Complications during dental implantation in the upper jaw. Complications during dental implantation. Cases from medical practice

Anastasia Vorontsova

After implantation, various unpleasant consequences may occur.

But it is worth noting that complications during dental implantation occur extremely rarely, since currently the technology for implantation has been worked out quite well.

Complications after dental implantation can appear within the first days or months, or they can be late and appear after two to three years or later.

Problems Dental implants are possible for several reasons:

• Due to the characteristics of the patient’s body.
• Carrying out a superficial examination, incorrect diagnosis, insufficient identification of indications and contraindications for surgical intervention.
• Violation of implantation technology, most often associated with insufficient experience of the implantologist.
• Failure of the patient to comply with the doctor’s recommendations in the postoperative period.

Early complications

Pain

Pain is inevitable and begins after the anesthesia wears off.

• The norm is the presence of pain for two to three days after the operation.
• During this period, it is recommended to take painkillers prescribed by your doctor.
• If the duration painful sensations if it drags on, this may indicate the presence of an inflammatory process or nerve injury.

Edema

Photo: Swelling and inflammation of the gums

• This is the body's natural response to tissue damage.
• It does not appear immediately, but two to three hours after the start. surgical intervention and after five to seven days it completely disappears.
• Timely application of ice to the site helps reduce swelling. surgical intervention.
• If the swelling does not go away after seven days after implantation, then we can assume the onset of an inflammatory process in the soft tissues.

Bleeding

Light bleeding in the first days is normal. Bleeding may be associated with patients taking anti-clotting medications.

If bleeding on the first day after implantation is quite intense or does not stop ten days after implantation, this indicates vascular injury and the risk of hematoma formation.

A hematoma occurs with prolonged bleeding; the result of hematoma formation can be suppuration of the postoperative wound, as well as suture dehiscence.

Temperature increase

• Fever is a natural reaction of the body to surgery and implant placement.
• If the body temperature is 37°C and lasts no more than three days, then this is a normal situation.
• If the temperature does not drop, this may indicate the onset of an inflammatory process.

Seam divergence

This may happen due to:

• Incorrect suturing.
• Mechanical damage.
• With the development of the inflammatory process.

Numbness

It is observed within three to five hours after implantation and is the result of local anesthesia.

• If after five hours the feeling of numbness persists, then this condition may indicate nerve injury.
• This is typical only for lower jaw, due to the fact that the facial nerve passes here.
• Nerve healing occurs sufficiently long time, which takes several months.

Inflammation

An inflammatory process of the soft tissues surrounding the jaw may develop.

Negative consequences of dental implantation are also possible during the implant healing period.

Most Serious Side Effects

• Reimplantitis.
• Implant rejection.

Reimplantitis is inflammation bone tissue surrounding the implant.

Causes of reimplantitis:

• Damage to the wall of the paranasal sinus.
• Hemorrhage over the plug with further suppuration.
• Improper closure of the postoperative wound.
• Inaccurate bone bed preparation technique.
• Inflammatory process of a neighboring tooth.
• Inaccurate crown manufacturing.
• Failure of the patient to comply with personal hygiene rules.

Implant rejection is the failure of bone tissue to accept a titanium rod.

Reasons for rejection:

• Reimplantitis.
• Lack of bone tissue.
• Surgical trauma.
• Exacerbation of chronic diseases.
• Allergic reaction to titanium.
• Smoking.
• Thermal damage to bone tissue.
• Osteoporosis of the jaw bone.

Implant exposure – does not apply serious complications, but has a negative impact on aesthetics.

The most common cause of implant exposure is improper formation of tension on the gingival flap.

Video: “Complications during dental implantation”

How to avoid complications

• You need to choose your clinic carefully.
• Study reviews from real clinic patients.
• Strictly follow the doctor’s recommendations after installing implants.

Clinical case

• The patient had an implant installed on upper jaw. While screwing it in, it sank deep into the bone. The dentist assured that it was not scary and everything would heal. After the operation, the patient did not undergo painful sensations and he turned to another dentist. After an X-ray examination, it became clear that the implant protrudes significantly into the cavity maxillary sinus. The doctor's conclusion is removal of the implant. Three months later, the patient underwent bone augmentation and the implant was reinstalled. The reason for this complication is that the dentist who performed the implantation did not correctly assess the thickness of the bone tissue.
• A patient came to the clinic who had BOL plate implants installed a year ago. The complaints boiled down to the fact that all the implants were loose. The dentist made a decision: remove the implants, build up the bone, and then install new implants. The process of removing the implants caused damage to the jawbone. As a result, two operations were performed to build up bone tissue, then new titanium rods were installed. As a result, the treatment lasted quite a long time: more than nine months, the patient was exhausted and the treatment cost her much more than planned. Attempts to save money on the procedure can lead to such consequences.
• The patient received an implant, the bone thickness was sufficient for the procedure, and everything went great. Five months after implantation, during the installation of a permanent dental crown, the implant rotated, which is not normal. It became clear that the healing of the implant was not complete. The dentist had to make a choice: remove the implant and start the whole process over again or leave the implant. The doctor decided to leave the rod and installed a crown on it, warning the patient about the possibility unfavorable outcome and if something happens, consult a doctor. The patient has had no complaints for three years now, and the implant has taken root.
• The implant was installed in such a way that the rod damaged the root of the adjacent tooth. As a result, the implant had to be reinstalled and the damaged tooth removed. This is an example of medical error.

