Course Objectives HDA 2018 Dental Implant Complications
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HDA 2018 Dental Implant
Complications
1
Course Objectives
- Understand protocols for diagnosing and treatment planning to
minimize complications
- Recognize and manage intraoperative complications during implant
placement
- Recognize early and manage post-operative complications
- Recognize and manage esthetic and functional complications
- Understand the etiology and manage peri-implantitis
2
What are some common failures /
problems we all encounter?
Implants placed in wrong positions….
Post op complications....
Patient with fx implants….
Broken abutments and screws….
Managing the unknown implant….
Periimplantitis….
3
When Implants Fail…
How does it impact our patients and practice
Loss of time
Loss of confidence
Loss of money
Influences our tx planning in the future
4
Define Successful Implant Treatment
5
Bone Quantity and Quality
Bone Quality relates to the degree of bone density present. Type 1
is dense bone, which provides great cortical anchorage, but limited
vascularity. Type 2 bone is the best bone for osseointegration of
dental implants. It provides good cortical anchorage for primary
stability, yet has better vascularity than Type 1 bone.
Types 3 and 4 are soft bone textures with the least success in
type 4 bone.
6
Dimensions for success
The Influence of Bone Thickness on Facial Marginal Bone Response: Stage 1 Placement Through Stage 2 Uncovering
J. Robert Spray 7
8
Site Evaluation
Adequate interocclusal and
interdental dimension
-4 millimeters of minimum vertical
space is required for structural
integrity in posterior single
crowns and fixed partial Rec. Min. 5 mm
dentures. However, dimensions
greater than 3-4 mm are required
to achieve an esthetic result.
Dental Implants and Esthetics
Charles J. Goodacre, DDS, MSD; Chad J. Anderson, MS, DMD
9
10
Furthermore, maxillary anterior
regions require a subtle palatal
angulation to increase labial soft
tissue bulk.
For every millimeter of lingual inclination,
the implant should be placed an additional
millimeter apically in order to create an
optimal emergence profile.
Potashnick SR. Soft tissue modeling for the esthetic single-tooth
implant resto- ration. J Esthet Dent. 1998;10(3):121-31.
11
Bone Dimensions For Success
Safe Zone
1.5-2.0 mm
Want 1.8-2.0 mm
Danger Zones bone around
12 Implant
Restorable or not? Why?
13
Dreaded Black Triangle!
14
15
Predicting the Post Surgical Papilla
16
Gingival Biotype
17
Gingival Scaffold/Biotype
Biotype of gingiva,The
effect of gingival
biotype on peri-implant
tissue response seemed
to be limited only to
facial gingival recession
and did not influence Gingival thickness faciopalatally (Biotype)
Transgingival Probing Determina
Gingival Recession on Implant
21
26 yo Female hx Trauma
22
23
24
2 weeks PO
25
6 mos PO
26
Does Age Matter ?
27
28
29 30 31 32
33
34
Surgical Complications
35
Why not just put them in straight?
36
What do we think about this?
37
Anatomical Considerations
38
Surgical Complications
39
Lingual Perforation
401 Year Post-op
41
Poor clinical judgment – resulted in post op anesthesia
Patient was numb
post op and
regained feeling
after moving
implant.
42
43
8mm Guide Pin Position
4445
Osteotomy Translation to Distal
3 mm
46
Improved Osteotomy Position
47
Post-op 19, 20 PA
48oops!
The special Box!!
49
50
51
5253
Fractured Implant
54
55
5657
58
August 2010
59
May 2011
60November 2011
61
March 2012
62
April 2012
63
August 2014
64February 2017
65
66
67
6869
70
Fractured Implants
71
7273 74 75 76
77 78 79 80
81 82 83 84
85 86 87 88
Dental Tourism
89
Don’t Count on this….
90
91
9293 94 95 96
97
Connecting Natural Teeth To Implants
98
99
100101
Whats on your Implant?
102
103
104105
How do you manage the unknown
Implant?
Records from the previous practitioner…..
whatimplantisthat.com
osseosource.com
Preat - Get the app
106
Unknown Implant
107
108109
110
Peri-Implantitis
111
Peri-Implantitis
10% peri-implant disease
associated with dental cement
Goodacre CJ et al. Clinical Complications with Implants and Implant Prostheses.
The Journal of Prosthetic Dentistry, August 2003, Volume 90, Issue 2, pp. 121-132.
112113
Compromise
114
Implant # 9, non restorable tooth
115
116117 118 119 120
121 122 123 124
Problems with this case?
1. Position (B&D)
2.Gingival Biotype /
Available KT
3.Type of implant (-PS)
4.Constraints of patient
(Rest at least 8)
125
126
127
128129
Doctor Perceived Complications
Compromised Healing
Compromise in Function
Compromise in Esthetics
Implant Failure
Prosthesis Failure
130
131
132Immediate Provisional With Problem
Immediate Extraction Placement and Provisionalization
Extraction, Immediate placement
#11 Immediate provisional
61 y/o WF
PMH – High Cholesterol, Restless Leg,
Light Smoker
Meds – Gabapentin, Simvastatin, Advil
PSH – Back Surgery for bulged disc
All – NKDA
Custom Impression PostModel Work with Custom Abutment
11/17/15 and it keeps coming……..
Final Film of Custom Abutment and PFZ Crown…….
As Paul Harvey said, the rest of the story….Thank You!! Michael E Pruett, DMD The Dental College of Georgia Augusta University GC1355 Augusta, Georgia 30912 mpruett@augusta.edu 706-721-8541 – Office 706-723-0221 - Fax
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