Oral Health Assignment: Early & Late Failure of Dental Implants
Task: Oral Health Assignment Instructions:Many patients expect that dental implants will last for the rest of their lives. There are, however, failures. Please examine and comment on the expected failure rates of dental implants. These should be classified as early failures and late failures. You should define these terms. Please also comment on risk factors which may affect the success/failure rates of dental implants. Your discussion should be limited to the dental implants (fixtures) and not the prostheses attached to the implants. The aim of this review is for you to be able to discuss with a patient the expected success/failure rate of dental implants.
Title of review:
Failure rates of dental implants: Early and late.
The length of the assignments will be 2000 words. A maximum of 25 references should be used and the review referenced following the Vancouver style as used by the Australian Dental Journal (ADJ).
The current oral health assignment sheds light on the topic of “Dental implants” which have revolutionized the treatment of dental success by gaining considerable attention from the scientific community. Loss of tooth is a very common problem and the use of the dental practice has emerged as a common practice. Through a considerable amount of research on dental designs, materials as well as techniques have emerged considerably in the past few years and are further expected to increase considerably. Tooth loss has become extremely common and can arise from disease or trauma, hence using dental implants for supporting missing teeth has had a multifaceted history (11). There has emerged a global demand and a market for dental implants which is increasing in the cosmetic industry. In the current scope of discussion early and late failures along with the risks impacting success or failure rates associated with dental implants have been discussed here.
Early Implant failure
The early failure implant takes place when the dental implant is rejected or fails during the early stages of healing. However, such rates of failure with dental implants are low with increasing risks from early implant failures (5). Successful rates of dental implants are dependent upon the patient's overall oral health, the experience of the periodontist, in the case when the implant is placed in the mouth, along with the type of used dental implant. Failure in early implants is mainly from poor osseointegrationthat can arise from impaired healing of the bone. Risk factors arising from failure encompass risks from smoking, insufficient bone quantity, characteristics of the implant, and poor bone quality. There might be other risk factors arising from the age as well as sex of the patient (3). Recognizable and preventable risk factors as well as mitigating them can enable dentists to enhance patient outcomes significantly.
Post the discovery of the fact that osseointegrationcan take place between the bone and titanium, dental implants have developed as a highly expected approach modality for replacing of lost teeth in a partial as well in a completely edentulous patient (16).
As per Buser et al. Evaluation of “511 implants”with“sandblasted”, “acid-etched (SLA) surface”, large-grit surface there was reported a “10-year success rate around 97%”. Yet all implants are not expected to be successful in nature and adverse results might arise which results in removal which arises from a number of contributing factors (9). Research indicates that rates of dental failure have been higher in earlier phases as compared to late phases regardless of its loading time. There is attributed high vulnerability during the earlier stages of implant failure, where there is a decrease arising in primary stability with a gradual increase in secondary stability rates. According to Esposito et al early failures arise due to lack of osseointegration as well as clinical discernible mobility of the implant is a sign which reflects early failure as against factors which include a patient who experiences pain, infection signs, dull sounds while percussing and peri-fixtural radiolucency (21). As dental implants are located in a complex biological environment, varied aspects can lead to early implant failures (18). There can be patient-related, biomedical-related, and surgeon-related factors that contribute to early implant failures.
Late Implants failure
Dental implants are more widely accepted around the world. Dental implantology is becoming accepted widely as a successful procedure that can be done, however, there can still fail(4). The late implant failure is less common with fewer causes associated with the overall implant failure, which typically arises within one to three years after placement of the implant. When issues arise in cases then there arises a need for removal of the same. Removal of failed dental implant is fairly easy and a safe process, which depends on the implant, in case they are fully integrated with the bone then it might lead to severe trauma and loss, hence it has to be conservative approach. In case of late dental implant failures which arise in cases of the first few months of placement of the surgery and they are quite loose hence is easy to remove (12). There is prevalence of early failure in implant levels to the tune of 1.3% to 6.36%. The rates of cut-off time for dividing early and late phases with the abutment connection time having the advantage of reducing heterogeneity from loading methods. In case the cut-off time is set at 1-year after the final prosthesis delivery, there can be delayed rates of failure suspected in implant surgery and tendency of evaluating radiography performed for understanding rates of marginal bone loss (20). While evaluating cluster behaviour in patients, there was reported 1 implant failure amongst 6 patients, which is almost 23%, which totalled 43% of early implant failure rates. In case of repetitive failure rates at same site there was found to be failure rates at 86.7% which decreased considerably to 67.1% where in case of previous implants had already failed more than two times (17). For maintenance of survival rates is taken to be secondary aspect at implant placement sites, where earlier failures have taken place such that further failure can be prevented.
Dental implants lead to high rates of survival in academic as well as clinical literatures. Late failures can be subcategorised as biologic and mechanical complications. Mechanical complications include components to prosthetic damage or screw implant arising from occlusal trauma or in fatigue of material. Literature indicates biological incidence complications over a 10-year period function of dental implant can be as high as 69% (7).
