Possible complications of dental implants and how to avoid them

What are the advantages of dental implants over prosthetics? How is implantation performed? What are the best implants today? What is the process of implanting implants into bone tissue? What are the possible complications? An analysis of the use of implants was carried out, the results of which provide answers to all questions and demonstrate the advantages of implantation over prosthetics.

What are the current problems of implantation and prosthetics

Lack of bone volume or height should not lead to rejection of implant treatment. With bone augmentation, increasing the treatment time does not satisfy the desires and requirements of patients. To solve the problem of prosthetics in case of atrophy of the jaws, the installation of short implants in deficient areas allows. It is also possible to install long implants in connection with the sphenoid bone through the maxillary tubercle. It is important to pay due attention to the indications for use, the analysis of errors at the planning stage and complications during treatment with short implants or tuberosal screw implants.

A retrospective analysis of the use of implants for atrophy of the alveolar ridge, as well as cases of disintegration of these implants without the use of augmentation techniques, was carried out.

Subject of the clinical trial performed

The study group consisted of 44 patients aged 25 to 60 years who were asked to treat defects in the dentition with implant-supported fixed dentures. The patients included 23 women and 21 men. The study began in 2005 and continues to this day. During this period, a total of 54 implants of the "AB-dental", "Implife" systems were installed; and "U-impl-Maxi" in the area of ​​bone tissue atrophy after a preliminary X-ray examination. The width of the alveolar process (excluding soft tissues) according to CT data was from 5 to 10 mm, but the height of the alveolar process was no more than 4-7 mm. This group does not include patients who underwent alveolar ridge augmentation before implantation.

Preoperative examination consisted of history taking, orthopantomography, computed tomography. Clinical research methods included an examination of the oral cavity, the condition of the wound in the healing process, the presence of pain, hyperemia, the degree of implant mobility and the presence / absence of granulation tissue around the implants.

In the case of gum attachment to the tubercle area, either a short "U-impl-Maxi" or "U-impl-Maxi" implant was placed. (these implants are 7 mm in diameter, 5 mm high), or a long implant from 14 to 18 mm in the maxillobasal suture, which connects the pterygoid processes of the underlying tissue and the tubercle of the upper jaw. To assess the result after installation, as well as the appearance of mobility after installation, X-ray control was carried out. While maintaining sufficient stability and the absence of inflammation around the implants, on the 28-35th day, a temporary (non-functional) orthopedic structure was made on the implant for 2-4 months.

The results of these studies and their discussion

Mistakes in the planning and implementation of the surgical protocol, ways to eliminate complications, and measures for their prevention were analyzed. In 7 patients with one-stage implantation during the period of primary residence, 9 implants were rejected, which is approximately 18%

After analyzing the success and failure cases in such situations, the following mistake was noted in the planning of the operation. If there is no keratinized gingival margin around the installed implant, this is a hallmark of imminent disintegration of the implant, even with reliable stability. If there is no such area along the crest of the alveolar process of the upper jaw, implantation is temporarily contraindicated. The next mistake is the incomplete extraction of the cortical bone core before installing the U-impl-Maxi implant.
Causes of implantation complications and methods of their solution

Injury to the bone tissue provokes tension in the tissues, which is manifested by tissue edema, then a drainage installation is needed. Hyperemia and edema of inflamed bone tissue are not observed. But prolonged pain, the main component of inflammation, is regarded as an increased reactivity of the patient. The causes of pain and discomfort are infection of the blood clot under the implant in the absence of bone drainage. It could also be caused by an overcompressed implant.

In such cases, immediately after disimplantation, pain stops, inflammation decreases, tension in the bone disappears, but most importantly, after bone healing, reimplantation is possible without losing the patient's faith in the advantage of the implantation method over removable prosthetics. In cases where, despite the ongoing treatment with antibiotics, anti-inflammatory drugs, the pain does not go away for more than a week, it is necessary to remove the implants from the bone tissue.

If the intraosseous part of the implant is lost, it becomes contaminated with the microflora of the oral cavity, the ongoing lysis of the bone and the migration of fibroblasts along the implant make the process of disintegration irreversible. If there is no space under the implant, there will be no precedent for the formation of immature bone tissue (possibly granulomas).

It is known that the redistribution of occlusal forces must be projected onto the cortical plates from the opposite side. This was the reason for the installation of pterygoid implants. It is attached through the maxillary tubercle to the maxillo-basic suture. When the alveolar process atrophies due to loss of teeth, the pterygoid processes do not atrophy. From the standpoint of bicortical fixation, the installation of such implants is fully justified. During the follow-up period (2 years), there were no complications at the surgical stage.

After the introduction of implants into the orthopedic structure, complications were noted in the form of implant disintegration (3 cases), associated with a traumatic occlusive factor at the stage of the functioning of the prosthesis. In addition, these were cases of independent use of "U-impl-Maxi", without involving neighboring, defective teeth or implants.

The complications that were observed were the result of incorrect handling of the bone wound, because after optimizing the technique for installing pterygoid implants bypassing the maxillary sinus and short "U-impl-Maxi" immediate and long-term results of treatment have improved significantly.

Helpful insights to promote implantation without complications

If we take into account the pathogenesis of inflammation and pain, then avoiding complications is quite realistic. To do this, it is important to correctly handle the bone tissue of the jaws.

Analysis of clinical experience makes it possible to assert the following rules:

• When installing implants «U-impl-Maxi» in areas with a minimum height, this allows you to avoid additional material costs, trauma during various types of bone tissue augmentation, and reduce the treatment time.

• The analysis of cases of disintegration made it possible to optimize the technique for installing pterygoid implants and "U-impl-Maxi" implants, to determine the risk factors for postoperative complications.
• When planning a surgical intervention in the area of ​​atrophy of the alveolar process in the lower or upper jaw for the installation of implants, it is necessary to be guided by the presence of a sufficient amount of attached gum.