Implant failures/ dental implant courses

IMPLANTIMPLANT
FAILURESFAILURES
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.comwww.indiandentalacademy.com

CONTENTSCONTENTS
 Introduction
 Definition of implant failure
 Signs and Symptoms
 Criteria for successful Implants
 Failing and Failed Implants
 Classification of implant failures
 Systematic factor contributing to implant
failure
 Perioperative errors contributing to
implant failure
 Errors due to anatomic variation
 Errors due to implant contamination
 Error in implant position
 Error in implant exposurewww.indiandentalacademy.comwww.indiandentalacademy.com

 Peri implantitis
 Prosthodontic consideration in first stage implant
failure
 Factors affecting Implant Failures
 Implant related factors
 Host factors
 Prosthodontic consideration in implant failure
 Esthetic failure
 Force delivery and failure mechanism
 Tooth implant connection
 Single implant restoration
 Factor effecting choice of occlusal scheme
 Important guideline to follow
 Summary and conclusion
 References

INTRODUCTIONINTRODUCTION

Definition:An implant failure may be defined as
the first instance at which the performance of the
implant, measured in some quantitative way falls
below a specified acceptable level.
Or
Can be defined as an implant that has a hopeless
prognosis.

Signs and symptoms of implantSigns and symptoms of implant
failurefailure
 Horizontal mobility beyond 0.5mm or any clinically
observed vertical movement under <500g force
 Rapid progressive bone loss regardless of the stress
reduction and peri implant therapy
 Pain during function or on percussion
 Dull sound on percussion
 Continued exudation in spite of surgical attempts at
correction

 Generalized radiolucency around an implantGeneralized radiolucency around an implant
 >1/2 of the surrounding bone is lost>1/2 of the surrounding bone is lost
 Pocket depth of 5mm .Pocket depth of 5mm .
 Bleeding on probing (BOP) Index of 2 or above

CRITERIA FOR SUCCESSFULCRITERIA FOR SUCCESSFUL
IMPLANTSIMPLANTS
 The criteria used to evaluate the success of oral implantThe criteria used to evaluate the success of oral implant
treatment have changed considerably during the last 35treatment have changed considerably during the last 35
yearsyears
 The criteria proposed during the first national institutes ofThe criteria proposed during the first national institutes of
health consensus meeting on this subject in 1979 are nowhealth consensus meeting on this subject in 1979 are now
considered inadequate according to current standardconsidered inadequate according to current standard
 1986 Alberktsson and colleague proposed a more1986 Alberktsson and colleague proposed a more
stringent set of criteriastringent set of criteria
 Individual unattached implant that is immobile whenIndividual unattached implant that is immobile when
tested clinicallytested clinically
 Radiograph that does not demonstrate evidence of perRadiograph that does not demonstrate evidence of per
implant radiolucencyimplant radiolucency
 Bone lose that is less then 0.2mm annually after theBone lose that is less then 0.2mm annually after the
implant first year serviceimplant first year service

•Individual implant performance that is Characterized by anIndividual implant performance that is Characterized by an
absence of persistent and irreversible sign and symptoms ofabsence of persistent and irreversible sign and symptoms of
pain ,infection, neuropathies, paresthesia or violation of thepain ,infection, neuropathies, paresthesia or violation of the
mandibular canalmandibular canal
A success rate of 85% at the end of a 5 year observationA success rate of 85% at the end of a 5 year observation
period and 80% at the end of a 10 year observation as aperiod and 80% at the end of a 10 year observation as a
minimum criteria for successminimum criteria for success
Smith And Zarb (1989) added to the criteria for implantSmith And Zarb (1989) added to the criteria for implant
success by suggesting that the implant design should notsuccess by suggesting that the implant design should not
preclude placement of a crown or prosthesispreclude placement of a crown or prosthesis with anwith an
appearance that is satisfactory to the patient and dentistappearance that is satisfactory to the patient and dentist