Diseases or injuries sometimes lead to tooth loss. This affects not only a decrease in functionality oral cavity, but also affects aesthetic perception and self-esteem. The quality of life itself can be determined by the quality of teeth. And you can fill the gap with bridges, crowns and pins, as well as implants. At the same time, the latter is visually indistinguishable from a real tooth, does not require grinding of neighboring teeth, and does not force the attachment of special structures, for which it is valued. However, no matter how wonderful dental implantation is, there are contraindications and possible complications are still present.

A short excursion into history

People tried to make the first dental implants back in ancient times. Archaeological finds indicate that gold coins were in Ancient Egypt, Indians were carried out from semi-precious stones, ancient Chinese from Ivory, ancient Roman made of metal. But then it was extremely difficult to do this, accompanied by high risks. The complications after implantation were even more dangerous.

The main problem was that the materials used simply could not harmonize with the human jaw, so sooner or later problems arose. But in the 60s of the 20th century, scientists discovered amazing properties titanium, which turned out to be biologically inert, and since the 80s they have already learned how to integrate this material into human bone, beginning the era of implantation. It is titanium that can grow into bone, so screw cylindrical implants were created based on it.

Not everything is so simple: contraindications and complications

On the one hand, an implant can be placed at any age in any vacant space in the jaw. Even if it was damaged, its integrity modern medicine is restored by building up bone tissue, into which a new tooth is then placed. But on the other hand, this procedure is not available to everyone. There are a number of contraindications that will not allow you to restore a beautiful smile using this method.

The level of medicine is now high, the technology is proven, and the materials are reliable. It would seem that dentistry is not dangerous, even if it is dental implantation. Are there any complications? Some people don't even think about it. In fact, this is still a surgical intervention, which has a number of risks, so the issue must be taken seriously. It is not always possible to foresee absolutely everything, but doctors do everything possible to ensure that complications do not arise.

General absolute contraindications

This service is not provided to people who have blood diseases or cancer. bone marrow, tuberculosis, immune disorders and autoimmune diseases, as well as type I diabetics. The operation is not performed on clients with certain congenital or acquired diseases of the central nervous system, including mental ones. These diseases are among the absolute contraindications. Even bruxism can become an obstacle, i.e. teeth grinding, and hypertonicity masticatory muscles, which will not allow the implant to fix normally and the wounds to heal. Intolerance to anesthesia also becomes an obstacle to surgery.

Among the medical contraindications there are also relative ones, which are temporary. Thus, if a person is in distress or is taking medications that would negatively affect healing, then intervention may be denied. The operation is not performed on patients who have recently undergone radiotherapy or chemotherapy, but over time this procedure may become available to them.

Relative and temporary contraindications

For the above indications, from a medical point of view, dental implantation is not performed. Contraindications and possible complications may also be associated not with diseases, but with physical condition. The specialist may not allow persons to participate in the procedure if they have poor condition are the nerve endings of the jaw or the bone tissue itself. This issue is individual and is revealed during a personal examination. Misdiagnosis can cause complications. So, if a patient has osteoporosis, i.e. the bone tissue is sparse, then implantation is difficult.

A relative contraindication is the presence of problems with other teeth. But it is enough to ensure that there are no carious teeth and other diseases for the issue to be reconsidered. It is also necessary to first cure periodontitis and gingivitis. Arthrosis of the temporomandibular joint can become an obstacle. Implantation is not performed for pregnant women. Also on the list of undesirable phenomena are alcoholism, smoking and drug addiction.

Contraindications are not a reason for despair

But when certain conditions However, dental implantation is still possible for those who were not initially allowed to have contraindications. Many relative and temporary causes can be eliminated, cured, waited for a certain time, etc. Sometimes it is possible to completely get rid of contraindications, and sometimes it is enough to minimize their possible influence so that successful implantation becomes possible.

In some cases, treatment or special preliminary preparation, which evens out the situation. For example, if the problem is that there is insufficient bone tissue in the right place, then a procedure can be carried out that will then allow an implant to be placed. And there are a number of procedures that counteract osteoporosis, stimulate bone growth and help it recover over time.

Possible complications

Dental implantation has contraindications and possible complications. Some of them may occur during the installation of a titanium rod and/or former with a crown, others appear in the postoperative period, and some may occur after a rather long time. The qualifications of a specialist and his experience are very important in order to competently assess the condition of the client’s tissues before surgery, as well as professionally perform the procedure itself. According to some estimates, complications occur in 5% of operations.

It is worth noting that in some cases complications arise due to the fault of the patients themselves. Medical recommendations must be followed strictly: carefully monitor hygiene, give up certain bad habits and, most importantly, adhere to the load regime that falls on the implant. You should not skip scheduled periodic examinations in order to keep the process of osseointegration under control, and if complications arise, identify and eliminate them at the initial stage.

Complications during surgery

During the procedure itself, soft tissues, alveolar canals, or even the facial artery may be damaged. Sometimes there are reviews that there has been a perforation of the maxillary sinus or nasal cavity. When working with nerves, sometimes there is damage to the nerves and penetration of bone tissue into the mandibular canal. There are also dangerous bleeding, or the bone tissue overheats during the formation of the bed for the future implant.

