Understanding the advantages, patient risk factors, and complications of dental implants
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Abstract
When a patient comes to a dental office and needs a tooth replaced, there are a variety of approaches that can be used to remedy the problem. These solutions include using a bridge, dentures, or dental implants each coming with advantages and disadvantages. This thesis will focus specifically on dental implants, the newest of these techniques and highlight the history, advantages, patient risk factors, and complications that both patients and doctors should be aware before an implant procedure is performed.
The concept of dental implants is not novel, and in fact it dates to ancient civilization. Items such as bamboo pegs, stones, seashells, animal bones, and other people’s teeth have all been used to fill the gap left by a missing tooth. As technology and our understanding of dentistry and medicine has advanced significantly over time, dental implants have become more popular today than at any other point in history. This is because implants have a very high success rate and have long term predictable outcomes for most patients.
The main advantage implants have over other forms of tooth restoration is that osseointegration occurs when properly placed. This is where the bone grows on the implant securing it in place. Osseointegration enables bone to continue to remodel and prevents bone loss. This is not often seen in other forms of restoration. For osseointegration to occur, bone quality plays an integral role in the success.
If the bone is not very dense, there is a higher rate of osseointegration not occurring, and fibrous tissue forming around the implant. This is a risk factor that is most often present in the posterior maxilla where the bone is less dense. Another risk factor for implant failure is smoking. Smoking slows healing and can lead to a higher rate of infection. Additionally, patient health complications can lead to implant failure. Patients who are on SSRIs or have a penicillin allergy have a higher rate of implant failure than those who are not on medication.
Patients who are either obese, have well controlled diabetes, osteoporosis, or take bisphosphonates intraorally have a greater risk of complications such as peri-implantitis after an implant procedure. These conditions may or may not lead to a greater rate of implant failure, however, having them does not help with implant success. Since placing implants is an elective procedure, doctors should evaluate their patients to help mitigate any complications that may arise.
Additionally, during surgery there can be surgical complications. These do not happen often but can occur. Post-surgery, if there is premature loading where the prothesis is placed on the implant before osseointegration fully occurs, or if there is inadequate prosthetic construction, both can lead to the implant moving and implant failure.
The advantages implants provide such as longevity, comfort and aesthetic appeal make them an attractive option, so they are becoming more and more popular. Along with the advantages and risk factors of implants, this thesis will address the relevant factors that dentists must take into consideration prior to recommending implant surgery. This study should help to provide an overview of the current state of the field as well as where it will be heading in the future. In addition, it will provide considerations for clinicians to assist in making evidence-based decisions when guiding patients who are deciding between implants and other restoration approaches.