3D illustration of peri-implantitis with visible bone recession.

In the realm of oral rehabilitation, dental implants have emerged as an enticing option for addressing incomplete smiles. While widely acclaimed for their role in restoration, it’s crucial to understand dental implant risks. Despite the procedure’s high success rate, candidates must be aware of its possible complications. In this article, we will delve deeper into these risks and how you can manage them.

The Basics of Dental Implants

Tooth implants consist of titanium posts that are inserted into the jawbone via surgery, serving as a foundation for artificial crowns. These posts integrate with the bone through a process known as osseointegration, providing stable support for the crowns attached to them.

The procedure involves several key steps:

Pre-Operative AssessmentInitiation of planning via evaluations such as X-rays or CT scans
Surgical Phase– Extraction of the missing cogs, if needed- Introduction of the fixture into the bone- Waiting period for healing (osseointegration)
Prosthetic PhaseCoupling the crown with the fully healed fixture

General Success Rates

The success rates of dental implants are impressively high, with literature reviews indicating rates exceeding 95%. One review published in the International Journal of Oral and Maxillofacial Surgery suggests the survival rate to be 95.7% over two decades. [1] However, the longevity of implants can vary based on several factors, including the location of the implant in the jaw, the patient’s overall health, and adherence to post-operative care instructions.

Common Complications and Risks

As also highlighted above, despite a high success rate, it’s essential to be aware of the dangers of dental implants as part of making a well-informed decision and preparing accordingly.

1. Surgical Risks

Certain risks are associated with the operative phase, as the areas adjacent to the operation site are susceptible to harm during the process. One of the more severe possible outcomes includes the risk of affecting neural paths, resulting in numbness or a tingling sensation. Additionally, especially for procedures in the upper jaw, the sinus cavities can be affected, leading to an array of sinus-related complications. [2]

2. Improper Implant Placement

The accuracy of placement is paramount to ensure success, functionality, and aesthetics. Improper placement can lead to a range of complications that may require corrective actions. 

ComplicationDescriptionPotential Consequences
Proximity to Adjacent RootsPlaced too close to neighboring teeth rootsDamage to adjacent teeth, leading to sensitivity or loss
Incorrect AngulationNot aligned properly within the boneCompromised aesthetics, difficulty in placing the crown, and impaired function
Insufficient Bone OverlapLack of adequate boneIncreased risk of exposure and failure
Proximity to Nerve CanalsPlacement near critical nerve structures in the jawChronic pain, numbness, or tingling in the affected area
Sinus PenetrationUpper jaw implants encroaching into sinus cavitiesSinusitis, discomfort, and potential dental failure

Although incorrect placement poses significant challenges, it can often be corrected or managed with appropriate interventions. 

Let’s take a look at some of these: 

  • Revision surgery: Removal and repositioning of the implant, often requiring grafting to enhance the site for re-implantation.
  • Orthodontic treatment: In cases of minor misalignment, orthodontic solutions may adjust the position of adjacent teeth.
  • Nerve repositioning: Rarely considered due to the risk of permanent nerve damage; applicable in specific cases of lower jaw implants.
  • Sinus lift procedure: For implants in the upper jaw that have penetrated the sinus cavity, a sinus lift can create more space. 
  • Monitoring and management: Some cases of minor displacement may not require immediate correction but close monitoring for any signs of complications. [3]

3. Post-Surgical Complications

Following surgery, patients may encounter several possible post-operative challenges, such as:

IssueImpactPrevention and Treatment
Infection at the Implant SiteCan lead to failure and loss of surrounding boneStrict oral hygiene and possible antibiotic prophylaxis
Rejection or FailureBody’s refusal to integrate the implant or mechanical failureChoosing suitable candidates and materials, monitoring for early signs
Osseointegration FailureImplant does not adequately fuse with the boneEnsuring adequate bone quality and quantity, avoiding premature loading

Specific Complications to Watch Out For

Exploring the potential hazards related to prosthodontics provides necessary insight for you and your healthcare professionals. This understanding of the risks of dental implants enables you to advocate for your oral wellness effectively.

