Dental implants are life changing. For anyone who has lost teeth and is wearing a denture, you probably have already noticed many of the shortcomings with full and partial dentures. For those who have replaced their missing teeth with permanent bridges attached to natural teeth, you may not have as many functional issues compared to dentures, but in the long term you may find that even these bridges have problems and or fail due to decay, gum disease or fracture.
Fortunately dental implants can overcome many of these shortcomings. Dental implants are by far the best method of replacing teeth in the long term when one considers benefits, function and long term success. (Growing new teeth using stem cells may one day be an even better solution but that is at least 15+ years away.) Studies show that traditional crowns and bridges have a 15-20% failure rate within ten years, yet implants have less than 2% failure rate after ten years. If one were to collect longer term data, say 15 to 20 years, the disparity would be even greater.
Unfortunately, there are few things in life that last a lifetime and dental implants are no different. Despite the fact that less than 2% of implants fail, it is not much consolation if you are one of those 2%…as far as you are concerned you have been affected 100%!
So what sorts of things can cause an implant to fail and what can be done to maximize the chance of success? To explain this we have to separate initial or short term failure from long term failure.
Short Term Complications With Dental Implants
Short term failure is best described as those failures that occur before the final teeth are made. It could be immediately following the surgery , during the first few months of healing or even a year later.
1. Infection and Poor Healing
Placing an implant is a surgical procedure. Provided the dentist follows aseptic/sterile surgical techniques and precautions the chance of infection is extremely low, even when we consider we are working within the mouth which is full of bacteria. Patients are generally covered with antibiotics as an added precaution. Discomfort following surgery is usually mild to moderate and lasts for 1-4 days on average, and of course depends on the specific procedure being done. Make sure to ask your dentist what is a normal expectation for yourself.
In over 20 years of placing implants I have only seen two immediate infections (within one to two weeks of surgery) and in both cases it was a result of poor compliance and not following instructions on behalf of the patient. In some cases an infection may develop one month or more following surgery but before the implant is fully integrated (healed). If an infection does occur it is usually because of the presence of an existing problem or infection in a tooth or area adjacent to the surgical site. If caught early in some cases it can be dealt with and the surgery can still be successful.
2. Medical Condition Affecting Healing
Generally speaking, if you have lost teeth, you are a potential candidate for dental implant surgery. However, there are certain conditions and diseases that can affect whether dental implants are right for you – this is where the importance of a proper medical assessment comes in.
Conditions such as cancer, radiation to the jaws, alcoholism, uncontrolled gum disease or diabetes, smoking, certain medications and various other ailments can affect your bodies ability to heal and whether dental implants will fuse to your bone. These are not necessarily absolute contraindications, but steps may need to be taken to ensure that you will heal properly. Your dental surgeon should be taking a thorough medical history and make sure he/she is fully aware of any ailments as well as any medication you’re currently taking to avoid any unnecessary complications.
3. Surgical Technique
A skilled dental surgeon will know the osseo-integration process (how the dental implant anchors to the jaw bone) and be skilled in proper surgical techniques. In those cases healing is often very comfortable and uneventful. If not, the site is more prone to swelling, pain, infection and possible failure of the implant. This becomes more critical if the area is slightly deficient in bone volume or is very dense….overheating of the bone will cause necrosis (bone death) and the implant will likely fail to integrate.
4. Micromovement of the Dental Implant
Dental implants must remain immobile for a long enough period to allow osseo-integration to occur. The analogy I give my patients is similar to when we break a bone in our arm or leg. The fracture is immobilized by use of a cast because if there is movement the bony fracture will not heal. Implants are very similar.
Dental implants take a full 16-17 weeks to fully heal and that is based on a “sigma” of bone…the sigma is the time required for bone to go through a process of remodelling and mineralization. this time frame is constant from person to person, regardless of age or ethnicity.
