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Common Problems With Dental Implants
Jilonova Zukhra., Rakhmatullayeva O ygul., Mannanov Javlon., O limov Azimjon
.
Assistants department of surgical dentistry and dental implantology,
T ashkent State Dental Institut, Uzbekistan
А
nnotation.
Dental implantation is currently one of the m ost promising areas in the
rehabilitation of dental patients. Despite the success achieved, dental implantation, like other
surgical methods of treatment, is accompanied by various kinds of com plications. The m ost
com mon complications are of an inflamm atory nature.
However, there are m any problems in dental im plantology. This article presents a review of the
scientific literature on risk factors for early and late com plications of dental im plantation.
It is considered that a well-established and integrated dental im plant should function for at
least 10 years, satisfy the patient in aesthetic and functional term s, have clinical stability, and be
biocom patible with respect to the surrounding tissues.
Keywords:
dental implant, m ucositis, periimplantitis, risk factors for dental im plantation,
autoimmune diseases.
Relevance.
T he success of dental implants depends on the General state of the patient's
div, as well as on the technique of implant placem ent, the skill and experience of the
implantologist and the management of the patient in the postoperative period.
Indications for dental im plantation are partial defects of the dentition or complete absence of
teeth, the inability for various reasons to use removable prostheses (deform ities of the jaws,
pronounced gag reflex on the prostheses).
O bjective :
Experimentally and clinically justify the advantages and disadvantages of dental
implants. Find the optimal resolve to avoid dental im plant problems.
Material and research m ethods:
Before the implantation operation, the patient must undergo a com prehensive examination,
which includes collecting com plaints, anamnesis, exam ination of the oral m ucosa, while assessing
the condition of the teeth, alveolar processes, the type of bite, the level of oral hygiene, and, if
necessary, consulting other specialists. In addition, x-ray examination of the dental system is
perform ed using computed tomography. This m ethod allows to visualize the state of the jaw bones
in three dimensions, and to assess bone density, the trabecular nature of the figure, the condition of
the sinuses, the volum etric param eters of the alveolar processes, the degree of atrophy of the jaw
bone, the distance between al-violarium ridge and maxillary sinus floor, the topography of the
mandibular canal. In addition, during the planning of the operation, an instrumental exam ination is
perform ed, which includes m easuring the width of the alveolar processes to select the location of
the future implant.
All com plications after dental implantation are usually divided into two groups: early
(manifested in the period from a few days to 2-3 weeks after surgery) and late (developed after
several years). Early complications are typical of the inflam matory process that occurs as a result of
mechanical trauma to the tissues of the maxillofacial region, namely: postoperative edem a, bleeding
in the area of the installed im plant, appearing after the termination of the VASO-constrictor action
of epinephrine, which is part of the solution for anesthesia. In addition, pain m ay occur, as well as a
rise in tem perature to 38°C. divergence of sutures, eruption of part of the im plant through the
mucous membrane are also early com plications, but unlike other complications, they are often not a
sign of failed im plantation and are usually the result of non-compliance with the patient's
precautions during the postoperative period.
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Late complications after dental implantation include the appearance of inflam mation in the
periimplantation zone during the period of osteointegration or after the completion of
osteointegration.
At a workshop of the European Federation of periodontists in 2008, an agreed opinion was
developed on infectious and inflamm atory lesions in the area of dental im plants, based on m odern
scientific evidence, which was proposed to include perim plantation mucositis and perimplantitis.
Mucositis is an inflam mation of the soft tissues adjacent to the structure, which is not
accompanied by a violation of osteointegration.
Peri-im plantitis is an inflamm ation of the tissues surrounding the implant, accom panied by
horizontal or vertical resorption of the supporting bone. According to current data, mucositis
develops in 80% of individuals, while peri-im plantitis was detected and described in 28-56% of the
examined patients.
Let's take a closer look at some of the causes of peri-implantitis. Sm oking is a significant
risk factor for peri-im plantitis. According to S. I. Zhadko and F. I. Gerasim enko, tissue healing after
implantation in Sm oking patients is significantly worse than in non-smokers [14, 15].
