A Review of the Risk Factors Involved in the Late Failure of the Dental Implant

Introduction

Dental implants are frequently used in clinical settings to replace natural teeth. Despite significant advances in materials, techniques, and implant design, implant failure remains a major concern for both the dentist and the patient. The most common causes of implant failure are peri-implantitis and a lack of osseointegration. Other causes of implant failure include occlusal overloading, a patient’s poor or compromised medical status, habits that harm oral tissues, and implant characteristics. ¹

An implant is defined as “a graft or insert that is set firmly or deeply into an alveolar process that has been prepared for its insertion.” Implants are used to replace single teeth, partially edentulous arches, and completely edentulous arches. They are inert, alloplastic materials that are typically made of titanium, titanium alloys, or vitalinium. An implant is made up of an implant body that is placed within the bone and an implant screw that is placed on the superior surface of the body and to which the healing cap is attached. Abutments are placed over the implant body to keep the prosthesis in place. Implants are inserted into the bone during stage 1 or stage 2 surgery. ¹

Dental implants have become a popular method of replacing missing teeth. The goal of implant-supported tooth replacement is to restore adequate function and aesthetics without affecting adjacent hard and soft tissue structures. Since clinical studies with dental implant treatment have revealed successful outcomes, the use of dental implants in oral rehabilitation has been increasing. The success of any implant procedure is determined by a number of patient-related and procedure-dependent parameters, such as the patient’s general health, the biocompatibility of the implant material, the design of the implant surface, the surgical procedure, and the quality and quantity of bone. ²

The possibility of implant failure is a major source of concern for implantologists. Failure of a dental implant is frequently associated with the implant’s failure to osseointegrate with the bone. Implant dentistry is currently being practiced in an upbeat and optimistic environment, owing to our increased knowledge and ability to provide such services to our patients in such a short period of time. Implant dentistry does have complications. ³

These are more frequently caused by ageing, changing health conditions, long-term wear and tear, poor home care, and insufficient professional maintenance. It is impossible to guarantee success. “Unfortunately, failure is the best teacher most of the time.” ³

Classification of Implant Failure ³

Working Classification ⁴

OPEN IN VIEWER

Figure 1.

Source: Sandhu et al. (2018). ⁴

Complications

Tissue Abuse and Parafunctional Habits

Implant success is harmed by tissue abuse habits, parafunctional habits, and psychiatric illness. Smoking has been linked to a considerable increase in bone loss. It decreases bone density, interfering with osseointegration, and increasing the failure ratio. Baig and Rajan ⁵ discovered that smokers had more implant failures, while Bain and Moy ⁶ discovered that smokers had a much higher percentage of implant failures (11.3%) than nonsmokers (4.8%). ¹

According to the research conducted by Dror Twito and Paul Sade ⁷ in Israel between 1999 and 2008, 4.2% of implants, or 321 out of 7,680, failed owing to smoking, which included passive smoking, Bruxism, and other dysfunctional habits which are on the rise. ¹

Conclusion

The pathogenesis of implant failure is multifaceted. Several factors have been identified as contributing to implant failure. To cure a current alignment, the practitioner must first identify the main root cause. A thorough history, patient feedback, regular follow-up sessions, and accurate diagnostic instruments will aid in determining the cause of failure. If there are regular follow-ups and check-ups, an early intervention can help with a better prognosis. The early detection of failing implants is critical to the treatment strategy for complications and failing implants.