Failing and failed implantsFailing and failed implants
Failing Implant
Definition-Definition-
Failure process is inFailure process is in
early stages and isearly stages and is
reversiblereversible
Clinical features-Clinical features-
 Progressive Marginal BoneProgressive Marginal Bone
loss (Saucerization)loss (Saucerization)
 Absence of mobilityAbsence of mobility
 Peri implant infection (periPeri implant infection (peri
implantitis)implantitis)
Failed Implant
Failure process has
reached the irreversible
state
# Marginal bone loss
reaching the apical 1/3 of
implant mobility
 Thin peri fixtural
radiolucency

Classification of ImplantClassification of Implant
FailuresFailures
According to Branemark et alAccording to Branemark et al
• Loss of bone anchorage
- Mucoperiosteal perforation
- Surgical trauma
• Gingival problems
- Proliferatative gingivitis
- Fistula formation
• Mechanical complications
- Fixture fractures
- Fracture of prostheses, gold screws, abutmentwww.indiandentalacademy.comwww.indiandentalacademy.com

According to MischAccording to Misch
Surgical failure inability to place the abutment at the
time of surgery
Osseous healing failure period from implant placement to
abutment connection,is related to
healing ability of bone
Early loading failure the first year the implant serves as a
prosthetic abutment
Intermediate implant time period after the 1st yr of loading
failure upto following 5yrs of function
Late implant failure after the implant and prosthesis have
been loaded for >5yrs but <10yrs.
Long term failure failures after 10 yrs.

Complications/FactorsComplications/Factors
leading to implant failuresleading to implant failures
.Surgical factorsSurgical factors (early failures)(early failures)
Stage I surgery
1) Overheating of bone - necrosis,osteomyelitis
2) Lack of primary stability - bone loss
3) Infection
4) Lack of osseointegration
5) Poor placement or angulation, slips, eccentric drills
6) Damage to vital structures
7) Implant fracture
8) Inadequate no. of implants

StageStage II surgeryII surgery
1) Loose abutment1) Loose abutment
2) Poor fixtures2) Poor fixtures
3) Early loading by3) Early loading by
prosthesisprosthesis
4) Poor abutments4) Poor abutments

Prosthetic factorsProsthetic factors
(late failures)(late failures)
1.Improper design, shape, contours
2.Poor fit of prostheses
3.Occlusal forces
4.Inaccurate framework
5.Cantilever extension
6.Framework fracture, prosthesis
fracture
7.Functional problems eg. speechwww.indiandentalacademy.comwww.indiandentalacademy.com

Systematic factors contributing toSystematic factors contributing to
implant failureimplant failure
 It is important for the implant team to understandIt is important for the implant team to understand
the risk factors responsible for implant failuresthe risk factors responsible for implant failures
 Systematic disease like diabetes, collagen diseaseSystematic disease like diabetes, collagen disease
like scleroderma , systematic lupus erythematous,like scleroderma , systematic lupus erythematous,
rheumatoid arthritis have microvascular changesrheumatoid arthritis have microvascular changes
….….
 Therapeutic radiation to the mandible and maxillaTherapeutic radiation to the mandible and maxilla
and long term steroid therapy also results in poorand long term steroid therapy also results in poor
vascularity and may contraindicate implant usevascularity and may contraindicate implant use
 Osteoporosis ,paget disease hormone disordersOsteoporosis ,paget disease hormone disorders
and renal tumors may also compromise implantand renal tumors may also compromise implant
ossiointegrationossiointegration

Perioperative errors contributingPerioperative errors contributing
to implant failureto implant failure
 Error due to anatomic variations andError due to anatomic variations and
abnormalitesabnormalites
 Errors due to implant contaminationErrors due to implant contamination
 Errors in surgical techniqueErrors in surgical technique
 Errors in implant positionErrors in implant position
 Errors in implant exposureErrors in implant exposure