This is due to the fact that people who are addicted to Smoking have an increased formation
of plaque, and, consequently, an increased risk of gingivitis and periodontitis, as well as the
occurrence of severe bone resorption. Sm oking reduces blood supply to tissues due to the
vasoconstrictor effect of nicotine on arterioles. Sm oking releases toxic by-products, such as
nicotine, carbon m onoxide, and hydrogen cyanide, which inhibit the reparative function of div
tissues. Treatm ent of dental patients with nicotine dependence using dental im plantation, if the
patient refuses to smoke, reduces the likelihood of developing complications to the level of non-
smokers [16].
Iatrogenic causes that may be risk factors for peri-implantitis include non-compliance with
the rules of asepsis and antiseptics; insufficient awareness of the doctor about the patient's health,
undiagnosed foci of chronic infection in the m axillofacial region, leading to an unsuccessful result;
discrepancy in the size of the im plant to the size of the implant bed; form ation of a subgingival
hem atoma at the tim e of surgery with its subsequent suppuration; destruction of bone tissue caused
by excessive force of screwing the im plant (more than 45 N / m); overheating and, as a
consequence, bone necrosis when dissecting at high speeds; excessive dissection of bone tissues;
errors at the stages of prosthetics, namely: chronic trauma and periodontal overload, incongruence
of the orthopedic structure; the presence of m icro-gaps between the im plant and the abutm ent
[17,18].
Systemic violation of bone remodeling is a contraindication to the restoration of chewing
efficiency using dental im plants [19].
The absence of a keratinized gum m ay also be the cause of peri-implantitis, since the long-
term service of the dental im plant, its aesthetic and functional role requires a good condition and
structure of the supporting tissues.
The function of protecting the im plant and the surrounding bone tissue from the penetration
of microorganisms and the traumatic impact of a food lump is performed by an attached gum
covered with a multi-layer flat keratinized epithelium, which norm ally surrounds a healthy tooth or
implant. T he width of the keratinized gum varies from 4 to 9 mm. Due to the rem oval or loss of
teeth, the attached gum is reduced and rarely exceeds 2 mm or even com pletely disappears. At the
sam e time, the risk of developing inflamm atory phenom ena around the implant increases.
Already in 1996, T . Berglundh, T . and Lindhe et al. we performed experiments on dogs and
found that when the thickness of the keratinized gum is less than 2 mm , bone resorption occurs
around the implant and reaches the visible size within 6 months.
According to T . Linkevicius et al. during the first 2 months after the dental implant is
installed, the biological width around the im plant is formed, similar to the biological width around
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the natural tooth. T his phenomenon provokes a loss of bone tissue in the case of initial insufficiency
of the soft tissue thickness in the implantation zone to form a minimum volume of biological width
(on average 3 mm). A narrow keratinized gum does not provide a tight fit of the soft tissues
surrounding the im plant, which in turn creates favorable conditions for plaque accumulation and
increases the risk of developing m ucositis and perim plantitis. T his is due to the fact that the tissues
around the implant (periimplant tissues) and periodontal tissues differ in structure and resistance to
bacterial infection. The gum surrounding the im plant consists of a large am ount of collagen and
contains half as m any fibroblasts as the gum around the tooth. In this case, the collagen fibers are
not attached to the surface of the im plant, but are located parallel to its surface, which leads to the
form ation of a space in which plaque accum ulates, causing inflamm ation. The pronounced m obility
of soft tissues around the neck of the im plant or abutm ent contributes to this. A sufficient width of
the keratinized gum form s a dense fibrous cuff around the neck of the im plant, thus preventing the
penetration of microorganisms and food residues.
Dental implantation is currently one of the m ost promising areas in the rehabilitation of
dental patients. Despite the success achieved, dental im plantation, like other surgical m ethods of
treatment, is accompanied by various kinds of complications. T he most comm on com plications are
of an inflam matory nature.
Results and discussions:
However, there are many problem s in dental im plantology. This article presents a review of
the scientific literature on risk factors for early and late com plications of dental im plantation.
It is considered that a well-established and integrated dental im plant should function for at
least 10 years, satisfy the patient in aesthetic and functional term s, have clinical stability, and be
biocom patible with respect to the surrounding tissues.
The success of dental implants depends on the General state of the patient's div, as well as
on the technique of implant placem ent, the skill and experience of the im plantologist and the
management of the patient in the postoperative period.
Indications for dental implantation are partial defects of the dentition or complete absence of
teeth, the inability for various reasons to use removable prostheses (deform ities of the jaws,
pronounced gag reflex on the prostheses).
