Our experience treating thousands of patients and teaching implant dentistry over the last 25 years has shown that over 90% of complications and mishaps in implant dentistry are dentist-induced and completely preventable. In nearly all cases, the root causes are poor planning, poor execution, and inadequate skills.
Here are the top three factors in the majority of dental implant complications and failures—and how to avoid them:
1. Failure in Diagnosis
In medicine and dentistry, diagnosis is key and always the first step. Without an accurate diagnosis, there can be no effective treatment plan. Before beginning implant treatments, a full and comprehensive evaluation is necessary to identify conditions and help patients understand their risk factors. This evaluation includes:
- Assessing general dental health
- Evaluating the condition of existing teeth, surrounding bone, and gum tissue
- Determining pulp vitality of existing teeth
- Assessing the quantity and quality of bone where implants are to be placed
- Assessing the quantity and quality of surrounding gum tissue
- Evaluating functional and aesthetic needs
- Performing a full assessment of the patient’s overall health
The basic diagnostic tools include clinical evaluations, periodontal assessments, gum tissue probing, full-mouth X-rays, Cone Beam CT scans (CBCT), diagnostic models, intra-oral and facial photos, digital scans, and 3D computer-assisted digital planning. Further evaluations by team specialists—such as oral surgeons, endodontists, orthodontists, and periodontists—are necessary to provide a deeper understanding of the patient’s condition. Once all the diagnostics are collected, a team meeting should be held to review the data and arrive at an accurate diagnosis.
2. Failure to Develop Adequate Bone and Gum Tissue
A solid foundation is critical for the success and longevity of dental implants, as well as for patient satisfaction. Too often, clinicians fail to develop the necessary bone and gum tissue, proceeding with what is available. This is often due to a lack of expertise in bone and soft tissue grafting, reluctance to recommend additional procedures for fear of scaring patients away, lack of 3D diagnostic tools to realize that grafting is necessary, or failure to consult with a surgeon to assist with tissue augmentation.
Using 2D imaging such as panoramic or peri-apical X-rays is inadequate for assessing bone support, often leading to miscalculations. Implants placed in areas with insufficient bone or gum tissue frequently fail due to functional or aesthetic complications or due to peri-implantitis (inflammation or infection around the implant).
3. Failure to Use Guided Implant Placement Techniques
Freehand placement of dental implants is a common cause of complications. No matter the experience of the surgeon or dentist, freehand placement is essentially guesswork and often leads to poor implant alignment. This can cause functional or aesthetic problems, damage to adjacent teeth or vital structures (such as the sinus or nerves), or result in implants placed in areas with insufficient bone support.
The current standard in implant dentistry involves 3D computer-assisted planning followed by the fabrication of a surgical guide to ensure accurate implant positioning and safety. This technology is widely available, affordable, and easy to use, leaving no justification for freehand implant placement.
In addition to these factors, the experience and skills of both the surgeon placing the implant and the dentist restoring it are critical. Team approach, more diagnostics, more planning, more collaboration, and critical decision-making—is vital to achieving successful outcomes and realizing our patients’ dreams. We only get one chance to do it right!
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Dr. H. Ryan Kazemi is a board-certified oral and maxillofacial surgeon in Bethesda, MD