome variable:
patients, implant,
anatomical, or specific- early failure
operation implant.

The significance of difference by 169 patients, 116

bivariate analyses, a multivariate women, 53 men, mean
logistic regression model to
identify independent predictors age 47 (16-80). 399
for early loss of implants inserted implant.
Abstract

The early loss of dental implants

was significantly associated with
width of keratinised gingiva
(p=0.008), the use of polyglactin
sutures (p=0.048), and the use of
narrow implants (p=0.035)
Strongest predictors of early
failure of implant: narrow
keratinised gingiva and the use
of polyglactin sutures
Introduction
The first line of treatment and
long-lastng rehabilitation was
replacement of missing teeth
with endosseous implants and
implant-supported prosthesis1
The success of dental implants:
abscence of mobility2, continuing
radiolucency around the implant3,
peri-implanitis with suppuration,
and subjective complaint from
patient3,4
Failure of endosseous Clinical studies:
implant is etiher Most failures quality and volume The aim:
early or late occurs early, so of bone, site, investigate the
depending on grafted bone, as potential risk
recognition of
whether it occurs well as systemic factors that lead to
before or after potential risk factors (gen, early failure of
occlusal loading with factors is smoking, endosseous
prosthetic important6 metabolic implants
superstructure5 disorders)7
Subjects and Methods (Design of Study)
Prospective clinical observational study of patients referred to the Oral and Maxillofacial
Surgery Division at the University of Jordan Hospital (March 2006 – March 2010)

Patients listed for replacement of a single missing tooth or more with implants

Patients with uncontrolled metabolic diseases or osteonecrosis were exluded

Treatment plan was prepared by the surgeon and prosthodontist, considered of evaluation
patient’s history, alveolar availability was evaluated by orthopantomograph or CT
All patient were operated by single consultant surgeon, no evaluation of
prosthetic treatmenr or after starting prosthetic treatment

Standard protocol. Local anesthesia by local infiltration (2% lignocaine

with 1:100.000 adrenaline) following with mucoperiosteal flap

Co-amoxiclav 625mg was given orally 1 h before op, and cont 5 days post
op

Allergic penicillin patient were given clindamycin 150mg 6 h for 5 days

All patients were prescribed chlorhexidine digluconate rinse PO twice a day
for 7 days

Threaded, grit-blasted, and acid etched implant were used from Xive
(Dentsply, Germany) and ITI (Straumannm Switzerland)

Flaps were closed with polyglaction 910 sutures or black sutures

The implants were evaluated from time of placement until reopening (second
op) for starting prosthetic treatment
 Implant considered fail: peri-
implant radiolucency, was
detected on intraoral radiographs

sign or symptoms of infection,

Slightest movement when the

implant was tested by feeling at
the same time that all the cover
screw was removed
Variables and Statistical Analysis

Variables specific to patients:

Predictive variables: patient,
implant, anatomical, and
operative-specific
age, sex, smoking habits, and
general health (hypertension,
ischaemic cardiac diseases,
gastric prob, osteoporosis, hypo
or hyperthyroidism, asthma,
diabetes)
Variabel dan Analisis Statistik

Anatomical variables: site of

implant, widht of keratinised
gingiva (measured with periodontal
probe), and quality of bone.
Variables specific to implant: length
and diameter
Operative variables: timing and
method of placement, use bone
graft, internal sinus lift, type of
sutures
 Descriptive statistics
Data were collected on were calculated,
designed form and Statitical analysis with
bivariate analysis using
entered into SPSS
chi square test and
spreadsheet student’s t test

Probabilty of less than

Fisher’s exact test
0.05 were accpeted
 Results
Kelompok studi terdiri dari 169 pasien
yang berusia 16 hingga 80 tahun (rata-
rata (SD) 47 (16) tahun). Ada 53 pria
(31%) dan 116 wanita (69%). Pasien-
pasien ini diberi total 399 implan, dengan
rata-rata 2,4 implan / pasien.
Dari jumlah total yang dimasukkan, 15
(4%) pada 14 pasien gagal melakukan
osseointegrasi. Distribusi di antara pasien
dari variabel yang diteliti dan
hubungannya dengan hasil ditunjukkan
pada Tabel 1-4.
 Analisis regresi logistik multivariat (Tabel 5)
menegaskan pentingnya lebar gingiva keratin dan jenis
Tiga variabel secara signifikan terkait dengan hasil
bahan jahitan yang digunakan sebagai prediktor
implan dalam analisis univariat: keberadaan gingiva
independen dari kegagalan implan. Implan yang
yang menyempit (2 mm) di lokasi insersi (p = 0,008)
disisipkan di daerah gingiva yang melekat sempit
(Tabel 2); penggunaan jahitan polyglactin (p = 0,048)
memiliki risiko lima kali lipat mengalami kegagalan
(Tabel 3); dan implan sempit (<3,5 mm) dibandingkan
dini (OR = 4,7, p = 0,005), dan penggunaan jahitan
dengan sedang (3,5-4,5 mm) atau lebar (> 4,5 mm) (p
poliglaktin dikaitkan dengan risiko kegagalan awal
= 0,04) (Tabel 4).
yang hampir empat kali lebih tinggi (OR = 3,8, p =
0,04).
Discussion
Early failure of dental implants caused by failure of bony healing
and osseointegration, local or systemic factors1,8

Implants could fail early after insertion (implant system, clinical exp,
adecuacy of soft and hard tissues). The reported early failure 0,7% to 3,8%
1,5,6,9,10

The incidency of early failure of implants in this study was

4%
A narrow keratinised gingiva was significantly
associated with early loss of implants

To our knowledge, no studies have been published that considered its

width and early failure. There is no consensus, no evidence to support
a relation between widht of keratinised tissue and survival of implant8

Hwvr, thin or absent of masticatory gingiva was associated with

bop and a significantly greater mean loss alveolar bone11
Our results showed that the use of polyglactin 910 was associated with
a higher incidency of early loss implants (p=0.048) than silk sutures

Silk is a non-resorbable, natural, braided material that is preferred by some

surgeons because its easy to handle, good tension, good stability for duration
of sutures13

Silk was less likely to support bacterial colonisation than other suture
materials, which minimises tha chance of odontogenic infection14
A recent study described the largest early loss of implants
with short and narrow implants10

Systemic diseases
Periodontal and endodontic state of neighbouring teeth has to be taken
into consideration5

Lost of one implant in this study was atributed to failed RCT, higher
failure rates neighbouring teeth than implants in a edentulous ridge

Type 4 and 1 bones are more likely to fail5

The lack of keratinised gingiva and
use of polyglactin sutures may be
strong predictors of early failure of
implants
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