Peri-implantitis – Rejection of implants – Why do dental implants fail?

Peri-implantitis is a chronic inflammatory pathology that causes the loss of implants.

It is the main problem of treatments with dental implants, as the loss of the implant could lead to partial or total failure of the entire treatment.

This complication is one of the most frequent problems that sometimes leads to difficult situations for the doctor and the patient.

In our dental clinic in Albania, Oxa Clinic, we do on average 2000-2500 implants per year.

According to studies, 10% of patients may have problems with calcification of the implants.

Why does an implant fail? What are the reasons for implant rejection?

-smoking is the main reason. 87% of smokers have rejected at least one implant. Those who smoke up to 5 cigarettes a day have an average risk. However, more than 5 cigarettes a day is considered high risk.

-idiopathic rejection, the human body simply does not accept the implants. It happens in 4% of cases.

-untreated systemic diseases, diabetes and osteoporosis.

– untreated local infections.

-lack of collaboration on the patient’s side. Incorrect use of medicines. Lack of cleanliness.

-technical errors in the processing.

-trauma, road accidents or violence.

These factors cause loss of bone around the implants which is replaced with fibrous tissue. This tissue is unable to keep the implant fixed in the bone causing treatment failure.

Rejection of dental implants is classified into two types:

1. Failure of the dental implant during the calcification period.
2. Failure of the dental implant after fixing the teeth.

The mechanism of rejection is the same but the reasons are totally different.

1. Failure of the dental implant during the calcification period, i.e. between the first and second phases of treatment.

Implants need a period of 2-6 months to be calcified, i.e. integrated into the bone.

During this period the bone cells attach to the surface of the titanium, making a biological connection between the implants and the bone.

This physiological process can be compromised by various factors:

-Smoke

– Wrong technique

– Presence of infection etc

Patients do not know that they are having implant rejection as there are no symptoms.

Rejection in this phase is understood when a control x-ray is taken or rarely when the implant falls from the mouth and the patient sees it.

What to do if the systems do not integrate? What to do if the implant does not hold?

1- Failed/fibreintegrated implants can be replaced. This in two cases.

-there are few implants left and the treatment cannot proceed

-the implant is the last, the lack of this implant leaves the entire arch without support.

2-The failed implant is located between two other implants with a distance of less than 20 mm.

In this case the remaining implants can support the crowns.

3-The remaining implants can be connected via a metal bar to compensate for the lack of the dental implant.

In this case the patient had total rejection of the upper dental implants. Bone resorption is noted around dental implants. All dental implants have been removed. The patient began a 6-month treatment with vitamin D. After the treatment we did dental implants again.

In this case the central dental implant of the lower arch is not integrated into the bone. We did the removal of the dental implant. We connected the remaining dental implants via a metal bar where we placed the arch.

2) Failure of the dental implant after fixing the teeth. After the second phase of treatment.

This type of failure can come for various reasons:

-Smoke

– Lack of hygiene

– Incorrect fixation of the teeth

In any case, this type of failure can be avoided.

As? By doing control overviews, the first year every 6 months, then every year for 5 years. 85% of patients do not have any control overview. They only do it when problems start. By taking the check overview periodically, it helps in early diagnosis of issues and resolution of these issues.

If the problem is detected late, the costs are high.

The patient had finished treatment 2 years ago. He felt pain on his left side. This was the only check up that he did in 2 years. The last implant had failed.

• The first check up in 3 years.
• The patient does not feel any discomfort.
• The last implant below on the left has lost all the bone around it.
• We removed the failed implant and inserted another one.
• The entire lower arch is redone, thus increasing the costs of the treatment
• We have seen that there are additional costs for retreatment.
• But who pays these costs? This is where the problems arise, because most clinics do not offer a detailed report of the treatment carried out, in which the details of the work, the expected duration and the responsibility in each type of problem are written.
• This report can serve as a guarantee for the patient and a document for the doctor.
• Usually the costs for failures due to smoking, lack of hygiene and lack of periodic checks are borne by the patient.
• However, failures due to incorrect technique or incorrect fixation are the responsibility of the doctor.
• All this makes us reflect on the importance of periodic checks for these treatments.