Before the implantation operation, the patient must undergo a com prehensive examination,
which includes collecting com plaints, anamnesis, exam ination of the oral m ucosa, while assessing
the condition of the teeth, alveolar processes, the type of bite, the level of oral hygiene, and, if
necessary, consulting other specialists. In addition, x-ray examination of the dental system is
perform ed using computed tomography. This m ethod allows to visualize the state of the jaw bones
in three dimensions, and to assess bone density, the trabecular nature of the figure, the condition of
the sinuses, the volum etric param eters of the alveolar processes, the degree of atrophy of the jaw
bone, the distance between al-violarium ridge and maxillary sinus floor, the topography of the
mandibular canal. In addition, during the planning of the operation, an instrumental exam ination is
perform ed, which includes m easuring the width of the alveolar processes to select the location of
the future implant.
All com plications after dental implantation are usually divided into two groups: early
(manifested in the period from a few days to 2-3 weeks after surgery) and late (developed after
several years). Early complications are typical of the inflam matory process that occurs as a result of
mechanical trauma to the tissues of the maxillofacial region, namely: postoperative edem a, bleeding
in the area of the installed im plant, appearing after the termination of the VASO-constrictor action
of epinephrine, which is part of the solution for anesthesia. In addition, pain m ay occur, as well as a
rise in tem perature to 38°C. divergence of sutures, eruption of part of the im plant through the
mucous membrane are also early com plications, but unlike other complications, they are often not a
sign of failed im plantation and are usually the result of non-compliance with the patient's
International Journal of Research
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p-ISSN: 2348-6848
e-ISSN: 2348-795X
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precautions during the postoperative period.
Late complications after dental implantation include the appearance of inflam mation in the
periimplantation zone during the period of osteointegration or after the completion of
osteointegration.
At a workshop of the European Federation of periodontists in 2008, an agreed opinion was
developed on infectious and inflamm atory lesions in the area of dental im plants, based on m odern
scientific evidence, which was proposed to include perim plantation mucositis and perimplantitis.
Mucositis is an inflam mation of the soft tissues adjacent to the structure, which is not
accompanied by a violation of osteointegration.
Peri-im plantitis is an inflamm ation of the tissues surrounding the implant, accom panied by
horizontal or vertical resorption of the supporting bone. According to current data, mucositis
develops in 80% of individuals, while peri-im plantitis was detected and described in 28-56% of the
examined patients.
Let's take a closer look at some of the causes of peri-implantitis. Sm oking is a significant
risk factor for peri-im plantitis. According to S. I. Zhadko and F. I. Gerasim enko, tissue healing after
implantation in Sm oking patients is significantly worse than in non-smokers [14, 15].
This is due to the fact that people who are addicted to Smoking have an increased formation
of plaque, and, consequently, an increased risk of gingivitis and periodontitis, as well as the
occurrence of severe bone resorption. Sm oking reduces blood supply to tissues due to the
vasoconstrictor effect of nicotine on arterioles. Sm oking releases toxic by-products, such as
nicotine, carbon m onoxide, and hydrogen cyanide, which inhibit the reparative function of div
tissues. Treatm ent of dental patients with nicotine dependence using dental im plantation, if the
patient refuses to smoke, reduces the likelihood of developing complications to the level of non-
smokers [16].
Iatrogenic causes that may be risk factors for peri-implantitis include non-compliance with
the rules of asepsis and antiseptics; insufficient awareness of the doctor about the patient's health,
undiagnosed foci of chronic infection in the m axillofacial region, leading to an unsuccessful result;
discrepancy in the size of the im plant to the size of the implant bed; form ation of a subgingival
hem atoma at the tim e of surgery with its subsequent suppuration; destruction of bone tissue caused
by excessive force of screwing the im plant (more than 45 N / m); overheating and, as a
consequence, bone necrosis when dissecting at high speeds; excessive dissection of bone tissues;
errors at the stages of prosthetics, namely: chronic trauma and periodontal overload, incongruence
of the orthopedic structure; the presence of m icro-gaps between the im plant and the abutm ent
[17,18].
Systemic violation of bone remodeling is a contraindication to the restoration of chewing
efficiency using dental im plants.
The absence of a keratinized gum m ay also be the cause of peri-implantitis, since the long-
term service of the dental im plant, its aesthetic and functional role requires a good condition and
structure of the supporting tissues.
