Secrets of successful dental implant placements

Implant based restorations are now becoming a norm in dentistry. It continues to show impressive contribution to aesthetics, restorative functions, preservative functions for bones and orthodontic anchorage purposes.

Implant placement is therefore a combination of art and science requiring deep understanding of the orofacial structures, the aesthetic demands of a balanced facial appearance, the physics involved in the loading and finally, the biological responses leading to success or rejection of the implant.

Selection of the right patient for implant placement is the first step in attaining successful results and outcomes. This stage requires deep consideration and investigation of the patient and a number of success factors. While any patient can be an ideal candidate for the placement of implants, certain medical and physical conditions prohibit its application. These include medical conditions such as poor oral hygiene, uncontrolled or untreated diabetes, diabetes not treated with insulin, blood dyscrasias with poor clotting mechanisms, corticosteroid treatment for long durations, osteoporosis and related drug intake, hyperthyroidism, presence of any tumor in the oral cavity or any history of irradiation within the span of one year, and habits such as bruxism respectively.

Contradictions to dental implants include presence of acute psychotic disorders, acute bone resorption and non-compliant patient, bone atrophy due to high stress, metabolic disorders and chronic inflammation respectively.

The implant success factors are divided into implant dependent, operator dependent and patient dependent factors respectively. Implant dependant factors include the shape and the dimensions of the implants. Operator related factors include correct selection of the implant site, bone density, soft tissue considerations, technique and direction of placement, implant placement torque, loading protocol, preventing overgrowth soft tissues, use of mini-plates, sterilization and clinical experience of the operator.

Some complications that can take place immediately after placement of implant include infections at the wound site and any damage to the surrounding normal tissue due to poor technique. Damage to the nerve is a very strong risk for implant placement. This is even more so in the maxillary arch, where care should be taken not to impinge in the natural cavity spaces.

Early failure is caused by overheating the bone, contamination of site, presence of epithelium at the osteotomy site, poor bone selected for implant placement and osseo-integration marred by excessive force placement respectively. During the later stages, lateral loading and excessive forces lead to implant failures.

Post implant care is as important a factor in the outcomes of the implant as the pre-implant care. Patients must follow proper oral hygiene practices and use toothbrushes, inter-dental brushes and floss to clean area around the implant.

The patients must continue follow up in order to prevent, detect or treat any early signs of failure. Signs of implant failure include presence of peri-implantitis, epithelial infiltration, bleeding on probing, suppuration, loss of bony support and mobility. Habits that can compromise the outcomes of implants such as smoking and bruxism must be discontinued to achieve optimal outcomes.

A successful implant when placed remains immobile or displays less than 1 mm mobility on clinical evaluation. The annual vertical bone loss allowed for the implant is 0.2 mm after one year of service. No natural structures are violated or invaded and there is no infection or damage in the surrounding areas of implants. The ideal implant success rate should be 85% after five years and 80% after ten years.
In summary, proper selection of the case, proper use of technique according to the case and its proper execution are key elements in the successful placement of implants.