Sometimes in such cases the procedure simply has to be interrupted, but there is a risk that this dental implantation will become unavailable altogether. Contraindications and possible complications reviews here are characterized as the most unpleasant. Thus, overheating of the bone tissue will no longer allow the titanium rod to take root in this place. Perforation of bone tissue and penetration into the sinuses are even more dangerous. Fortunately, the risk is minimal and such cases are extremely rare.

Postoperative and long-term complications

Let’s assume that dental implantation has already taken place. What complications can there be after it? Sometimes there is divergence of the seams, pain and inflammation. Titanium rod It may simply not take root, not being completely fixed or becoming loose. Sometimes the bone tissue around it can collapse, which is called perimplantitis. Sometimes it’s the other way around - bone growths appear around the place of fixation. It is also possible for the implant to fail due to an allergy to titanium, osteoporosis or as a result of a bone burn, which does not allow continued implantation.

Choosing a specialist

Haste and economy in this matter are unacceptable. This operation is not cheap, and it is also associated with the most precious thing - health, and therefore requires the most serious approach. To find out for sure whether dental implantation is suitable, to clarify contraindications and possible complications, you should contact at least two specialists good clinics. This advice are given by experienced people regarding all doctors, but here it is also very relevant. This approach will allow you to better understand the issue, listen to the opinions of different doctors, perhaps identify some contradictions and sort them out in a timely manner.

It is also worth learning more about the clinic and the doctor, both from official sources and from real patients who had implantation performed here. Ideally, these will be familiar people whose word you can completely trust. But it won’t hurt to study the reviews of others.

Most owners of new implants, which are indistinguishable from real teeth, are very satisfied with their purchase. But there are also those who experience pain or discomfort when biting for a long time, and those who have gone through inflammation. By the way, it’s worth immediately understanding what dental implantation is, what complications there are, and what should be done in these cases.

So, with the same inflammation, “cleaning” is carried out in a clinic, treatment is prescribed, after which the problems can be forgotten forever. Under no circumstances should the process be left to chance. If anti-inflammatory therapy does not produce results, the implant may be removed.

The first time after surgery there is always numbness associated with anesthesia. But if sensitivity has not recovered after 4 or more hours, this may indicate damage to the mandibular nerve. Also, in the first hours after surgery, bleeding from the wound may occur. If after a week it has not stopped, we can say that a vessel was damaged during the operation. These complications require specialist intervention.

Medicine is a specific branch of human activity.
It is wrong to assume that any treatment must be perfect.
It is no secret that the human body has not been fully studied and many health issues are a mystery of nature.
It is no secret that recovery largely depends on the psycho-emotional status of the patient.
Therefore, as a result of erroneous and sometimes correct actions of a doctor, adverse consequences of preventive, diagnostic and therapeutic interventions or procedures can be observed.

What is the likelihood of complications with dental implantation?

No type of dental treatment is immune from errors and complications. How more difficult treatment, the more stages of this treatment, the higher the likelihood of various complications.

Implantation, of course, is a complex type of treatment, therefore there are risks. The doctor’s task is to quickly solve any problems that arise during treatment. But it’s even better to prevent complications from occurring.

The likelihood of no complications after the installation of dental implants in the long term
depends on many factors: the quality of the implantologist, proper planning treatment,
the choice of materials, the complexity of the design, the location of the implants, the absence of concomitant diseases, the patient’s behavior and the quality of his oral care, regular monitoring by the dentist.

It is also important to distinguish between complications:

• Reversible complications. After repair or treatment, the implants can continue to function.
• Irreversible complications - leading to loss of implants. Implants removed as a result of such complications contribute negative statistics to the “survival of dental implants” indicators.

The term "implant survival" is used very often when considering the issue of implantation complications. In each clinic, the survival rate of implants and the number of complications will differ. We bring to your attention, in our opinion, the most objective research.

A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years. Pjetursson BE, Thoma D, Jung R, Zwahlen M, Zembic A. 2012

The value of this publication in a professional journal is this:

• This article was published in 2012, it is actual information(takes into account experience in the most modern conditions);
• The publication analyzes data from 90 scientific articles and 32 studies on this topic.

According to Pjetursson BE, implant survival rate:

• after 5 years - 95.6%;
• after 10 years - 93.1%.

The total number of complications is much higher, 33.6% during the first five years. The most common complications over the 5-year observation period were:

• fractures of facing material - 13.5%;
• peri-implantitis and soft tissue complications - 8.5%;
• violation of the seal blocking access to the fixing screw in the case of screw fixation of crowns - 5.4%;
• violation of screw fixation - 5.3%;
• decementation of crowns - 4.7%.

However, it must be taken into account that these are average indications for successful implant prosthetics, and the results may deviate for the worse or worse. the best side depending on the complexity of the tasks being solved, the presence or absence relative contraindications, health status and patient behavior.

We systematize the problems associated with implant treatment, dividing them into several groups.

I. Surgical problems

We will talk about complications that arise during the operation or the first day after installation of the implant.

Bleeding

Bleeding during surgery is associated with damage to large blood vessels the following reasons:

1. Incorrect treatment planning. For example: not using panoramic and CT images;
2. Insufficient experience of the surgeon and violation of the basic rules of implantation;
3. Atypical (non-standard) arrangement of large blood vessels.

