John Cavallaro

Failed dental implants: Diagnosis, removal and survival of reimplantations

BACKGROUND Over time, the percentage of dental implants that fail increases because of biological and technical issues. Inevitably, clinicians will dedicate more time to dealing with ailing and failing dental implants. METHODS The authors searched the literature for articles that addressed diagnostic manifestations of failed implants and reasons for their demise, as well as survival rates of dental implant reimplantations. RESULTS The authors found that there is no precise cut point (besides 100 percent) with regard to the amount of bone loss in the absence of mobility that indicates an implant has failed. The decision to treat or explant an ailing implant is a judgment call by the treating clinician. Survival rates found in the literature after first and second reimplantations ranged from 71 percent to 100 percent and 50 percent to 100 percent, respectively. The 100 percent findings were based on small groups of implants, and there were scant data addressing implant survival after second reimplantations. CONCLUSIONS The decision to remove an implant needs to be based on clinical assessments, radiographic evaluations or both. If the implant is deemed hopeless, there are devices that facilitate their removal. Furthermore, reimplantations can be performed successfully, but their survival rate appears to be lower than that of implants placed at sites from which they were not lost formerly. PRACTICAL IMPLICATIONS Ailing dental implants should not be condemned prematurely, because patients often respond to treatment of peri-implantitis. Many patients desire reimplantations in sites in which implants have failed. This procedure is valuable, especially if it makes possible the fabrication of an implant-supported fixed or removable prosthesis.

Dental Implants in the Periodontal Patient

The principal reason for providing periodontal therapy is to achieve periodontal health and retain the dentition. Patients with a history of periodontitis represent a unique group of individuals who previously succumbed to a bacterial challenge. Therefore, it is important to address the management and survival rate of implants in these patients. Systematic reviews often are cited in this article, because they provide a high level of evidence and facilitate reviewing a vast amount of information in a succinct manner.

Original ContributionsImplantsOpen contacts adjacent to dental implant restorations: Etiology, incidence, consequences, and correction

BACKGROUND The aim of this investigation was to evaluate the potential causes, clinical significance, and treatment of open contacts between dental implant restorations and adjacent natural teeth. TYPES OF STUDIES REVIEWED The authors searched the dental literature for clinical trials in humans that addressed the incidence of open contacts that develop after implant restorations are placed next to teeth. RESULTS The authors found 5 studies in which the investigators addressed the incidence of open contacts after implant restorations are inserted next to teeth. Results from these studies indicated that an interproximal gap developed 34% to 66% of the time after an implant restoration was inserted next to a natural tooth. This event occurred as early as 3 months after prosthetic rehabilitation, usually on the mesial aspect of a restoration. CONCLUSIONS The occurrence of an interproximal separation next to an implant restoration was greater than anticipated. It appears that force vectors cause tooth movement and an implant functions like an ankylosed tooth. PRACTICAL IMPLICATIONS Clinicians should inform patients of the potential to develop interproximal gaps adjacent to implant restorations, which may require repair or replacement of implant crowns or rehabilitation of adjacent teeth. Furthermore, steps should be taken to check the continuity of the arch periodically. If the clinician detects an open contact, it is prudent to monitor for signs or symptoms of pathosis so that prosthetic repair of the gap can be initiated, if needed. These problems could add to treatment costs and decrease overall patient satisfaction related to implant treatment.

Open contacts adjacent to dental implant restorations: Etiology, incidence, consequences, and correction.

BACKGROUND The aim of this investigation was to evaluate the potential causes, clinical significance, and treatment of open contacts between dental implant restorations and adjacent natural teeth. TYPES OF STUDIES REVIEWED The authors searched the dental literature for clinical trials in humans that addressed the incidence of open contacts that develop after implant restorations are placed next to teeth. RESULTS The authors found 5 studies in which the investigators addressed the incidence of open contacts after implant restorations are inserted next to teeth. Results from these studies indicated that an interproximal gap developed 34% to 66% of the time after an implant restoration was inserted next to a natural tooth. This event occurred as early as 3 months after prosthetic rehabilitation, usually on the mesial aspect of a restoration. CONCLUSIONS The occurrence of an interproximal separation next to an implant restoration was greater than anticipated. It appears that force vectors cause tooth movement and an implant functions like an ankylosed tooth. PRACTICAL IMPLICATIONS Clinicians should inform patients of the potential to develop interproximal gaps adjacent to implant restorations, which may require repair or replacement of implant crowns or rehabilitation of adjacent teeth. Furthermore, steps should be taken to check the continuity of the arch periodically. If the clinician detects an open contact, it is prudent to monitor for signs or symptoms of pathosis so that prosthetic repair of the gap can be initiated, if needed. These problems could add to treatment costs and decrease overall patient satisfaction related to implant treatment.

Management of a perplexing sinus lift complication.

BACKGROUND This case report describes a dilemma that occurred after a maxillary right lateral window sinus lift was performed. The patient developed a gnawing pain in the sinus region but manifested no signs of sinusitis, and the subjacent teeth were asymptomatic. Differentiating between a pain that could be originating in the maxillary sinus or adjacent premolars was problematic. METHODS After several weeks, a CT scan revealed no signs of sinusitis, despite the patients belief that her discomfort was caused by her sinus lift. By the process of elimination, the decision was made to extract subjacent, asymptomatic premolars that had 50% bone loss and were previously endodontically treated. RESULTS Extraction of asymptomatic premolars resulted in total elimination of her pain. CONCLUSIONS A differential diagnosis with regard to the source of the patients pain had to be arrived at by the process of elimination rather than by validation. Confirmation that there was no sinus infection facilitated making the decision to remove asymptomatic premolars.