Errors due to anatomic variationErrors due to anatomic variation
and abnormalitiesand abnormalities
 Ideal fixture placement depends on a preoperative clinicalIdeal fixture placement depends on a preoperative clinical
assessment of boneassessment of bone
configuration quality and quantity…configuration quality and quantity…
 In addition careful digital palpation of lingual surface ofIn addition careful digital palpation of lingual surface of
mandible provide information on the configuration of the bonymandible provide information on the configuration of the bony
surface.surface.
 Often this area is concave, perforation of the lingual plate canOften this area is concave, perforation of the lingual plate can
occur if the bony prominence And concavity are notoccur if the bony prominence And concavity are not
anticipatedanticipated
Errors due to implant contaminationErrors due to implant contamination
Contamination of the implant surfaces interferesContamination of the implant surfaces interferes
with osseointegrationwith osseointegrationwww.indiandentalacademy.comwww.indiandentalacademy.com

 Errors in surgical techniqueErrors in surgical technique
 Successful implant placement depends highly onSuccessful implant placement depends highly on
proper surgical techniqueproper surgical technique
 Maintaining an adequate blood supply and reducingMaintaining an adequate blood supply and reducing
hard and soft tissue surgical trauma lessen thehard and soft tissue surgical trauma lessen the
perioperative causes of failed implantperioperative causes of failed implant
 Incision design..Incision design..
 When there a minimal amount of keratinized tissueWhen there a minimal amount of keratinized tissue
the incision should be placed buccal or labial to thethe incision should be placed buccal or labial to the
alveolar crest.alveolar crest.
 Such placement minimizes the possibility ofSuch placement minimizes the possibility of
compromising the blood supply to this area ,andcompromising the blood supply to this area ,and
preserves the keratinized tissue as a part of thepreserves the keratinized tissue as a part of the
lingually based flap.lingually based flap.

Healthy ,viable bone is critical for the success forHealthy ,viable bone is critical for the success for
integration between the bone and the implantintegration between the bone and the implant
surface…surface…
 A study by Eriksson and Albrektsson showed that theA study by Eriksson and Albrektsson showed that the
threshold temperature for heat induced injury to bonethreshold temperature for heat induced injury to bone
tissue is 47tissue is 47°C°C applied for 1mit . (JPD 50;101,1983)applied for 1mit . (JPD 50;101,1983)

Error in implant positioningError in implant positioning
 An implant may integrate successfully with the surroundingAn implant may integrate successfully with the surrounding
bone but ultimately be a clinical failure because it is toobone but ultimately be a clinical failure because it is too
poorly positioned to support a functional prosthetic restorationpoorly positioned to support a functional prosthetic restoration
 Attention to proper intraoperative angulation as wellAttention to proper intraoperative angulation as well
maintenance of a parallelism between implants and betweenmaintenance of a parallelism between implants and between
implant and natural dentition , contribute to optimal andimplant and natural dentition , contribute to optimal and
successful prosthetic design and function.successful prosthetic design and function.
 Implant placed too buccal or lingual, this can cause a boneImplant placed too buccal or lingual, this can cause a bone
dehiscence, a lack of bicortical support, and eventual implantdehiscence, a lack of bicortical support, and eventual implant
exposureexposure

Error in implant exposureError in implant exposure
 Generally 4-6 months are allowed for healing..Generally 4-6 months are allowed for healing..
 If there is an adequate amount of keratinized gingivaIf there is an adequate amount of keratinized gingiva
but is not located over the implant, a labial or buccalbut is not located over the implant, a labial or buccal
flap can be elevated and the tissue shifted to surroundflap can be elevated and the tissue shifted to surround
the implantthe implant
 When exposing implant in the anterior maxillaWhen exposing implant in the anterior maxilla
providing sufficient soft tissue bulk for a convex ridgeproviding sufficient soft tissue bulk for a convex ridge
formform
 Creation of interproximal papillaCreation of interproximal papilla
 Proper gingival counterProper gingival counter
 Assure that there is keratinized gingiva surrounding theAssure that there is keratinized gingiva surrounding the
labial aspect of the crownlabial aspect of the crown