Implant mobility

It is known that achieving high quality osseointegration (“engraftment rate”) is possible when implantation ensures tight contact of the implant with the bone tissue along the entire interface surface. In implantology this is called primary stability. The result with low primary stability of the implant can be attributed to problems at the surgical stage.

1. Peculiarities anatomical structure bone tissue, its density
   To avoid this situation, it is necessary to carefully assess the condition of the bone tissue using computed tomography (CT). CT allows you to objectively assess the success of implantation. If there is a deficiency of bone tissue, then successful implantation cannot be expected. It is necessary to first carry out bone augmentation, and only then carry out implantation. Ignoring this rule will lead to failure.
2. Violation of implant installation protocol
   You cannot rush the processes occurring in the body. We have described in detail the protocols for installing dental implants. Some of them require more than 6 months for the entire implantation cycle. All the described dental implantation protocols were invented and shown for a reason. There are situations when you can get results only by following a multi-stage, long-term treatment algorithm. And it is impossible to get a high-quality result faster. Haste and the desire to get everything at once, to do everything during one operation, lead the doctor and the patient to vicious path"chasing the pie in the sky"
3. Negligence in the work of a surgeon
   The same work can be done carefully and efficiently, or it can be done carelessly and formally. This rule works not only in medicine and therefore should be understandable to anyone. Therefore, it is worth choosing doctors who take their work responsibly.

Proper planning of dental implantation, use of an implantation protocol according to indications (choice of implantation technique), accurate implementation of all stages of dental implant installation allows one to minimize the occurrence of this type of complication such as implant mobility.

Pain after installation of dental implants (pain syndrome)

If only the procedure for installing implants is carried out, and no other manipulations are carried out, then a complication in the form pain syndrome observed very rarely. In most cases, patients feel pain in the first hours when the anesthesia wears off. The pain is not intense and is easily relieved by taking one or two analgesic tablets.

If the pain syndrome persists for a long time, we can talk about a complication. This pain syndrome may be associated with thermal injury(during the operation, saline solution was not used to cool the cutting instruments and bone tissue) or inflammation that occurred in the area where the implant was installed. When preparing a bed for a dental implant, irrigating the instrument with saline solution is mandatory!

Another thing is when implantation is carried out simultaneously with bone augmentation. The pain syndrome may be longer lasting. But the pain intensity is also low. The patient takes painkillers for a longer period of time, and the doctor informs the patient about the possibilities of such a scenario before augmentation, when planning treatment.

Prevention of many complications, including pain, is the use of a physiodispenser.

For dental implantation, a physiodispenser must be used. This is an analogue of a drill machine, but specially designed for implantation.

A conventional drilling machine is unable to ensure the installation of implants without complications.
The physiodispenser provides precise selection:

• rotation speed of implantological mills;
• rotational moment forces;
• and supplying sterile saline solution to cool the instrument during operation.

During operation, the sterile solution is applied directly to the rotating instrument.

This avoids overheating of the instrument and bone tissue at the implant site.

If during the operation the bone overheats, this leads to denaturation of protein structures, as a result of which the “engraftment” processes become impossible. And of course, the patient has severe pain.

Paresthesia

Paresthesia is a sensitivity disorder characterized by sensations of numbness, tingling, and crawling.

This type of complication is associated with injury to one of the nerve trunks during dental implantation. The greater the damage to the nerve trunk, the longer the symptoms of paresthesia persist.

Injury can be caused by instruments preparing the installation of the implant, or it can be injured by the implant itself. If a dental implant is placed in such a way that it touches the nerve trunk, then the dental implant must be removed.

It is possible to prevent the occurrence of paresthesia through proper planning of implant treatment: the use of CT ( CT scan), right choice the size of the dental implant and its position in the jawbone.

Infection

Infectious complications occur very rarely. However, it is important to note two important things:

1. All procedures for installing dental implants must be carried out with the most serious and strict adherence to asepsis and antisepsis. Therefore, infection during surgery is impossible.
2. The oral cavity is always potentially rich in breeding ground for a wide variety of infections. Therefore, competent and diligent oral care in the first days after surgery is very important.

Exposure of the implant after its placement

Exposing the implant after its placement is negative factor for integration of a dental implant into bone tissue.

Two-stage implantation involves the implant being isolated from the oral cavity for 3 months for the lower jaw and 6 months for the upper jaw. If the gums do not cover the implant, then the conditions of the two-stage protocol are not met. Therefore, if after the first stage of dental implantation the situation looks like in this picture, then everything is not going perfectly.

There may be several reasons:

• improper formation of the gingival flap, excessive tension of the flap;
• pressure from the temporary prosthesis;
• careless attitude of the patient towards the postoperative wound: poor hygienic care, injury to the gums by rough food in the first day after surgery.

II. Problems arising during prosthetics

Complications caused by improper installation of the abutment

The abutment must be inserted into the dental implant body in the correct position, and then secured in this position with a retaining screw. This means that the abutment must be completely immersed in the corresponding bed, without pathological gaps.

If the abutment is installed incorrectly, a pathological gap will form between the body of the dental implant and the abutment. Problems after such an error will appear in the first weeks - inflammation of the gums around the dental implant will be observed. In more late dates There will definitely be a fracture of either a screw or a dental implant.

