HDA 2018 Dental Implant Complications 1 Course Objectives - Understand protocols for diagnosing and treatment planning to minimize complications - Recognize and manage intraoperative complications during implant placement - Recognize early and manage post-operative complications - Recognize and manage esthetic and functional complications - Understand the etiology and manage peri-implantitis 2 What are some common failures / problems we all encounter? Implants placed in wrong positions. Post op complications... Patient with fx implants. Broken abutments and screws. Managing the unknown implant. Periimplantitis. 3 When Implants Fail How does it impact our patients and practice Loss of time Loss of confidence Loss of money Influences our tx planning in the future 4
Define Successful Implant Treatment 5 Bone Quantity and Quality Bone Quality relates to the degree of bone density present. Type 1 is dense bone, which provides great cortical anchorage, but limited vascularity. Type 2 bone is the best bone for osseointegration of dental implants. It provides good cortical anchorage for primary stability, yet has better vascularity than Type 1 bone. Types 3 and 4 are soft bone textures with the least success in type 4 bone. 6 Dimensions for success The Influence of Bone Thickness on Facial Marginal Bone Response: Stage 1 Placement Through Stage 2 Uncovering J. Robert Spray 7 8
Site Evaluation Adequate interocclusal and interdental dimension -4 millimeters of minimum vertical space is required for structural integrity in posterior single crowns and fixed partial dentures. However, dimensions greater than 3-4 mm are required to achieve an esthetic result. Dental Implants and Esthetics Charles J. Goodacre, DDS, MSD; Chad J. Anderson, MS, DMD Rec. Min. 5 mm 9 10 Furthermore, maxillary anterior regions require a subtle palatal angulation to increase labial soft tissue bulk. For every millimeter of lingual inclination, the implant should be placed an additional millimeter apically in order to create an optimal emergence profile. Potashnick SR. Soft tissue modeling for the esthetic single-tooth implant resto- ration. J Esthet Dent. 1998;10(3):121-31. 11 Bone Dimensions For Success Safe Zone 1.5-2.0 mm Danger Zones 12 Want 1.8-2.0 mm bone around Implant
Restorable or not? Why? 13 Dreaded Black Triangle! 14 15 Predicting the Post Surgical Papilla 16
Gingival Biotype 17 Gingival Scaffold/Biotype Biotype of gingiva,the effect of gingival biotype on peri-implant tissue response seemed to be limited only to facial gingival recession and did not influence interproximal papilla or proximal marginal bone levels. J.Kan 18 Gingival thickness faciopalatally (Biotype) Transgingival Probing Determina<on Direct co-rela<on between suscep<bility of recession followed by a surgical procedure J Periodontol. Kinaia et al. 2017 19 20
Gingival Recession on Implant 21 26 yo Female hx Trauma 22 23 24
2 weeks PO 25 6 mos PO 26 Does Age Matter? 27 28
29 30 31 32
33 34 Surgical Complications 35 Why not just put them in straight? 36
What do we think about this? 37 Anatomical Considerations 38 Surgical Complications 39 40
1 Year Post-op 41 Poor clinical judgment resulted in post op anesthesia Patient was numb post op and regained feeling after moving implant. 42 43 8mm Guide Pin Position 44
45 Osteotomy Translation to Distal 3 mm 46 Improved Osteotomy Position 47 Post-op 19, 20 PA 48
oops! The special Box!! 49 50 51 52
53 Fractured Implant 54 55 56
57 58 August 2010 59 May 2011 60
November 2011 61 March 2012 62 April 2012 63 August 2014 64
February 2017 65 66 67 68
69 70 Fractured Implants 71 72
73 74 75 76
77 78 79 80
81 82 83 84
85 86 87 88
Dental Tourism 89 Don t Count on this. 90 91 92
93 94 95 96
97 Connecting Natural Teeth To Implants 98 99 100
101 Whats on your Implant? 102 103 104
105 How do you manage the unknown Implant? Records from the previous practitioner.. whatimplantisthat.com osseosource.com Preat - Get the app 106 Unknown Implant 107 108
109 110 Peri-Implantitis 111 Peri-Implantitis 10% peri-implant disease associated with dental cement Goodacre CJ et al. Clinical Complications with Implants and Implant Prostheses. The Journal of Prosthetic Dentistry, August 2003, Volume 90, Issue 2, pp. 121-132. 112
113 Compromise 114 Implant # 9, non restorable tooth 115 116
117 118 119 120
121 122 123 124
Problems with this case? 1. Position (B&D) 2.Gingival Biotype / Available KT 3.Type of implant (-PS) 4.Constraints of patient (Rest at least 8) 125 126 127 128
129 Doctor Perceived Complications Compromised Healing Compromise in Function Compromise in Esthetics Implant Failure Prosthesis Failure 130 131 132
Immediate Provisional With Problem Immediate Extraction Placement and Provisionalization Extraction, Immediate placement #11 Immediate provisional 61 y/o WF PMH High Cholesterol, Restless Leg, Light Smoker Meds Gabapentin, Simvastatin, Advil PSH Back Surgery for bulged disc All NKDA Custom Impression Post
Model Work with Custom Abutment 11/17/15 and it keeps coming.. Final Film of Custom Abutment and PFZ Crown. As Paul Harvey said, the rest of the story.
Thank You!! Michael E Pruett, DMD The Dental College of Georgia Augusta University GC1355 Augusta, Georgia 30912 mpruett@augusta.edu 706-721-8541 Office 706-723-0221 - Fax