Risk factors affecting failure rates of dental implants
There are varied risk factors that impacts failure rates in dental implants. These failures arises from effects of periodontitis, diabetes and smoking leading to early and late failures of dental implants.
Periodontitis consists of varied types of pathological conditions impacting the health of the periodontium seen in its chronic forms (16). Patients depict gingival inflammation which destructs tooth supporting structures, which encompasses periodontal ligament, bone and connective tissue. There is no significant difference in patient with periodontitis and periodontally healthy individual history post 5-year follow-up. There is a history of periodontitis which depict greater depths and greater marginal loss that surrounds implants with higher incidence of peri-implantitis (1). Diabetes mellitus includes a chronic disorder that leads to distortion in physiological equilibrium. Overall low success of implant in patient with diabetes of longer duration might be due to greater chance of complications at the micro-vascular levels that in turn leads to delay in healing around implants, which in turn leads to higher rates of early failure (10).
Survival in dental implant in controlled diabetic patient is good across general population. By application of prophylactic antibiotic, greater duration in post-surgical antibiotic course, use of bioactive material with implant coating, chlorhexidine mouth rinse and implant with higher length and width is seen to further enhance rates of survival implant in diabetic individuals.
Internal dental implant failure may occur before or after the load occlusion with the top structure of the prosthesis or after loading (14). According to chronological criteria, biological failures can be divided into "early errors" from the failure of bone integration, i.e. bone loss and "late failure" as a result of the loss of bone consolidation. Several factors, such as smoking, implant characteristics, infections, and a lack of bone or bone appearance, is associated with early implant failure. Identifying risk factors can reduce failures and increase prediction of dental implant treatment (19).
Identifying potential risk factors for premature implant failure can help reduce the failure rate and prevent premature implant loss. Early failures were caused from the inability to obtain close contact between bones and implants, lack of circumference, and fibrous tissue between the surrounding bones andimplant surfaces(8). Infection and scarring are the two main reasons that cause dental implant failure. Bacterial infections can cause the implant to fail, which can take place at any time during implant treatment, but this is important at an early stage of healing. Inappropriate treatment procedures can be caused by surgical trauma (insufficient irrigation, overheating) and patient-related local and systemic factors that play a vital role in dental implant failures. The surface of dental implants is a key factor in the contact of the bone-implant and the positioning of the bones around the implant. Of the four surface types studied in the study, the highest failure rates in the RBM series and calcium phosphate coated implants were the least recorded (22).
Research regarding the survival of implants with PMS and calcium phosphate also found no significant differences between them. The high failure rate in the current study may be due to other factors such as technical errors, different brands of implants on RBM surfaces with different design and production processes, and the choice of implants (types) in different situations (24).
Tapered implants have greater primary stability and offer better clinical outcomes than cylindrical implants. There is no clinical evidence of increased survival for conical or cylindrical implants.A single-stage approach is preferable for some patients, as it does not require more surgery and the treatment process is shorter, as a two-scene immersion method can be used if optimal on-site stability is not achieved or when control tissue regeneration is indicated (11). There is no significant difference between a phased program and a two-step program. Previous studies have also not found any difference in survival between underwater implants and non-immersive implants (23). The survival of dental implants places fresh extraction shrubs similar to dental implants placed on mature bones. Immediate implants in the hind jaw tend to have a high error rate. Recent studies show that implant failure rates are high and placed in a new drawer. Age is a predictive factor determining the success of implants (15). The recovery time for elderly patients was longer, health risks, and bone condition was relatively poor. Some studies have shown the predictability of dental implants in elderly patients. Recent studies have found no difference in the failure rate between age groups. It reported a strong link between age and increased implant failure (6). Most previous studies have shown no correlation between age and gender, and early implant failure. The preventive use of antibiotics can reduce the early failure of dental implants. It is recommended to use preventive single-dose antibiotics before treatment of dental implants. The efficacy of prophylactic antibiotics implanted in dental implants has been studied in randomized clinical trials using a practical, multi-sceptical placebo (13). Their results do not ensure the effectiveness of prophylactic antibiotics to reduce the degree of loss.
Although advanced oral health practices have delayed tooth loss, it remains a serious problem in aging societies around the world. Tooth loss can affect the function of chewing and aesthetics a person, which in turn affects the quality of life and well-being. Dentists are often forced to choose traditional denture or prosthetic treatment supported by a combined dental implant based on clinical conditions and patient requirements. Implant assistant prostheses are now often used to replace missing teeth. In addition, the use of dental implants usually prevents the installation of external teeth or the use of detachable prostheses. Lack of implantation can be characterized by implant mobility, but no specific criteria have been established for failed dental implants. There can be varied risks with contributing factors which can deteriorate rates of implants leading to early and late failures. With increasing rates of periodontitis and rising diabetic population globally, there has increased rates of implant failures.
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