 Most common postoperative complication involvesMost common postoperative complication involves
soft tissue breakdown of the wound and exposuresoft tissue breakdown of the wound and exposure
of the implant body or cover screwof the implant body or cover screw
 Forces on the mucosa cause the soft tissue to beForces on the mucosa cause the soft tissue to be
compressed over the implant ,….compressed over the implant ,….
 Perforation of the soft tissue also may be causedPerforation of the soft tissue also may be caused
by supracrestal protrusion of the implant orby supracrestal protrusion of the implant or
inadequate tightening of the cover screwinadequate tightening of the cover screw
 Insertion of the interim prosthesis too early alsoInsertion of the interim prosthesis too early also
may affect the healing process adversely ,may affect the healing process adversely ,
resulting in gingival perforation and implantresulting in gingival perforation and implant
exposure.exposure.
 Premature loading can lead to micromovement..Premature loading can lead to micromovement..
Prosthodontic considerations in first stage
Implant failures

 The totally edentulous patient should not wearThe totally edentulous patient should not wear
any prosthesis over the implant sites forany prosthesis over the implant sites for
approximately 2 weeks…approximately 2 weeks…
 After 2 weeks the old denture must be relievedAfter 2 weeks the old denture must be relieved
over the implant site and relined with a resilientover the implant site and relined with a resilient
soft liner materialsoft liner material

Peri ImplantitisPeri Implantitis
Definition- American Academy ofDefinition- American Academy of
Periodontology defines Peri implantitis asPeriodontology defines Peri implantitis as
““progressive Peri implant bone loss inprogressive Peri implant bone loss in
conjunction with a soft tissueconjunction with a soft tissue
inflammatoryinflammatory
lesion.”lesion.”
CausesCauses ::
Bacterial AccumulationBacterial Accumulation
Overloading orOverloading or
CombinationCombinationwww.indiandentalacademy.comwww.indiandentalacademy.com

ETIOLOGIC FACTORS
Two primary etiologic factors are acknowledged today
as causative in peri implant marginal bone loss:
Bacterial infection
Biomechanical overload

Biomechanical Overload
Bone loss at the coronal aspect of implants can
result form biomechanical overloading and the
resultant microfractures at the coronal aspect of the
implant-bone interface. The loss of osseointegration
in this region results in apical down growth of
epithelium and connective tissue.

. The role of over loading is likely to increase
in four clinical situations:
1.The implant is placed in poor quality bone.
2.The implant position or the total amount of
implants placed does not favor ideal load
transmisson over the implant surface.
3. The patient has a pattern of heavy occlusal
function associated with Para function.
4. The prosthetic superstructure does not fit the
implants precisely.

Other etiologic factors such as traumatic
surgical techniques, smoking, inadequate amount of
host bone resulting in an exposed implant surface at
the time of placement and a compromised host
response can act as co-factors in the development of
peri implant disease.
.

BACTERIAL INFECTIONS
Most authors have assumed that peri-implant diseases
(mucositis, peri-implantitis) are comparable to periodontal
diseases in that they are primarily plaque-induced.
If plaque accumulates on the implant surface, the sub epithelial
connective tissue becomes infiltrated by large number
inflammatory cells and the epithelium appears ulcerated and
loosely adherent.
When the plaque front continues to migrated apically, the
clinical and radiographic signs of tissue destruction are seen
around both implants and teeth.

In addition, the implant lesions
extend into the supracrestal connective
tissue and approximate/populate the bone
marrow. While the lesions associated with
teeth do not.

Additional Possible Etiologic and Modifying
Factors
In addition to bacterial infection and excessive
biomechanical loading, other etiologic and modifying
cofactors have been considered as potential initiators
of peri implant disease.
Implant Shape and Implant Surface
Peri implant soft tissue attachment

IMPLANT SHAPE AND IMPLANT SURFACE
Over the long term, users of the Branemark
system have generally observed peri-implant bone loss
of approximately 1.5mm during the first year implant
insertion and 0.1 mm per year in subsequent years.
Bone resorption was reported to be exclusively
horizontal in nature: vertical defects were not
observed. (Adell et al. 1986, Alberktson et al. 1988).

with other systems (eg : IMZ, care vent) higher bone
resorption rates and occasionally vertical defect have been
reported.
very little information is available regarding whether the
implant design (cylindrical ,screw type) implant surface
morphology (e.g. highly polished cervical region) the
technique of surgical placement, or other factors may be
responsible for the various peri-implant reactions.