The structure can function successfully only if correct ratio all elements of the overall design.

Complications associated with installing a dental implant in the wrong position

There are several rules that regulate in what position implants should be installed. These rules are not always clear to patients. However, patients want to be sure that implants will last a long time and their teeth will be beautiful. This largely depends on how many implants are used as support and in what position they are installed.

Let's look at a simple and understandable example for patients.

	Correct position of dental implants. It is possible to obtain an aesthetic result. As can be seen in this schematic image: implants occupy positions in the center of the crown parts of the teeth, for which they are a support. The distances between dental implants are proportional.
	It is NOT possible to obtain an aesthetic result. One implant is positioned so that it occupies a position in the area between two teeth. The distances between implants are not proportional.

These schematic images primitively demonstrate this problem. Here the error is taken to the point of absurdity.

IN practical work The implantologist is faced with other situations - when the bone is thin and has a small height. After tooth loss, processes of bone atrophy (decrease in volume and density) are observed to a greater or lesser extent. To avoid such complications, proper and careful treatment planning is required. Bone augmentation is required.

The blame for aesthetically poor results often lies with the patient. Patients insist on dental implantation without additional preparatory bone augmentation operations. Patients are driven by fear and economic motives. If the patient says that he is not interested in aesthetics, just to chew well, then the patient consciously accepts such a complication as an “unaesthetic result.”

There are implantation techniques that deliberately address this type of complication. A striking example- basal implantation. If you are planning to undergo basal implantation, then you should not expect a good cosmetic result. (see What is basal implantation)

III. Problems associated with implants in the long term

Peri-implantitis

Peri-implantitis is an inflammatory phenomenon in the tissues surrounding the implant.

The most common causes of peri-implantitis are:

1. Poor hygiene and poor oral care of the patient. Unfortunately, in such cases, the doctor cannot help the patient and the failure of implantation lies entirely with the patient.
2. Systemic factors that are contraindications for dental implantation, such as: hormonal diseases, diseases of the blood, immune system, connective tissue. This form of peri-implantitis indicates poor treatment planning and disregard for contraindications to dental implantation.
3. Poor quality removal of cement residues used for fixing crowns. Residues of cement located on the surface of the abutment under the gum cause mechanical injury, as well as a prerequisite for persistent infection around the dental implant.
4. Overloading of dental implants with high chewing loads. This type of peri-implantitis indicates improper planning of prosthetics. Calculation of the endurance of implants to loads should be based on the principle: instead of each extracted tooth, one dental implant should be installed.

As can be seen from the list of causes of peri-implantitis, most arise due to infectious aggression. Similar microbes are present everywhere: streptococci, staphylococci, spirochetes, etc. This infection is pathogenic, but not a dangerous infection.

The problem is not what kind of infection... The problem is that the pathogenic part of the infection prevails over the saprophytic flora (beneficial microorganisms).

The second part of the problem is the property of the immune response. In some cases, the response of the immune system becomes destructive to the tissues surrounding the tooth or implant. It is in these situations that peri-implantitis becomes very aggressive.

Dentists find great similarities between diseases such as periodontitis and peri-implantitis. This is reflected in the names of the diseases. The names are based on Latin terms:
Periodontitis is inflammation of the complex of tissues surrounding the tooth;
Peri-implantitis is inflammation of the complex of tissues surrounding the implant.

Peri-implantitis occurs in several stages:

1. Inflammation of the mucous membrane (gum) around the dental implant - the initial phase, reversible;
2. Loss of connection between bone and implant, bone loss is a severe stage, often irreversible, leading to loss of the implant.

Fractures of dental implant structural elements

Fixing screw fracture

The fixing screw provides the connection between the implant and the abutment and is one of the key elements for the successful functioning of the entire structure for many years. The tightening force of the fixing screw is regulated by the implant manufacturer. The doctor controls the twisting force with a special torque wrench.

Reasons for failure of fixing screws:

1. Tightening the screw with a force exceeding the established norms;
2. Tightening the screw with insufficient force, leading to micromobility of the abutment in the implant mounting hole;
3. Fixation of the abutment in the wrong position with distortion and gaps;
4. Overload of the abutment-implant connection. Chewing loads not along the implant axis, use of prostheses in the form of a cantilever;
5. Fracture due to fatigue loads.

Fracture of the implant body

A fracture of the implant body indicates that the loads exceeded the maximum permissible norms. This is possible in two cases:

1. Extreme loads resulting from acute trauma: blow, fall, car accident, etc.
2. Incorrect planning of implantological treatment: incorrectly selected implant sizes, incorrect number of supports used, low-quality implantological products.

Failures of dental implant elements require replacement of faulty elements. This task is difficult, but it is possible to solve it successfully. About this in our article “Dental implant failures”

Conclusions:

Unfortunately, complications during implant treatment are possible. We have described the main ones. Complications can lead to dysfunction of the body and limitation of usual activities.

Thank God, complications are rare. Most of them are successfully resolved.

But patients should be aware of potential complications.

This is necessary for patients to make an informed choice - to restore teeth using implants.

This is necessary for each patient to take a more responsible approach to choosing a dental clinic and implantologist.