The function of protecting the im plant and the surrounding bone tissue from the penetration
of microorganisms and the traumatic impact of a food lump is performed by an attached gum
covered with a multi-layer flat keratinized epithelium, which norm ally surrounds a healthy tooth or
implant. T he width of the keratinized gum varies from 4 to 9 mm. Due to the rem oval or loss of
teeth, the attached gum is reduced and rarely exceeds 2 mm or even com pletely disappears. At the
sam e time, the risk of developing inflamm atory phenom ena around the implant increases.
Already in 1996, T . Berglundh, T . and Lindhe et al. we performed experiments on dogs and
found that when the thickness of the keratinized gum is less than 2 mm , bone resorption occurs
around the implant and reaches the visible size within 6 months.
According to T . Linkevicius et al. during the first 2 months after the dental implant is
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installed, the biological width around the im plant is formed, similar to the biological width around
the natural tooth. T his phenomenon provokes a loss of bone tissue in the case of initial insufficiency
of the soft tissue thickness in the implantation zone to form a minimum volume of biological width
(on average 3 mm). A narrow keratinized gum does not provide a tight fit of the soft tissues
surrounding the im plant, which in turn creates favorable conditions for plaque accumulation and
increases the risk of developing m ucositis and perim plantitis. T his is due to the fact that the tissues
around the implant (periimplant tissues) and periodontal tissues differ in structure and resistance to
bacterial infection. The gum surrounding the im plant consists of a large am ount of collagen and
contains half as m any fibroblasts as the gum around the tooth. In this case, the collagen fibers are
not attached to the surface of the im plant, but are located parallel to its surface, which leads to the
form ation of a space in which plaque accum ulates, causing inflamm ation. The pronounced m obility
of soft tissues around the neck of the im plant or abutm ent contributes to this. A sufficient width of
the keratinized gum form s a dense fibrous cuff around the neck of the im plant, thus preventing the
penetration of microorganisms and food residues.
It should be noted that the absence of a dense keratinized cuff around the implant makes
daily hygiene procedures less com fortable due to the high trauma of the mobile mucosa.Increasing
the thickness of the soft tissues covering the coronal part is achieved by transplanting a free
connective tissue graft, which helps to increase the volume of the gums.
One risk factor for peri-implantitis is the presence of im plant rejections in the patient's
history. T wenty years ago, m any dentists had great doubts about dental im plants and considered
them unreliable and unpromising, since the treatm ent was accompanied by quite frequent
com plications that led to the rejection of im plants. Currently, due to the use of new technologies,
the num ber of rejections has significantly decreased and, according to statistical analysis of m odern
dental practice, is 2-5 % of im plant rejections in the first 5 years of their operation.
According to M. D. Perov and V. A. Kozlov, the destruction of bone tissue that occurs after
the rejection of im plants has a negative effect on the overall health of the patient. In the patient's
oral cavity, the consequences of implant rejection are m anifested in the form of loss of bone volume
in the dentoalveolar region, and in som e cases, the im possibility of repeated dental im plantation.
Therefore, the rejection of implants in the history must be taken into account when selecting
patients, determ ining the indications for surgery and predicting the results of dental im plantation.
Speaking of systemic pathologies, when planning im plantation, it is necessary to pay
attention to the presence of diabetes in the patient first of all. T his disease is at the forefront of risk
factors and relative contraindications to surgical interventions, including dental implantation.High
blood glucose levels negatively affect the ability of tissues to repair. Accordingly, the process of
osteointegration is significantly slowed down.
It is im portant to note another group of diseases that affect the development of mucositis and
perimplantitis-thyroid disease. T hese diseases are characterized by an increase or decrease in the
production of thyroid hormones. At the sam e time, both hyperfunctions and hypofunctions of the
thyroid gland have a negative im pact on the osteointegration of the implant. According To M. V.
Shcherbakov, the risk group includes women with a tendency to hypothyroid States. If both bone
resorption and bone formation are slowed down when thyroid horm ones are deficient, then
hyperthyroidism results in increased bone rearrangem ent, but its structure is disrupted, in particular,
the level of mineralization decreases and bone resorption increases.
Autoim mune diseases (exacerbation of collagenoses, autoimm une thyroiditis, etc.) can be
attributed to the risk of developing postoperative complications after implant placement. Diseases
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of this category, as a rule, are a direct contraindication for reconstructive operations and dental
implantation, since they prevent the successful course of reparative processes and sharply reduce
the likelihood of postoperative recovery of functions.
