Dental implant complications are no mystery! A patient presented to us about 8 months after her dentist placed multiple upper dental implants to replace her missing back teeth- No CBCT (cone beam CT scan), No surgical guide, and No comprehensive evaluation and planning. The implants were placed in poor alignment transecting root of adjacent tooth. It was also placed in inadequate bone. Additionally the remaining teeth were carious and the bite was poorly balanced. The implants had been restored with a bridge but developing advanced bone loss and exposure of the implant surface and patient began to experience pain.
Here is what we know about implant dentistry: Complications are inevitable when there is no proper diagnostics, no thoughtful treatment planning, and lack of understanding of biology and basic dental principles. Dental implants are meant to improve patient’s oral health, function, and aesthetics and to complement health of other dentition. Why rush and throw in bunch of implants in a patient with missing teeth and put them in difficult situations shortly down the road! Patients invest their time, money, and confidence in dentists and expect something better. With our current technology, diagnostics, and team approach, dentistry can do much better and deliver the type of results that patients want.
This patient was not ready to loose the entire bridge, even though the prognosis of the implants and the bridge were quite guarded. Hence the adjacent tooth was extracted and the site and the implants were cleaned and grafted. While the success of such a treatments on dental implants with advanced peri-implantitis is highly unpredictable, patient elected to try it.
The current recommendations are first a comprehensive evaluation of the entire mouth BEFORE placement of dental implants and design a treatment plan that fits the big picture. Additionally, the surgeon must use CBCT (cone beam CT scan) and other diagnostic techniques to position the implant precisely and safely with long-term success in mind. The restorative dentist must also evaluate and treat the entire mouth- and not be a ‘tunnel dentist’. The path to successful treatments become more clear when the treating dentists follow evidence-based dentistry and partner with the patient in achieving the desired goals.
Dr. H. Ryan Kazemi is a board-certified oral and maxillofacial surgeon in Bethesda, MD