If there is movement of the implant during the first 8-12 weeks the implant will not become stable because the bone will not grow against the side of the implant. You will get soft tissue ingrowth instead and the resulting implant will be loose and possibly painful.
This is very important for dentists who offer “immediate teeth” or “immediate implants”. In some cases we can place a tooth immediately onto an implant but we have to take steps to ensure that the forces and function on that implant are minimal. That could mean making the tooth shorter so that the food does not press on the tooth, eating a soft or liquid diet for ~2-3 months and/or splinting the tooth to other implants or natural teeth.
Immediate teeth are a wonderful way to have implants especially when it is a front tooth but you need to aware that it does or can pose an increased risk of failure. One final comment…your “bite”…how your teeth fit together…may make it possible or impossible to provide immediate teeth.
5. Lack of Bone
For an implant to be successful, it ideally needs to have bone grow around it on all sides. If the bone is deficient in height or width, steps need to be taken to ensure that bone will indeed grow against the implant.
If you have been missing a tooth for a long time, you will likely have lost some bone volume in that area. We can increase the volume of bone with various techniques. In some cases it has to be done as a separate step, and in other cases it can be done at the same time that the implant is placed.
Your implant dentist should be well skilled in being able to either grow bone via a bone graft or manipulate the site in a way that bone will fill the site. If there is a lack of bone volume and a dental implant is placed without correcting these deficiencies, your implant will likely fail.
Keep in mind that there is a very wide range of skills and techniques among implant surgeons. I have had many patients come to me after they have been told that “they don’t have enough bone and that they can never have an implant(s)”. What a wonderful experience it is for me to see the joy on their face when I tell them that it can be done…and an even greater joy when the final teeth are placed and the work is all said and done!!
6. Not Following Doctor’s Instructions
The post-op instructions are usually fairly straight forward and simple. Keep heavy physical activity to a minimum (usually for a few days), keep the surgical site clean, avoid eating certain foods if instructed to do so, and take your medications as recommended. There may be other specific recommendations that are given to you depending on the surgery being performed or your particular circumstances.
I have had patients do wonderfully the first couple of days and assume that they just happen to be a very fast healer so they carry on with their normal activities….in some cases things they were specifically told not to do…such as swimming, heavy cardio or exercise, eating certain foods etc. Then they begin to experience increased discomfort, swelling and or other complications and soon realize I was serious about the instructions. Keep in mind some medications that we prescribe help to reduce the usual post op problems people expect, and if they begin to overdo things too early they may have a more difficult time healing.
Long-Term Complications With Dental Implants
1. Failure to keep the area clean and maintained
So you finally have your dental implants and your final teeth are in place and now you’re ready to bite into crisp apples and smile bigger than ever before.
Now before you go riding off into the sunset with your new pearly white(s), it’s very important you maintain these new teeth and implants. Although I mentioned in previous blogs that implants are not prone to the same problems we see with natural teeth such as fracture decay and in infections they do require maintenance. I have treated patients who lost their teeth due to long term neglect and lack of care…sometimes these same people still seem to forget to brush their teeth now that they have implants!
If you have dental implants, you have made a major investment in your dental health. It needs to be maintained with simple brushing, flossing and a regular checkup with your general dentist and/or implant dentist.
If you get excessive food or bacterial plaque around an implant and do not clean it regularly it will cause inflammation in the gums which can lead to bone loss, infection and problems and/or even loss of the implant.
For some other reasons I will mention below it is very important to have your teeth checked regularly. I see and treat many patients who have their own “family” dentist and they come to see me for implant treatment only. Even in those situation where I know they are being seen by their own general dentist, I will have them come back for a follow up after one month, one year and then every 3-5 years just to make sure that everything is Ok.
2. Too much stress and forces on the implants
Once an implant has integrated with the bone it is extremely solid…it feels much like a “nail in concrete”. Unfortunately bone is not concrete. If there is excessive stress on a dental implant physiologically the bone will be lost. This may create a periodontal (gum) pocket which in turn will then allow unhealthy bacteria to grow and colonize….this sets up a cascade of event whereby more bone can be lost, infection set in and the implant can eventually be lost.
