Lifespan and implants
Featured Products Promotional FeaturesPosted by: Dental Design 17th March 2020
Dental implants are the gold standard for rehabilitation of edentulous patients, offering the closest approximation to a brand new tooth so far devised. While dental implants enjoy a favourable success rate well in excess of 90%, there are still some cases where the implant ultimately fails.[i] Osseointegration failures are the primary cause in the short-term, while in the long-term peri-implantitis and excessive loading are the leading drivers of failure.[ii]
Nothing lasts forever and though they are durable, this is true of implants as much as anything else. Early failures due to insufficient osseointegration can be minimised through good case selection, technique and appropriate implant systems. However, dental implants are expected to serve for years in a challenging environment. While implants in more senior patients may ultimately outlast the recipient, with growing numbers of more youthful patients receiving surgery, we must consider the long-term survival of the solution.
The population is aging. Based on cohort life expectancies, it is projected that British adults today will live on average into their late 80s or early 90s (with women living around 3 years longer on average).[iii] While this projection may ultimately prove inaccurate, increasing lifespans do require us to consider not only if an implant is the best choice for a patient right now, but also how well it will serve them in the long-term. One study found implant survival rates of over 89% after 10 years, and 83% after 16 years. Following successful osseointegration most failures were attributable to peri-implantitis. Smoking was found to be a significant risk factor for implant failure.[iv]
In the long-term, compatibility may become an issue. There are already various system designs requiring a proliferation of tools. When looking two decades ahead, we cannot be certain that all current providers of these systems will remain. Opting for proven, dependable systems is the best means practitioners have of mitigating this issue. In the long-term it would be beneficial for suppliers to adopt greater standardisation.[v] As the implant may serve for well over a decade, it is not unlikely that the patient may see a different practitioner by the time problems with the implant may have developed (the patient may have moved, the dentist retired, etc.). Consequently, producing an “implant passport” could be very helpful.[vi] Such a document records details of the system used, making future clinical work easier and more efficient. For example, there are numerous types of screw in use, knowing the specific type and tool required in advance, could save valuable time.
It may be advisable to avoid permanent cementation where possible, especially in younger patients, as it can complicate future maintenance and adaptations.[vii] Dental cement has been found to lower osteoblast survival, so where required it should be used sparingly. Particular care must be taken to remove excess as its presence can harbour bacteria and provoke inflammation.[viii]
Another possible cause of failure is fracturing of the implant. This is a rare complication (around 1% of implants), but the probability increases over time. There are various factors that can lead to excessive forces acting on the implant, including screw loosening or overtightening. Parafunctional habits are a particular risk factor, with over half of patients with fractured dental implants exhibiting bruxism. Bruxism can exert high magnitude forces on the implant and for protracted periods. Ideally teeth/implants should only come into contact with each other for around half an hour per day. In patients with bruxism, contact can occur for several hours and at greater intensity. As the habit continues, the patient’s jaw muscles can strengthen from the exercise, increasing the forces at play.[ix] Bruxism can have numerous causes including sleep dysfunction, stress, psychological issues, medication and a variety of medical disorders. Parafunctional habits are a significant threat to both natural teeth and protheses and reliable treatment of causes is not always possible. One bit of good news is that the prevalence of bruxism gradually declines with age.[x]
If you are dealing with a complex case, such as a failing implant requiring surgical intervention, consider referring your patient to the Centre for Oral-Maxillofacial and Dental Implant Reconstruction. Led by Professor Cemal Ucer – Specialist Oral Surgeon – the practice offers a wide variety of advanced procedures, including nerve lateralisation and repositioning, allografts and zygomatic dental implants. With a wealth of experience and state-of-the-art facilities, your patient will receive the best of care. The clinic also provides an online advisory service and comprehensive marketing and maintenance packages for referring practitioners.
Most implant failures occur relatively early on. Provided that osseointegration is successful, implants generally survive for a considerable length of time. Being proactive in correcting early complications is therefore important to the overall success of the treatment. By ensuring that patients continue to attend regular check-ups and comply with instructions, implant failures can be further minimised. Where conditions arise that can jeopardise the implant, early detection and intervention can make a huge difference.
Please contact Professor Ucer at ice@ucer.uk or Mel Hay at mel@mdic.co
01612 371842
[i] Hickin M., Shariff J., Jennette P., Finkelstein J., Papapanou P. Incidence and determinants of dental implant failure: a review of electronic health records in a U.S. dental school. Journal of Dental Education. 2017; 81(10): 1233-1242. https://doi.org/10.21815/JDE.017.080 November 29, 2019.
[ii] Sakka S., Baroudi K., Nassani M. Factors associated with early and late failure of dental implants. Journal of Investigative and Clinical Dentistry. 2012; 3(4): 258-261. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.2041-1626.2012.00162.x November 29, 2019.
[iii] Office for National Statistics. Past and projected data from the period and cohort life tables, 2016-based, UK: 1981 to 2066. Office for National Statistics. 2017. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/pastandprojecteddatafromtheperiodandcohortlifetables/latest November 22, 2019.
[iv] Simonis P., Dufour T., Tenenbaum H. Long-term implant survival and success: a 10-16-year follow-up of non-submerged dental implants. Clinical Oral Implants Research. 2010; 21(7): 772-777. https://doi.org/10.1111/j.1600-0501.2010.01912.x November 22, 2019.
[v] Sato Y., Kitagawa N., Isobe A. Implant treatment in ultra-aged society. Japanese Dental Science Review. 2018; 54: 45-51. https://doi.org/10.1016/j.jdsr.2017.12.002 November 22, 2019.
[vi] Visser A., de Baat C., Hoeksema A., Vissink A. Oral implants in dependent elderly persons: blessing or burden? Gerodontology. 2011; 28(1). https://doi.org/10.1111/j.1741-2358.2009.00314.x November 29, 2019.
[vii] Sato Y., Kitagawa N., Isobe A. Implant treatment in ultra-aged society. Japanese Dental Science Review. 2018; 54: 45-51. https://doi.org/10.1016/j.jdsr.2017.12.002 November 22, 2019.
[viii] Tatullo M., Marrelli M., Mastrangelo F., Gherlone E. Bone inflammation, bone infection and dental implants failure: histological and cytological aspects related to cement excess. Journal of Bone & Joint Infection. 2017; 2(2): 84-89. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423581/ November 29, 2019.
[ix] Sanivarapu S., Moogla S., Kuntcham R., Kolaparthy L. Implant fractures: rare but not exceptional. Journal of Indian Society of Periodontology. 2016; 20(1): 6-11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795137/ November 29, 2019.
[x] Guaita M., Högl B. Current treatments of bruxism. Current Treatment Options in Neurology. 2016; 18(10). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761372/ November 29, 2019.