Complications of dental implantation are rare. Problems with dental implantation are possible due to a number of reasons:

• characteristics of the patient's body
• incorrect diagnosis, identification of indications and contraindications for surgery, superficial examination
• non-compliance with the technology of the operation, usually due to insufficient experience of the implantologist
• failure by the patient to follow the doctor’s recommendations in the postoperative period.

Complications after dental implantation are divided into early (occur within a month after surgery) and late (occur a month later).

TO early complications include the following:

• pain. Its cause, as a rule, is swelling after dental implantation, resulting from inflammation.
• bleeding associated with wound healing characteristics and the state of the patient’s coagulation system
• suture separation due to incorrect application technique or due to developed inflammation
• hematoma, the outcome of which may be suppuration of the postoperative wound and suture dehiscence
• inflammatory processes in soft tissues, surrounding the jaw, an inflammatory infiltrate occurs, which many mistakenly refer to as a “tumor” after dental implantation.

Negative consequences of dental implantation are also possible some time after the installation of the implant. These are late complications that arise during the period of reparative regeneration of bone tissue around the implant.

Similar dental implant problems include:

• Peri-implantitis (inflammation of the bone tissue surrounding the implant). Represents the most common complication
• Rejection of implants (this is extremely rare, since modern materials used are biocompatible with bone tissue).

Side effects of dental implantation are also possible long after the implant installation surgery. These are the consequences of dental implantation during the period of operation of the implants. These include inflammation of the gum tissue surrounding the implant, peri-implantitis, mechanical damage to the implants, and mobility of the implants.

What to do in case of unsuccessful dental implantation?

In case of inflammation, treatment consists of eliminating the cause that caused it, removing plaque, improving oral hygiene, drug treatment, including antibiotic therapy. In case of peri-implantitis or mobility of the implant, it may have to be removed and anti-inflammatory therapy administered. If a fracture of the implant components occurs, they are replaced. In any case, you must immediately contact a specialist.

As practice shows, a successfully performed implantation operation almost never causes complications. Statistics indicate 1-3% of cases. Implantologists have been working for several years now, and they have managed to achieve an almost 100% case rate without complications or side effects.

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Articles on the topic

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Dental implantation - a panacea or...?

Dental implantation is a kind of breakthrough in modern dentistry. The technique of implanting an artificial root is complex and simple at the same time. But if you choose it to restore lost teeth, you will certainly not be disappointed.

Temporary abutment

A temporary abutment connects the implant and the prosthesis and is used in dentistry as a connecting element for prosthetics. Can be made from different materials (depending on the expected service life and goals).

Stages of dental implantation

Dental implantation, depending on the technique used, is carried out in several stages. By following established rules and standards, the dentist will be able to minimize possible risks and achieve excellent implant healing results.

What is dental implantation

When a tooth is lost or removed, the load on the bone stops. This leads to the destruction of the jawbone due to lack of nutrients and bone resorption. In this case, the best solution is dental implantation.

What is basal dental implantation

With the help of basal implantation, it is possible to achieve solutions to such problems as the rapid restoration of the chewing function of the jaws, without discomfort and danger to the patient’s health, and the aesthetics of the smile.

Nobel Biocare implants

Implants from the Swiss company Nobel Biocare are rightfully considered the leaders among all implants. Successful private dental clinics prefer this company because for many years it has been producing products of the highest quality that meet all international requirements.

Nobel Biocare is the only company that gives a LIFETIME guarantee on its implants

Implantation is extremely common dental service. This procedure allows you to replace missing teeth with artificial rods, completely restoring the aesthetics of your smile.

Nobel Active implants expand prosthetic options for patients with low bone density

Nobel Active implants are designed for use by patients with low bone density. Thanks to the double aggressive thread and the unique shape of the apical part, the artificial root fits very tightly into the bone and is securely fixed in it. This eliminates the need for unnecessary surgical interventions and significantly speeds up the implantation stage.

The Nobel Active line is one of the most successful developments in the history of dental implantology!

The Swiss company Nobel Biocare produces the most reliable implants in the world. Their Nobel Active line rightfully occupies a leading position among the most elite and high-quality products for implantology. Nobel Active implants have unique shape thread, thanks to which artificial roots quickly and easily enter the bone tissue, without requiring additional threading inside the bone.

Manufacturing of individual abutments

The better the quality of dental structures, the longer their service life. Therefore, the demand for individual abutments is growing: they are manufactured in special dental laboratories using modern equipment. But the end result is abutments that are ideally compatible in shape with the patient’s tissues.

Simultaneous dental implantation using the Immediate Loading method

Until recently, the process of prosthetics took long months. But with the introduction of the technique simultaneous implantation teeth, it has become possible to solve all aesthetic problems and restore the beauty of your smile in one visit to the dentist.

Dental implantation using laser

New technology The introduction of artificial teeth will allow you to bypass the procedure of bone augmentation and avoid intermediate operations. New tooth with a crown can be installed in just one day.

How to choose the right implants?

Modern implantology does not stand still, but is actively developing, opening up wide opportunities for implanting implants in place of lost or extracted teeth. But how to choose the right implant so that it is as biocompatible as possible with the tissues of the human oral cavity and can last for many years?

