Avoid the pitfalls of implant therapy with meticulous planning
Poor treatment planning is a major risk factor for suboptimal outcomes in all dental disciplines. In implantology, the consequences of inadequate preparation can be considerable, leaving patients with serious ongoing complications and increasing the chance of implant failure. For clinicians providing implant surgery and restoration, it is imperative to conduct a thorough assessment and create a meticulous treatment plan before commencing any procedures.
Patient factors
A number of patient-related factors impact the success and survival of dental implants. For instance, the patient’s dental and medical history must be explored in detail as part of the initial assessment and planning stage of treatment. The literature demonstrates that the presence or history of systemic health conditions can impact oral surgery, whether that is due to delayed healing, impaired osseointegration, or increased risk of infection.[i] Common conditions like cardiovascular disease, diabetes mellitus, and osteoporosis are not contraindications to implant treatment, but they should be addressed during treatment planning to mitigate the added potential risks. The same can be said of patients with genetic factors that increase their risk profile, such as those with polymorphisms, Down’s syndrome, and other gene mutations.[ii]
In addition, systemic conditions and the associated medications are also often more important to understand in older patients, rather than approaching age alone as a risk factor for implant surgery.[iii]
Of course, the standard of oral hygiene maintained by the patient during and after implant placement is crucial for excellent long-term outcomes as well. Prevalence of peri-implantitis is estimated to be 20% at patient-level and 13% at implant level, showing that it remains a concern for many individuals.[iv] Supportive peri-implant therapy should be customised for each patient to encourage high-quality maintenance routines alongside regular professional monitoring.[v] This should all be incorporated into the original treatment plan to ensure that patients understand exactly what to expect and encourage their engagement from the beginning for the best results.
Surgical considerations
Several surgical aspects must also be considered by the clinician during the treatment planning phase. Implant positioning is one of the main factors that can influence treatment success during surgery.
Firstly, anterior versus posterior location can impact success and warrant specific consideration by the oral surgeon.[vi] Beyond this, implants that are placed at a suboptimal angle, depth or area of bone are also linked with problems. In fact, mispositioned implants can cause an array of aesthetic, biological, and technical complications following placement. In the most extreme cases, they can make it completely impossible to restore the dentition, requiring removal and reassessment.[vii] This is true when placing single implants, though the impact can be much greater when approaching full-arch rehabilitation. The position of each implant within an arch – whether parallel to each other or tilted, for example – influences the outcome. The greater the number of implants placed in each arch, the more complex positioning becomes.[viii]
Finally, implants placed in sites where previous implants had failed are also associated with a higher risk of complications. However, with sufficient bone volume and appropriate technique, these implants can be successfully delivered in the right situations.[ix]
As such, carefully evaluating the anatomy and planning for optimal implant positioning – with regard to bone quality, prosthetic space, and restorability in the anterior zone – is crucial for predictable results.
Many other surgical factors must be reviewed to optimise outcomes too. The surgical protocols selected – including placement technique and bone management solutions – must be explored before the scalpel is in hand. The clinician’s skill and experience also play a role, emphasising the importance of high-quality training and education in the field before taking on complex cases in practice.
Preparing for success
This training is widely accessible to all dental professionals, with courses of varying length, content, and prestige available across the nation. For education you can rely on completely, discover the MSc in Dental Implantology from the ICE Postgraduate Dental Institute & Hospital. The 3-year part-time programme discusses patient assessment and treatment planning in great detail, offering practical guidance to help practitioners approach every case with confidence. Further modules cover implant surgery, restoration, and maintenance, with first-class teaching delivered by a globally renowned faculty – featuring specialist Oral Surgeon, Professor Cemal Ucer – in cutting-edge teaching facilities. Find out more today to get started in the next cohort starting in September.
Implantology is a complex field of dentistry. Treatment can make a significant difference to patients, but achieving excellent outcomes depends on optimising a number of factors. Both patient and surgical considerations must be addressed in the planning phase in order to mitigate the risks and pave the way for excellent results.
Please contact Professor Ucer at ucer@icedental.institute or Mel Hay at mel@mdic.co
01612 371842
Author: Professor Cemal Ucer, BDS, MSc, PhD, Oral Surgeon, ITI Fellow
[i] Osorio, Andres. (2024). Systemic Factors in Dental Implant Therapy: Insights from the Literature. Revista Estomatología. 32. 10.25100/re.v32i2.14558.
[ii] Baqain, L., & Baqain, Z.H. (2026). Impact of health, drugs and genetics on dental implant success: a scoping review of recent literature. Faculty Dental Journal.
[iii] Fretwurst T, Nelson K. Influence of Medical and Geriatric Factors on Implant Success: An Overview of Systematic Reviews. Int J Prosthodont. 2021 Suppl;34:s21-s26. doi: 10.11607/ijp.7000. PMID: 33571324.
[iv] Diaz P, Gonzalo E, Villagra LJG, Miegimolle B, Suarez MJ. What is the prevalence of peri-implantitis? A systematic review and meta-analysis. BMC Oral Health. 2022 Oct 19;22(1):449. doi: 10.1186/s12903-022-02493-8. PMID: 36261829; PMCID: PMC9583568.
[v] Mojaver S, Zad A, Sarmiento H, Fiorellini JP. Efficacy of supportive peri-implant therapy in the management of peri-implant mucositis and peri-implantitis: A systematic review. J Am Dent Assoc. 2026 Feb;157(2):141-152.e4. doi: 10.1016/j.adaj.2025.08.015. Epub 2025 Nov 7. PMID: 41204923.
[vi] Lang NP, Pun L, Lau KY, Li KY, Wong MC. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Clin Oral Implants Res. 2012 Feb;23 Suppl 5:39-66. doi: 10.1111/j.1600-0501.2011.02372.x. PMID: 22211305.
[vii] Tallarico M, Scrascia R, Annucci M, Meloni SM, Lumbau AI, Koshovari A, Xhanari E, Martinolli M. Errors in Implant Positioning Due to Lack of Planning: A Clinical Case Report of New Prosthetic Materials and Solutions. Materials (Basel). 2020 Apr 16;13(8):1883. doi: 10.3390/ma13081883. PMID: 32316361; PMCID: PMC7215328.
[viii] Sharaf MA, Wang S, Mashrah MA, Xu Y, Haider O, He F. Outcomes that may affect implant and prosthesis survival and complications in maxillary fixed prosthesis supported by four or six implants: A systematic review and meta-analysis. Heliyon. 2024 Jan 20;10(3):e24365. doi: 10.1016/j.heliyon.2024.e24365. PMID: 38317918; PMCID: PMC10839890.
[ix] Gareb B, Vissink A, Terheyden H, Meijer HJA, Raghoebar GM. Outcomes of implants placed in sites of previously failed implants: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2025 Mar;54(3):268-280. doi: 10.1016/j.ijom.2024.10.006. Epub 2024 Oct 26. PMID: 39490354.