1. Loose Implants

Loose anchors represent a significant concern, undermining the efficacy and longevity of the procedure. [4] They can impact oral health negatively in the following ways:

  • Bone integrity: A loose implant may lead to the erosion of the surrounding bone, a crucial structure that supports the anchor.
  • Tissue inflammation: The movement of an unstable anchor can irritate surrounding tissues, leading to discomfort and inflammation.
  • Infection risk: Openings created by the movement can act as a gateway for bacteria.
  • Further surgical interventions: In many cases, rectifying a loose anchor requires additional procedures, affecting the overall timeline and cost of rehabilitation.

This complication can manifest due to various factors, such as: 

CauseDescriptionPrevention Strategy
Inadequate OsseointegrationFailure of the bone to fully bond with the anchor surfaceEnsure adequate healing time and avoid premature loading
Excessive ForceForces from biting or grinding can cause disruptionUse of night guards for bruxism and avoiding hard foods during the healing period
Infection (Peri-Implantitis)Bacterial infections leading to bone loss around the placement siteRigorous oral hygiene and regular dental check-ups to catch early signs
Bone Quality IssuesInsufficient bone density or volume to support the implant securelyPre-operative assessment with imaging and possible bone grafting if needed

2. Infections

Following the placement of oral anchors, infections can pose significant risks to one’s well-being. Some of the factors contributing to this include:

  • Contamination during surgery: Introduction of bacteria into the surgical site. Also, poor hygiene can lead to microbial build-up around the surgical site.
  • Pre-existing oral conditions: Conditions like periodontitis can increase risks.
  • Compromised immune system: Individuals who are immunocompromised will be more susceptible. [5]

Recognizing the early signs can lead to prompt treatment. Some of the main symptoms include:

  • Localized swelling: Edema around the site of the surgery.
  • Redness and warmth: Signs of inflammation.
  • Discomfort or pain: Especially when not alleviated by over-the-counter medicine.
  • Fever: Elevated body temperature may indicate a systemic response.
  • Pus discharge: An evident sign of infection that necessitates immediate medical attention.

Treatment strategies are contingent on the severity and nature of the infection. 

TreatmentDescription
AntibioticsOral or, in severe cases, intravenous antibiotics to combat infection
Antiseptic RinsesUse of medicated rinses to reduce bacterial load in the cavity
DebridementSurgical cleaning of the site to remove infected tissue
Implant RemovalIn cases where the problem cannot be controlled, removal of the implant may be necessary

3. Gum Recession and Bone Loss

Bone loss and gum recession are significant concerns that can affect both the stability of the implant and the overall aesthetics of the smile. A 2021 review published in Materials Today: Proceedings suggests that nearly 5-10% of patients display bone resorption. [6] 

To this end, early detection through regular examinations combined with prompt, targeted interventions can mitigate the progression of such tooth implant side effects. 

Treatment strategies may encompass:

Treatment StrategyApplication
Regenerative ProceduresTechniques aimed at stimulating the regrowth of bone tissue
Soft Tissue GraftsHarvesting oral tissues to cover exposed areas
Guided Bone RegenerationEmploying barriers to direct the growth of new bone tissue around the anchor

4. Allergic Reactions

Allergic reactions can occur as a response to the materials used in oral rehabilitative procedures. [7]  Symptoms can include redness, swelling, itching, or discomfort at the placement site. 

A comparison of common implant materials and their potential for allergic reactions is provided below.

MaterialCommon UseAllergic PotentialSymptoms
TitaniumImplant body and abutmentsLow [8]Rare cases of skin rashes, itching, or localized inflammation
NickelSometimes present in alloy materialsModerate to High Dermatitis, redness, swelling, and, in severe cases, blistering
Cobalt-ChromiumUsed in some implant frameworksModerateSimilar to nickel, including skin rashes and possible respiratory symptoms

For patients with known or suspected allergies to titanium or other metals, alternatives include:

  • Zirconia: Made from zirconium dioxide, these ceramic implants offer a metal-free option with excellent biocompatibility and aesthetic results.
  • Polyether Ether Ketone (PEEK): A high-performance thermoplastic with good mechanical properties and biocompatibility, used primarily in temporary implants or as part of a framework. [9]

5. Nerve or Tissue Damage

3D illustration of nerve break due to unsuccessful dental implantation.

Although such incidents are rare, nerve damage can have significant consequences for patients. Understanding the symptoms can aid in early detection, facilitating timely intervention and mitigation. 

The following symptoms indicate a degree of nerve impairment and should not be ignored:

  • Paresthesia: Altered sensation, such as numbness or tingling in the lips, cheeks, or tongue.
  • Dysphagia: Difficulty swallowing.
  • Altered taste: Changes in the perception of flavors.
  • Pain: May persist after the customary post-operative healing period.