A unique method of dental implantation

Today, dental implantation services are becoming increasingly in demand. Beautiful smile today is not only a gift of nature, but also an achievement of dentistry. Implantation is a method of replacing missing teeth with artificial analogues. This method will help restore attractiveness after tooth loss.

Postoperative period of dental implantation

Like any surgical intervention, dental implantation has rehabilitation period. At this time, the oral cavity is vulnerable to infection and reacts sensitively to external irritants. Of course, if the operation is successful, no complications should arise. However, each patient has his own characteristics of the body and everyone tolerates implantation differently.

Dental implants: convenience and comfort

Modern dental implantation is rightfully considered the most acceptable method of eliminating dental defects. Biocompatible artificial roots take root well and provide reliable support for existing teeth and dentures.

Bone tissue implantation

Bone implantation is necessary due to its natural decline after tooth extraction or loss. The process of bone loss is called resorption. Bone grafting during implantation is necessary to create high-quality support for the artificial rod on which prostheses will be subsequently installed.

Various complications can accompany any surgical procedure. Dental implantation is no exception. Here, a lot depends on the qualifications and experience of the doctor, the complexity of the manipulations performed and a number of other factors. The occurrence (or non-occurrence) of complications can be influenced by the patient himself, by following or ignoring the doctor’s recommendations.

Complications during implantation

• Fracture of the pilot drill or bur.
• Damage to the bottom of the maxillary sinus or penetration of the drill into the nasal cavity.
• Violation of the integrity of the wall of the mandibular canal and damage to the inferior ventricular nerve.
• Damage by bur to the lower and lateral compact layers of the lower jaw.
• Partial or complete absence primary fixation of the implant.
• Violation of the integrity of the wall of the alveolar process.

Damage to instruments may be various reasons: excessive pressure on the fissure bur at the time of longitudinal drilling of the implant bed, violation temperature conditions sterilization of equipment or the development of the implant’s resource in 30 sterilization cycles.

Damage to the floor of the maxillary sinus may be the result of an erroneous determination of the height of the alveolar process or excessive pressure on the instrument. If such a situation arises, you should refrain from installing the implant in this place and, if possible, install it in close proximity to the already formed bed. Another possible variant- installation of an implant, the length of the intraosseous part of which is two millimeters less than the depth of the finished bed. In this case, the bed must first be filled with bone chips or hydroxyapatite removed from the instrument. The recommended method of implantation in this case is a two-stage one, and it is better to choose a screw or combined intraosseous element.

Damage to the inferior ventricular nerve and injuries to the wall of the mandibular canal can be caused by negligence in preparing the bone bed or incorrect determination of the size of the implant due to possible distortion on the orthopantomogram of the vertical size of the lower jaw. If the preparation of the canal wall results in the occurrence of an intracanal hematoma and subsequent compression of the nerve, then restoration of sensitivity in the area of ​​innervation can be expected in two to three weeks. In cases of osteoporosis, the wall of the mandibular canal may be defective or absent altogether; in this case, the effect on the lower ventricular nerve can be explained by hemorrhage in the area of ​​the medullary spaces, as well as swelling of the reticular tissue of the bone marrow. Partial loss of sensation (or parasthesia) in the area lower lip may be felt the day after surgery and disappear completely after five to seven days. If the decrease in sensitivity of the lower lip, caused by a violation of the integrity of the wall of the mandibular canal and the inferior alveolar nerve, persists for one to two weeks, then the implant must be removed and the necessary symptomatic treatment performed.

Violation of the integrity of the lower or lateral compact layer of the lower jaw, by and large, is not a complication, but if during control radiographs it turns out that part of the implant extends beyond the jawbone by more than two millimeters, it is necessary to replace the installed implant with another one, whose height of the intraosseous part is less.

A fracture of the alveolar process wall very often occurs as a result of the installation of a plate implant if the bone bed under it was formed of a smaller size than necessary. Another one possible reason This complication is the narrowness of the alveolar process. In this case, you need to press the broken part to the appendage and stitch the wound.

If the implant in the bone bed is mobile and there is no fixation, the reason for this may be either improper preparation of the bone bed or osteoporosis. If the preparation of the bone bed was performed incorrectly, the installed implant can be replaced with a similar one, but of a slightly larger diameter (if this is allowed by the existing anatomical conditions), or the installed implant can be kept in the existing bed, filling the gaps in its upper part with bone chips. If the cause of implant mobility is osteoporosis, it can be fixed by filling the bed with osteoconductive or osteoinductive material. There is another option: replacing the existing implant with an implant of a different design, for example, a cylindrical one with a screw one, without cutting threads in the bed, which was prepared for installing a cylindrical implant.

Complications in the postoperative period

• Hemorrhages and hematomas.
• Seam divergence.
• The occurrence of inflammatory processes in the soft tissues surrounding the jaw.
• Pain.

Such complications are not very common and are caused either by complications arising during the operation or by the patient ignoring the doctor’s recommendations.

Complications during the period of reparative bone tissue regeneration

The cause of peri-implantitis is inflammation of the soft tissue in the surgical site, which leads to the destruction of the bone tissue surrounding the implant. This condition can be caused by the presence of a hematoma over the plug of the intraosseous element and its subsequent suppuration, as well as incorrect preparation of the bone bed, closure of the postoperative wound and the condition of the oral cavity, which leaves much to be desired.

