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Complications in implantology

Dental implants have now become the choicest treatment option for replacing the missing tooth or teeth. Dental implant placement is a controlled, systematic, step by step procedure requiring great skills. In spite of careful planning there is always a risk for surgical complications. In spite of careful planning there is always a risk for surgical complications although very rare and mostly easily manageable and relatively eventless. At Zental Dental care, we have almost all the technologies like 3D X-ray or CBCT and multiple implant systems to keep these complications minimal or zero.

Complications associated with implants placement can be broadly classified into three categories;

1) Preoperative conditions leading to complications
2) Intraoperative complications (complications that could occur during surgery)
3) Post-operative complications (complications occurring after surgery)

PREOPERATIVE CONDITIONS LEADING TO COMPLICATIONS

1) Insufficient bone width and height remaining to accommodate the implant
Reason:
a) Bone resorption

Solution:
a) Bone augmentation (addition of new bone to resorbed ridge), or expansion of the thin ridge.

2) Insufficient vertical space for implant placement
Reasons:
a) supraeruption of opposing tooth (opposing tooth intruding into the lost tooth space)
b) Generalized attrition (wearing away of all the teeth)

SOLUTION:
a) Occlusal adjustment
b) Using short implants.

3) Inadequate horizontal space for implant placement
Reason:
a) Improper ANGULATION of neighboring teeth (adjacent teeth tilting into the lost tooth space thereby leaving insufficient space for the tooth to be replaced).

SOLUTION:
a) orthodontic correction (correction of teeth angulation using braces)

4) Inadequate inter-arch space (insufficient space between upper and lower arches)
Reason: a) Attrition of teeth and therefore collapse of height.
Solution: FMR (Full Mouth Rehabilitation to increase vertical height)

5) Limited jaw opening
REASON: a) Trismus (muscle spasm of facial muscles)
SOLUTION: a) Heat therapy
B) Drug therapy (antibiotics, analgesics, muscle relaxants etc.)

6) Maxillary and mandibular tori (abnormal thickening of the bone in the region of implant placement)
REASON:
a) Present since birth (genetic)
b) Bruxism (abnormal grinding of teeth)

SOLUTION:
a) Occlusal rehabilitation
b) Removal of tori through surgery.

7) Close proximity to vital structures like inferior alveolar nerve, maxillary sinus etc.
SOLUTION:
a) Detailed examination using radiographs,3-D scan, CBCT) prior to surgery.
b) Nerve relocation.

INTRA-OPERATIVE COMPLICATIONS OF IMPLANT PLACEMENT

 

1)Incorrect implant angulation
Implant must be placed correctly in horizontal (buccolingual and mesiodistal) and tooth root planes for optimum esthetics and function.

Implants distribute masticatory forces most effectively when forces are applied in axial (vertically straight) direction.

Implant angulation of 15 degrees or less is considered acceptable.

Implant angulation of 25 degrees or more cause supporting bone resorption through transmission of masticatory forces.

SOLUTION: 1) Proper evaluation of dental arch, teeth and bone by means of detailed clinical examination, study casts (plaster models) and 3D radiographs,in India Zental Dental clinic is the only one equipped with a CBCT in-house since last 7 years.
2)Use of surgical template for guiding implant placement.

  

2) Excessive mandibular (lower arch) resorption 
REASON:
1) Prolonged edentulousness. 
Due to excessive lower arch resorption mental nerve may be positioned on the crest of the ridge.

SOLUTION:
1) Care must be taken not to injure mental nerve by placing the crestal incision more lingual
2. Nerve relocation.

  

3) Nerve injury
REASON:
Improper mandibular(lower) implant placement in the jaw bone may cause injury to inferior alveolar nerve thereby resulting in partial or complete anesthesia (loss of sensations). Such nerve injury influences the patient’s quality of life and produce negative psychological effect.

SOLUTION:
Best way to avoid such injuries is to have a clear 3-dimentional vision of the jaw by means of OPG and 3-Dimentional CT scan, which we are the only ones in the country to be equipped with.

4) Damage to neibouring teeth during implant placement
REASON:
1) Improper direction during fixture placement
2) Excessive depth of fixture placement
3) Implant fixture places too close to adjacent teeth
4) Use of excessively wide type of fixture owing to the insufficient height of residual alveolar (Jaw) bone.
5) Excessive heat generation during bone drilling

SOLUTION:
1) Accurate measurement of angle and distance of adjacent teeth by means of 3D radiographs(CBCT) prior to surgery. Thickness of alveolar bone surrounding the fixture should be at least 1-1.5 mm.
2) Establishing a placement guide by preparing a surgical stent using preliminary impression.
3) Use of coolant (saline) to avoid generation of excessive heat during bone cutting. Temperature must not rise above 33.8 degrees during a maximum of 5 seconds drilling.
4) Proper size fixture selection.

 

5) Bleeding
Severe hemorrhage (bleeding) during implant placement carries a high risk for upper airway obstruction.
REASONS:
1) Injury to the blood vessels caused by injudicious use of instruments.
2) Patient with bleeding disorders like hemophilia.
SOLUTION:
1) Adequate planning of surgery and use of advanced techniques like CBCT (available at Zental) so as to avoid injury to blood vessels and other vital structures.
2) Recording a proper medical history of the patient to rule out any bleeding   disorder.
3) Use of suction to continuously evacuate saliva and blood.
4) Ligation of bleeding vessel.

6) Perforation of nasal floor or maxillary sinus
REASONS:
1) Greater depth of implant insertion.
2) Insufficient alveolar (jaw) bone height due to bone resorption.
SOLUTION:
1) Accurate evaluation of bone anatomy with the help of radiographs, OPG and 3-D CT scans. The presence of this prestigious machine makes Zental Dental Center as the best dental implant hospital in India, also counting the number of years of experience with it.
2) Increasing the bone height through bone augmentation.
3) Carrying out sinus lift procedure prior to surgery to create more bone height between the implant and maxillary sinus.

7) Accidental partial or complete displacement of implant into maxillary sinus or maxillary incisive canal
REASON:
1) Insufficient bone height left due to resorption
2) Maxillary pneumatization (enlargement of maxillary sinus space)
3) Wrong planning or surgical inexperience
SOLUTION:
1) Use of short implants.
2) Maxillary sinus floor lift procedure prior to surgery.

8) Mandibular fracture
If implant is placed in severe atrophic (resorbed) mandible, fracture of mandible can occur during or after surgery because implant placement weakens the already compromised bone.
REASON:
1) Excessive bone resorption.
SOLUTION:
1) A 3-D surgical planning is recommended in order to prevent severe reduction of bone tissue.
2) Ridge augmentation (increasing the jaw height by bone addition) procedures prior to surgery.

                               

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