One of the best ways to prevent this is at the beginning..at the treatment planning stage. Although we are working on teeth, people and human bodies…. a lot of what we do has to do with engineering. If we do not place enough implants, if the implants are too small, too short or on too much of an angle the stress on the implant(s) can be excessive. In these cases your implants may do very well for the first five or so years but then you may begin to see bone loss and failure occurring.
This is why it is very important to be aware of certain treatment proposals that suggest using fewer dental implants or mini implants. There are implant companies out there whose prime directive is to sell more implants and to make the procedure appear simple so that any dentist can place them. I am not saying that fewer dental implants, mini implants or simple procedures are never successful in the long term. But if the forces on the teeth, type of teeth, bone quality, volume and other factors are not considered in the treatment planning you may have an unpleasant surprise as there is a much greater chance of long term failure.
About two years ago I had a patient come to see me as she was having pain with her upper implants. She had four implants placed and these were supporting a set of permanent teeth…the surgeries went well and she healed fine. The final teeth were placed just one and a half years prior to her seeing me. By the time she came into our office three of the four implants were failing and had infection around them, and this infection had caused further bone loss! There was only one implant that had some bone support but it was clear it was already beginning to fail. Once that failed the entire teeth would fall out. From my determination, she did not have enough implant support for the type and number of teeth being replaced and this caused too much stress on the bone. I explained some other options that would have been better and more successful in the long term and she said that someone else had told her something very similar. Basically she went with a less expensive treatment plan to save some costs..unfortunately she spent thousands (and thousands) of dollars and I don’t think she was able to recover any of the costs that she had spent. She will end up spending way more now to fix the damage done and then to restore her mouth more ideally.
3. Less than ideal placement or treatment planning
In some cases patients have had dental implants placed very successfully and have healed very well, only to find that when the teeth are to be made the implants cannot be used. In some cases it is because the implants are not in the right location or angle or the esthetics of the situation will not allow the implant to be useful.
This generally comes about from a lack of planning. The dental surgeon who is placing your dental implants should know exactly what type of teeth you will eventually have because that will determine exactly where, how many and at what angle the implants need to be placed. Therefore your implant treatment needs to start not with a surgeon, but with the dentist who will be providing in the final teeth. In some cases (such as our office) the implant dentist will provide both the surgical and prosthetic(teeth) phases of your dental implants. However, some dentists only provide the prosthetics, and some only provide the surgery. That can also work provided that the two of them communicate and that the treatment planning is done by the prosthetic dentist first…because (as described above) the type of teeth being placed will determine the type of surgery required.
Not to sound so pessimistic but I have had some patients come to see me to have teeth made after having the implants placed but with no prior consultation with myself or a prosthetic dentist. In some cases those implants were not restorable and had to be removed because of esthetic, health or functional concerns.
The Good News About Dental Implants!
While finding a skilled and qualified dentist(s) you can trust and feel comfortable with are important, the success or failure of dental implants also depends on the patient. By working together, you’ll help minimize any potential risks and before you know it, you’ll be read to take a big bite of life.
Despite the pessimistic outlook that you may derive after reading the above complications, dental implants are still the most successful and least problematic method of replacing your teeth. In my opinion, probably the biggest problem is that dental implants are often the most expensive option compared to traditional dentures and bridges. Therefore if you do have complications the potential loss of your investment can be huge. Make sure to ask your dentist(s) what sort of life expectancy is reasonable, and what is their policy regarding “failures.” I have many patients in the office who have had their implants for 15+ years with no issues, and several with implants for 25-37+ years, also with minimal to no issues. (I’ve only been placing and restoring implants for ~25 years so I cannot take credit for some of these patients…but I mention it to illustrate just how long they can last and endure)
If you have any questions, issues or problems you can always call, e mail us or even come in for a consult. We are here to help!