Treatment of peri-implantitis is carried out as follows:

• Plaque is removed from the part of the implant protruding into the oral cavity.
• The implant cuff is detoxified using a citric acid solution for 1 minute.
• The gingival cuff is treated with antibacterial gel.
• Drug therapy is carried out.
• Hygienic care of the oral cavity is recommended (rinsing with antiseptic solutions).

If the measures taken did not produce results, and the inflammatory process could not be stopped, or after some time a relapse of peri-implantitis was discovered, then the implant must be removed.

Implant failure is essentially an inflammatory process that begins in the bone surrounding the implant and spreads to adjacent areas. Rejection may cause thermal damage bone tissue during the preparation process (which leads to the formation of granulation tissue between the implant and the bone), as well as osteoporosis of a separate area of ​​bone tissue and insufficient blood supply (which leads to necrosis of the bone around the implant). There is only one way to get rid of this problem - removing the implant.

Complications during the second stage of the operation

• Removing the intraosseous element of the implant along with the plug.
• Penetration of the implant into the maxillary sinus.
• Formation of a section of bone tissue over the intraosseous element.

The intraosseous element may become unscrewed if the process of reparative bone regeneration is disrupted and implant integration is lacking. In this case, the implant can simply be returned to its original place, the patient can be prescribed calcium supplements, and after a month and a half, the second stage of the operation can be repeated.

Cases of pushing the intraosseous part of the implant into the cavity of the maxillary sinus, as a rule, are the result of subantral implantation and a slowdown or disruption of the course of reparative bone regeneration. In this situation, surgery is required to remove the implant from the sinus cavity.

If bone tissue has formed over the intraosseous implant, this phenomenon is not considered a complication. You just need to make an incision in the periosteum and mucous membrane and remove it with a saw. bone formation and during the installation of the former and the gingival cuff of the implant, make sure that nothing else prevents their correct screwing.

Complications during prosthetics

• An increase in the temperature of the implant at the time of preparation of its head.
• Incorrect placement of the implant head.
• Incorrect installation of dentures.

To prevent the implant from heating up during the preparation of the heads, it is necessary to constantly irrigate the preparation area and the bur itself.

If the head of the implant is not connected tightly enough to the intraosseous element, this inevitably leads to overload of the remaining supports of the prosthesis and becomes a site of accumulation of tissue fluid and microbial plaque, which is fraught with the occurrence of peri-implantitis.

Errors in the installation of conditionally removable dentures are, in fact, uneven tightening of the screws that secure the denture, and, as a result, overloading of some implants and loose fit of the denture to the heads of other implants, on which microbial plaque accumulates. This is dangerous due to the occurrence of peri-imlantitis.

Errors in installing a combined prosthesis may include untimely tightening of the screws when the cement has already hardened. The screws must be screwed in before the cement sets, because the hardened cement may crack.

Complications during the functioning of implants

• Hyperplasia and mucositis of the mucous membrane of the gingival cuff of implants.
• Inflammation of the bone tissue around the implant (peri-implantitis).
• Sinusitis of the maxillary sinuses.
• Mechanical damage prostheses and implant components.

Inflammatory processes in the tissues of the gingival cuff with their subsequent hyperplasia are usually observed in cases of inadequate oral hygiene, as well as incorrect installation of implant components. Mucositis is diagnosed based on bleeding, cyanosis, and thinning of the mucous membrane around the implant. Necessary treatment: plaque removal, proper oral care, removable denture correction, vestibuloplasty. If hyperplasia occurs, in addition to the above symptoms, more pronounced hyperemia, edema and the formation of granulation tissue may be observed. Necessary treatment (in addition to the above): curettage of the gingival cuff and correction of the tissues that form it using surgical methods.

Reimplantitis can be caused by a number of reasons, including weakening protective function gingival cuff around the implant due to improper oral hygiene, the presence of cement residues in the gingival cuff, permanent trauma to the gingival cuff. Any of these factors can cause an inflammatory process that spreads deeper along the bone/implant interface, which prevents osseointegration. Treatment consists of eliminating the causes of the development of the inflammatory process, as well as detecting a bone defect at the implant site and eliminating it.

Sinusitis can be caused by re-implantitis in the area of ​​the implant, which is installed in close proximity to maxillary sinus. If rhinogenic sinusitis appears in this place, the implant and the tissues surrounding it can become a secondary focus of the inflammatory process in the maxillary sinus. If there are signs of implant mobility or peri-implantitis, the implant must be removed and anti-inflammatory treatment performed. Repeating the plastic surgery is possible no earlier than six months later. If the implant is immobile and there are no signs of peri-implantitis, but there are signs of rhinogenic sinusitis, then treatment should be aimed at eliminating the cause of sinusitis, in addition, anti-inflammatory drug therapy is necessary.

Mechanical stress and cyclic loads, which inevitably arise in the components of the implant and prosthesis during chewing, can cause plastic deformation and cause fracture of the prosthesis, the implant itself or its components. If the orthopedic components of the implant are fractured, they are replaced, and if the implant itself is broken, the remaining part must be removed from the bone. Fractures of dentures are a consequence of fatigue deformations of the metal base. In cases of fractures of dentures, new dentures are made, and if the integrity of the plastic part of metal-acrylic dentures with a gum mask is damaged, the denture is repaired or a new plastic part is made.