It is known that im munodeficiency conditions of the oral m ucosa contribute to the
development of violations of microbial biocenosis. At the sam e time, in gingival tissues, especially
in periodontal tissues, there is a tendency to excessive bacterial growth and the formation of an
unhygienic state in the oral cavity. In this case, surgical interventions on the alveolar process
(reconstructive operations, tooth extraction, imm obilization of facial bone fragments, dental
implantation, etc.) are perform ed in conditions of increased risk of inflamm ation.
One of the key factors in the development of perim plantitis is infection of perimplant tissues
by oral microorganism s, which occurs due to poor oral hygiene and the form ation of dental plaque
on the surface of the implant suprastructure, as well as specific and non-specific reactions that occur
under the influence of anti-gene substances of m icrobial associations of dental plaque. The effect of
dental plaque implies microbial contamination of peri-im plant tissues.
According to N. W enz et al., for the formation of dental plaque in the area of the prosthesis
on the implant, the nature of the surface of the prosthesis is of great importance. N. Wenz et al. in
the experim ent, it was noted that twice as much plaque containing num erous bacterial colonies is
form ed on the rough surface of the suprastructure as on the smooth surface.
Of great im portance for the development of the inflamm atory process in the area of the
integrated implant is the adhesion of bacteria and the form ation of dental plaque on its protruding
part, and the higher their concentration, the lower the degree of colonization of bacteria.
Many studies have shown that orthopedic elements that rely on im plants last much longer if
the patient takes care of them properly.
However, the patient's inability to properly care for the prostheses leads to a decrease in the
service life and prem ature loss of the im plant. All this determines the need to develop and
implem ent additional means of individual oral hygiene, which allow for high-quality and effective
care of prostheses on implants.
After prosthetics on implants, daily thorough individual oral hygiene is required throughout
the entire period of operation of the prostheses. With poor hygiene in the area periim plantitis zone
is form ed dental plaque, which can lead to the developm ent of mucositis and peri-implantitis in the
future. Preventive examinations at least twice a year and professional hygiene procedures allow you
to identify the initial m anifestations of inflam mation and eliminate them. Otherwise, the service life
of implants is significantly reduced.
It should be noted that an important risk factor for dental implants is the presence of a
patient's history of periodontitis. The literature describes a lot of evidence about the relationship of
this disease with a predisposition to perim plantitis. T hus, in patients with chronic periodontitis,
com plications of dental implantation are m ore comm on. The developm ent of peri-implantitis in
individuals with inflam matory periodontal diseases in anamnesis is confirm ed by the results of
many scientific studies devoted to this problem.
The results of clinical studies have shown that the risk of developing periimplantitis in
patients with periodontitis, both in active form and in remission, is five tim es higher than in patients
with healthy periodontitis. There is reason to believe that the microorganism s that cause
periodontitis and peri-implantitis are identical. Similar pathogenic microorganisms are found in the
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periodontal pockets of the teeth and the area around the im plants, but a number of authors deny the
possibility of infection of the periimplant zone from pathological foci of infection in the periodontal
tissues.
In addition, crowns and prostheses on implants differ in shape and structure from natural
teeth in that they have undercuts that make it difficult to perform hygienic procedures. According to
som e authors, the microflora of the oral cavity after prosthetics on im plants changes and the patient
has a tendency to develop inflamm atory processes, which negatively affects the functioning of
prostheses and implants.
Conclusions:
Thus, there are a large number of problems in dental im plantology, the leading place among
which is occupied by the causes of m ucositis and perimplantitis. Risk factors for the developm ent of
peri-im plantitis are non-Smoking patient; iatrogenic causes; osteoporosis; availability of microscale
between the dental im plant and the overdenture; non-compliance with hygiene of the oral cavity; a
history of periodontitis; no keratinization gum s, providing stabilization of the gingival m argin;
systemic diseases (diabetes, thyroid disease, systemic lupus erythematosus, vasculitis, etc.); a
history of rejection of one or m ore im plants; immunodeficiency; infection of periimplant tissues
with oral microorganisms. W ith a good objective analysis of the preim plantation situation and
assessm ent of risk factors, good results can be achieved when placing a dental im plant that ensures
clinical stability and functioning of the implant for at least 10 years, without damaging the tissues
attached to it, without developing negative symptom s and sensations that satisfy the patient both in
functional and aesthetic aspects.
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