By : Dr.Rajat Sachdeva
With the increasing acceptance of Dental Implants
as a viable tooth replacement therapy, complications & failure rates have
also increased proportionately.
A
range of possible post-operative complications & their prevention are
described below:
1. Infection: Implants are made of titanium,
which is strong & biocompatible, which means that is not rejected by the
body. So the chances of developing post-operative infection are extremely rare.
At times when dentist do not follow effective & strict protocol of
sterilization, patient might be vulnerable to post operative infection.
Post-operative
infection causes pain & discomfort to the patient, reason being- bacterial
contamination of implant or surgical site during the procedure.
If the infection is limited to the soft
tissue, a small gum boil will be noticed over the implant site. It can be
punctured using a sharp probe & irrigated with chlorhexidine solution or
citric acid. It heals & the pain subsides within 24hrs. In
case of continuous pus discharge & severe pain which is not relieved by
analgesics, this depicts that the infection has reached to the bone-implant
body interface.
Prevention: one should follow strict protocol
of sterilization in the operatory in order to avoid any bacterial
contamination. Also, in such cases, the implant should be removed immediately
& prescribe good antibiotic like tab Augmentin 1000mg twice a day for 5-7
days. A new implant can be inserted when the site gets healed in 6 weeks.
2. Post-operative
Edema: Post-operative
edema develops in cases of traumatic implant placement. High speed drilling
& no constant stream of chilled saline causes bone to overheat & this
leads to accumulation of fluids in tissue spaces i.e. edema.
Prevention: Unnecessary trauma to the bone
must be avoided during osteotomy preparation. Drilling speed must be set
according to the density of bone along with a pumping motion of the drill
should be employed during drilling to allow the saline to cool down the bone.
This prevents overheating & necrosis of the bone.
Patient must be advised
to apply an ice pack over the facial
skin of the surgical site intermittently for 45 min to cool down the
bone in order to suppress heat generation & inflammatory oedema.
3.
Pressure necrosis: results
in cases where implant has been inserted & screwed at a very high torque,
it may lead to pressure necrosis of the surrounding bone & the patient will
complain of continuous pain not relieved by analgesics, for weeks after the
surgery.
Prevention: Drilling at higher
speed with maximum amount of chilled saline irrigation flow to cool down the
bone. Use of final drill with the diameter only 0.2mm less than the implant
diameter along with the use of bone tap to prepare threads in the bone to
accommodate implant threads. Following these instructions help in reduction of
post-operative pressure necrosis.
4. Suture
line opening: leads
to exposure of implant threads in the oral environment & may cause the
collection of plaque over the exposed rough surface of the implant, which may
further cause peri-implantitis & loss of hard & soft tissue around the
implant.
Causes of implant thread exposure-
·
Suture line opening
& loss of graft in cases where simultaneous bone grafting has been
performed with implant placement also leads to implant exposure.
·
More superficial
implant placement.
·
Thin mobile soft tissue
recedes with muscle pull.
Management:
·
Tension free sutures
should be used to avoid the suture line opening because of the tension in the
flap.
·
The open suture line
should not be re-sutured but the patient should be instructed to keep it clean,
as it heals by secondary intention in 2-3 weeks.
·
If soft tissue healing
has not covered the exposed threads, either cover the threads using soft tissue
grafting with or without simultaneous bone grafting, or adequate grinding &
polishing should be done to make the surface smooth & prevent accumulation
of plaque.
5. Bone
resorption: one of the most common complication
in dental implantology. When occlusal forces are not distributed equally i.e.
is off-axis to the implant prosthesis leads to resorption. Also, when implant
with a wider platform is placed into the narrow crestal bone causes crestal
bone resorption.
Prevention: Implant must be placed
along the axis of the future prosthesis. For large mesio-distal diameter two
implants should be placed with narrow occlusal table of prosthesis. Along with
the maintenance of oral hygiene, soft tissue grafting for compromised soft
tissue around the implant must be addressed.
6.
Peri-implantitis: is
an inflammatory reaction with the loss of supporting bone in the tissues
surrounding a functioning implant. Peri-implantitis is characterized by
bleeding/suppuration on probing, together with loss of supporting bone.
The peri-implantitis
lesion exhibits histopathological features that similar, but not identical, to
those in periodontitis. Similar to periodontitis, the treatment of
peri-implantitis must be based on infection control. Under these conditions,
progression of the disease may be arrested & subsequent, lost peri-implant
tissues may be generated by bone augmentation & soft tissue grafting
procedures.
With this increasing
trend of replacing the lost tooth with an implant, at Dr.
Sachdeva’s Dental Institute, we incorporate several associated
procedures like bone augmentation to provide this therapy to the maximum number
of patients. We follow strict protocol for sterilization & restore implants
to minimize postoperative or post loading complications.
For
More Information Visit Our Website: www.sachdevadentalcare.com
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