Peri-implant soft tissue attachment
Several authors have proposed that the
maintenance of healthy peri-implant conditions
requires a collar of attached gingival around the
implant neck.
Furthermore, clinical and animal experimental
research has demonstrated that if oral hygiene is
sufficient, healthy peri-implant conditions can be
maintained even if mobile oral mucosa surrounds
the implants.

Nevertheless, if recurrent inflammation persists
around implant surrounded by mobile mucosa, it
may be prudent to surgically create a peri-implant
zone of attached gingiva, which will also simplify
implant hygiene. (Langer et all 1980).

CLASSIFICATION
Classification – Peri-implantitis
Peri-implantitis - Class 1

Peri-implantitis - Class 1
Slight horizontal bone loss with minimal peri-implant
defects

Peri-implantitis class 2
Moderate horizontal bone loss with isolated vertical
defects.

Moderate to advanced horizontal bone loss with broad,
circular bony defects.

Advanced horizontal bone loss with broad, circumferential
vertical defects, as well as loss of the oral and/or vestibular
bony wall.

Clinical SignsClinical Signs--
Progression of pocketProgression of pocket
depthdepth
RadiographicallyRadiographically
detectable bone lossdetectable bone loss
Inflammatory ReactionInflammatory Reaction
of Mucosaof Mucosa

Implant related factorsImplant related factors
1.Screw design:
conical screws - loosen
flat head screws - better
2.Implant body design:
smooth cylinder implant - shear force at implant-bone
interface
threaded implant - can transform and change the direction of
force through thread geometry

b) Thread pitch:
smaller the pitch more
will be the surface
c) Thread depth:
increases surface area
Implant length : increases surface area
Implant width : increases surface area

Host factorsHost factors
• Patient dissatisfaction with the result.
• Inadequate patient follow-up
• Failure to maintain hygiene leading to periodontal
breakdown
• Para functional habits
• Systemic health( medical complications)
• Medications- alter tissue metabolism and repair
• Social habits like smoking, stress,alcohol abuse affect
wound healing
• Poor bone quality and quantity - a vascular bone,bone
density,
type of bone,etc.

Prosthodontic consideration in
implant failure
 Esthetic failureEsthetic failure
 Most common causes of estheticMost common causes of esthetic
failure is loss of the interdental papillafailure is loss of the interdental papilla
oror Cervical positioning of the facialCervical positioning of the facial
gingival margin or both.gingival margin or both.
 This often is caused by the surgeonsThis often is caused by the surgeons
failure to take into account the patentsfailure to take into account the patents
soft tissue needs before or during surgerysoft tissue needs before or during surgery

Force delivery and failure mechanismsForce delivery and failure mechanisms
Moment loads (torque or torsional loads):
is defined as a vector,the magnitude of which equals
the product
of force magnitude and the perpendicular distance
from the implant
to the line of action of force.

Possible rotationsPossible rotations
A total of six rotations may develop about three clinical co
ordinate axes.

Clinical Moment Arms
1.OCCLUSAL HEIGHT MOMENT ARM
2.CANTILEVER LENGTH MOMENT ARM
3.OCCLUSAL WIDTH MOMENT ARM

GEOMETRIC LOAD FACTORSGEOMETRIC LOAD FACTORS
 Increased bending exerted on implant has beenIncreased bending exerted on implant has been
identified and the term bending overload has beenidentified and the term bending overload has been
proposed as a major risk factor for failureproposed as a major risk factor for failure
 Geometric load factors that can compromise theGeometric load factors that can compromise the
support and result in increased overload includesupport and result in increased overload include
1.1. Fewer then three implantFewer then three implant
2.2. Implants connected to teethImplants connected to teeth
3.3. Implant in lineImplant in line
4.4. Cantilever extensionsCantilever extensions
5.5. Occlusal plane beyond the implant support eg.Occlusal plane beyond the implant support eg.
buccal and lingual cantileveringbuccal and lingual cantilevering
6.6. Excessive crown implant ratioExcessive crown implant ratiowww.indiandentalacademy.comwww.indiandentalacademy.com

