• In the past people wasn’t so familiar with implants, and not convinced by it’s idea .• People used to wear RPD, then they wanted to use fixed prosthesis, it has a lot of advantage over removable .
• Then people start using implant, it has more advantage than fixed prosthesis .• But unfortunately there is a lot of risk factors and complications .
Risk factors :• Patient factors : 1-Medical status 2-Diabetes 3-Cigarette smoking 4-age• Iatrogenic factors : 1-Overheating of bone during surgery 2-Implant orientation 3-Lack of communication
• Local factors: 1-Peri-implantitis 2-Position of the implant site 3-Bone quality and quantity 4-Irradiated bone• Technical factors: 1-Different implant systems 2-Length of implants
Bone quality and quantity• it’s the most important local patient factor for successful implant treatment• But it’s not contraindication to implant treatment .
Bone density classification• D1: dense cortical bone• D2: thick dense to porous cortical bone on crest• D3: thin porous cortical bone on crest• D4: fine trabecular bone
• D1: in anterior part of the mandible twice the posterior, and never in the maxilla .• D2: in the maxilla less than the mandible• D3: is more in the maxilla (premolar area) than the mandible .• D4: is more in posterior maxilla .
Smoking• In the medical literature, numerous reports state that patients who smoke tend to have decreased bone quality (bone density ).• Slemenda concluded in a review article that the bone density of women who smoked was significantly lower than that of their twin sisters who did not smoke.
Bain and Moy achieved a 11.3% failure rate insmokers compared to a 4.8% failure rate innon-smokers. DeBruyn and Collaert foundsmokers to have a 6% failure rate and non-smokers a 1% failure rate.Their study indicated that there all usedmachined-surface screw-type implants.
DM• Diabetes is currently classified as a relative contraindication for implant treatment .
DM• Chronic hyperglycaemia produces an inflammatory effect and, cause bone resorption .• diabetes inhibits osseointegration by the reduction in the levels of bone-implant contact .
• Constant hyperglycaemia delays the healing of the bone around the implants .
• Although numerous studies have shown that insulin therapy allows regulation of bone formation around the implants and increases the amount of neoformed bone, it was not possible to equal the bone-implant contact when compared with non-diabetic groups .
• The repercussions of diabetes on the healing of soft tissue will depend on the degree of glycaemic control in the peri-operative period .
• it is necessary to maintain good glycaemic control before and after surgery : 1- to ensure osseointegration of the implants• 2-understood as the direct bond of the bone with the surface of the implant subjected to functional loading• 3- to avoid delays in the healing of gum tissue.
Complications• surgical• implant loss• bone loss• peri-implant soft tissue complications• mechanical complications• esthetic and phonetic complications
• The most common surgical complications were: hemorrhage , neurosensory disturbance, mandibular fracture .• Implant loss: more in maxillary overdentures, then complete fixed mandibular denture and single crowns.
• Implant loss was more for implants shorter than 10-mm in length, and less for implants greater than 10-mm.• Type IV bone more failure than other types.
• Two local factors have been implicated in the etiology of chronic peri-implantitis:• 1. Bacteria : microbiota which inhabit subgingival plaque which adhere to implant due to cervical microporosity .• 2. Overload : Occlusal overload can cause destruction of peri-implant tissues.
• What If failure happen ?• implant should be removed, not to compromised other treatment .
When implant should be removed :• 1- pain on palpation, percussion, or function .• 2-greater than 0.5 mm horizontal mobility, and vertical mobility .• 3-uncontroled progressive bone lose, and exudate .• 4-more than one half of bone lose around the implant .• 5-generalized radiolucency andor implant unable to be restored .
References• Patrick Bing-Chi Wu and William Ching-Wah Yung Factors contributing to implant failure Hong Kong Dental Journal 2005;2:12-8• Valero Ana Mellado et al Effects of diabetes on the osseointegration of dental implants Med Oral Patol Oral Cir Bucal 2007;12:E38-43Med Oral Patol Oral Cir Bucal 2007;12:E38-43• Akshay Kumar The Effect of Smoking on Achieving Osseointegration of Surface-Modified Implants• Jaime L lozada and Robert A james surgical repair of peri-implant defect• Carl E. Misch implant dentistry second edition the implant quality scale 1999;21-30