Tooth implant connectionTooth implant connection
 Problem connecting implant to teeth in that first, if a rigidProblem connecting implant to teeth in that first, if a rigid
structure (implant) is connected to a non rigid structurestructure (implant) is connected to a non rigid structure
(tooth), the more mobile of two may act like a cantilever and(tooth), the more mobile of two may act like a cantilever and
result in increased load to the rigid structureresult in increased load to the rigid structure
 If non rigid connector is used ,there is a tendency for teethIf non rigid connector is used ,there is a tendency for teeth
to intrude ,with this intrusion there is a much greater risk ofto intrude ,with this intrusion there is a much greater risk of
bending overload..bending overload..
 The best solution is to design the implant restoration to beThe best solution is to design the implant restoration to be
fully implant supportedfully implant supported

. ATTACHMENT TO NATURAL TEETH
•Hobo in 1986 recommended a non rigid
attachment and a Key and Key way type of
attachment between teeth and implant.
•Lundgren in 1986 recommended the use of Semi
– precision attachment which detaches the teeth
from the implant prosthesis allowing a tooth to
move downward.

• The IMZ implant system uses a Intra mobile
element [IME] to act as a shock absorber during
function.
It can act as a PDL analogue.
•Misch: stated that biomechanical concern and
difference in Support should be understood and
applied before attaching natural teeth to implants.
He advocates initial occlusal contacts on the natural
teeth.
Once the equilibrium with a light bite force is
completed, a heavier CR occlusal force is applied to
have contacts on teeth as well as implant also, thus
harmonizing the occlusal forces.

Single implant restorationSingle implant restoration
 The replacement of single molars with implant hasThe replacement of single molars with implant has
provided more problems then originally anticipatedprovided more problems then originally anticipated
 The occlusal table of a normal sized molar is relativelyThe occlusal table of a normal sized molar is relatively
large compared with a standard sized implant (3.75-4)large compared with a standard sized implant (3.75-4)
 The potential for bending is tremendous because aThe potential for bending is tremendous because a
cantilever in all 360cantilever in all 360°.°. In order to reduce the bending aIn order to reduce the bending a
wider and stronger support system had to be designed.wider and stronger support system had to be designed.
 5mm diameter implants provide a stronger implant .5mm diameter implants provide a stronger implant .
 These feature combined with a narrower buccolingualThese feature combined with a narrower buccolingual
dimension for the restoration ,dramatically reduces thedimension for the restoration ,dramatically reduces the
potential for bendingpotential for bending

Lundgren , Laurell (1984) suggested the need to
minimize horizontal forces created by premature
contacts or steep cusps.
Albrektsson,et al., (1986) emphasized the need to
distribute the load mainly over the areas
supported directly by fixtures.
Jemt (1986) described that when Osseo integrated
implants are used in short span FPD and single
tooth replacements , the occlusion should be
distributed in maximum intercuspation and all cusp
interferences should be eliminated in eccentric
positions.
Review of occlusal scheme

Misch (1991) developed IPO ‘Implant protective occlusion’ for
implant supported restorations.
IPO - Medial positioned lingualized occlusion
is based on :
- Narrow occlusal table.
- occlusal table width similar to width of implant body.
- Increasing surface area.
- Design of occlusion in favour of weakest arch.
- Decreasing force of occlusal contacts.
- Eliminating or reducing all shear loads to implant to
bone interface.
- Posterior disocclusion by anterior components.
- Initial contacts on only natural teeth and later on
multiple. contacts on both teeth and implants

Factors affecting choice of occlusal
scheme
1.Arch form:
- Curve arch is favorable for less stresses
- Influences no. of implants to be placed
- Opposing arch form affects occlusion
2.Interarch distance and jaw relations :
- May prevent development of particular
occlusal scheme
- May force to adapt a particular scheme
- Affects biomechanical aspects

4. Abnormal mandibular movements
5. Bone support and bone mechanics :
Good bone support - occlusal contacts can be increased.
6. Occlusal material :
- affects the transmission of forces.
- affects the maintenance of occlusal contacts.
3. Orientation of the occlusal plane :
- Arch in which implant is placed becomes the
dominant arch and opposing edentulous arch
becomes weak arch.
- plane should favor weaker arch

. Zarb (1985): stated that acrylic teeth have shock
absorbing effect and can be modified for use very
easily.
They should be used to decrease overloading of implants.
However selection of occlusal material depends upon :
- Opposing occlusion.
- Remaining dentition.
- Arch to be restored.
7. Quality of Osseo integration
Its is the ability of implant to bear occlusal load .
It depends upon:
Implant length , width, design, surface coatings.
Number of implants, position of implants, orientation of
implants.www.indiandentalacademy.comwww.indiandentalacademy.com

IMPORTANT GUIDELINES TOIMPORTANT GUIDELINES TO
FOLLOWFOLLOW
 Infraocclusion upto 30 microns of implant supportedInfraocclusion upto 30 microns of implant supported
restorationrestoration
 No balancing contacts on cantilevers.No balancing contacts on cantilevers.
 No guidance on single implants.No guidance on single implants.
 Freedom in centric.Freedom in centric.
 Occlusal table directly proportional to implantOcclusal table directly proportional to implant
diameter.diameter.
 Narrow occlusal width.Narrow occlusal width.

•IMPLANT LENGTH – CROWN RATIO
ideal – 1:2
acceptable – 1:1 for removable denture.
•AVOIDANCE OF CANTILEVER LENGTH.
maximum 10 and 20 mm is advised.
7 mm is optimum .
•SHALLOW CENTRAL FOSSAE WITH TRIPODAL
CUSPAL CONTACTS.
•NO CONTACT IN LATERAL EXCURSION.
•SLIGHT CONTACT IN CENTRIC OCCLUSION.

Summary and ConclusionSummary and Conclusion
 Although the over all success rate of implantAlthough the over all success rate of implant
dentistry is very high, dental implantdentistry is very high, dental implant
occasionally failoccasionally fail
 The best steps to avoid encountering failingThe best steps to avoid encountering failing
implant involve proper case selection,implant involve proper case selection,
excellent surgical technique, placing anexcellent surgical technique, placing an
adequate restoration on the implant, educatingadequate restoration on the implant, educating
the implant patient to maintain meticulousthe implant patient to maintain meticulous
oral hygiene, and evaluating the implant bothoral hygiene, and evaluating the implant both
clinically and radio graphically at frequentclinically and radio graphically at frequent
recall visitrecall visit

ReferencesReferences
•. Carl.E.Misch : Implant Dentistry, 2nd ed
•. Davies S.J.,Gray R.J.M.,Young M.P.J.:Good occlusal practice in
the provision of implant
borne prosthes8es.BDJ 2002;192:79-88
•. Hobo, Ichida, Garcia: Osseointegration and Occlusal
Rehabilitation,1st ed.
• Michael D.Wise : Failure in the Restored Dentition:Management
and Treatment,1st ed.
• Palmer R,Palmer P,Howe L Dental implants: Part 10.Complications
and maintenance.
BDJ 1999 ; 187:653-658
• Vincent Jimenez-Lopez : Implant-support prosthese:
Occlusion,Clinical Cases and laboratory procedures, 1st ed.pp. 23-

Lindhe jan : Clinical periodontology and implant diseases
Glickman Irvin : Clinical periodontology 3rd ed. 1997
•James Robert A: Periodontal considerations in
implant dentistry JPD Aug 1973, vol 30, no. 2, 202-
209
•Weinberg L A Reduction of implant loading using a
modified centric occlusal anatomy.
Int J Prosthodont 1998 ; 11:55-69
•Louis. frose , brain z.mealey periodontics
•Oral and maxillofacial surgery clinics of north America
implant failures 1998
•hubertus spiekermann Color atlas of dental medicine
•implantology
•Erikssonar,Albrektsson .Temperature threshold levels
for heat induced bone tissue injury JPD50;101;1983

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