Being proactive in addressing these issues can significantly reduce the likelihood of tissue damage.

  • Pre-operative planning: Utilizing detailed imaging techniques, such as CBCT scans, to map out the anatomy and avoid nerve structures.
  • Minimal invasive techniques: Micro-surgical tools and techniques can limit tissue trauma.
  • Use of nerve protectors: In some cases, protective barriers can be placed during surgery to shield the nerve from potential damage.

Factors Influencing Dental Implant Success

The success of dental implants is subject to multiple determinants, each playing a critical role in the outcome and longevity of the procedure. 

FactorImpact on Dental Implant Success
Oral HygieneEssential for preventing infections that can lead to dental implant problems
SmokingIncreases the risk of failure by impairing healing and elevating the chances of peri-implantitis
Overall HealthConditions like diabetes and osteoporosis can delay healing and disrupt integration
Pre-existing ConditionsPeriodontal disease and insufficient bone density necessitate prior treatment
AgeNot a direct risk, but related health and bone changes in seniors can affect outcomes
Bone DensityCritical for implant stability; insufficient density might require bone grafting
Skill of the Dental SurgeonExpertise and experience of the surgeon play a crucial role in minimizing complications and ensuring proper placement
Post-Surgical CareAdequate care and follow-up are vital for healing and long-term success
Patient ComplianceFollowing the dentist’s post-operative care instructions is crucial for the healing process
Nutrition and LifestyleGood nutrition and a healthy lifestyle support healing and integration of the implant

Alternatives to Dental Implants

For individuals seeking other methods due to implant complications or personal preferences, there are two primary options: bridges and removable prosthetics.

Bridges

Bridges are often used to fill the gaps created by a missing tooth or teeth. They are anchored to neighboring teeth and can be an option for candidates seeking a non-surgical solution.

AdvantagesDisadvantages
Less invasive than implantsRequires alteration of adjacent healthy teeth
Shorter treatment timelineLess durable compared to implants
Cost-effective in the short termCan lead to bone loss in the tooth gap area

Dentures

Dentures or removable prosthetics offer another alternative, providing the flexibility of removal for cleaning and sleeping.

AdvantagesDisadvantages
Non-invasiveMay require adjustments over time for a better fit
Can be more affordableLess stable than implants and can affect speech and eating
Suitable for patients with significant bone lossDaily removal and cleaning required

The Decision to Forego Replacement

For some, opting to leave oral gaps unfilled is a personal choice, often influenced by the location of the gap or the dental implant cost. Nonetheless, it’s crucial to consult with a healthcare professional to understand the long-term implications of this decision on oral structure and functionality.

Final Takeaway

Navigating the path to enhancing one’s oral aesthetics and functionality comes with its set of challenges, including awareness of potential complications. Armed with the necessary insights and a dedicated team by your side, such hurdles can be addressed effectively. Ultimately, recognizing and addressing dental implant risks is key to achieving and maintaining optimal oral well-being.

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FAQs

What are the complications of dental implants?

Complications of fixtures may include peri-implantitis (gum and bone inflammation), infection, improper fusing to the bone, nerve or tissue damage, and rare allergic reactions to the materials used.

Can dental implants cause problems?

Yes, oral fixtures can cause problems such as infections, inflammation, and damage to adjacent structures if not properly placed or cared for post-procedure. 

What is the biggest reason implants fail?

The most significant reason for oral fixture loss is peri-implantitis, a bacterial infection that causes inflammation of the surrounding gum and bone.

What is the failure rate of dental implants?

The failure rate is relatively low, ranging between 5% to 10%, according to various studies. [10] Success rates can exceed 90%, depending on factors such as bone quality, patient health, and adherence to post-operative care.

References

  1. Goiato, M., Dos Santos, D., Jr. Santiago, J., Moreno, A., & Pellizzer, E. (2014). Longevity of dental implants in type IV bone: A systematic review. International Journal of Oral and Maxillofacial Surgery, 43(9), 1108-1116. https://doi.org/10.1016/j.ijom.2014.02.016
  2. Greenstein, G., Cavallaro, J., Romanos, G., & Tarnow, D. (2008). Clinical Recommendations for Avoiding and Managing Surgical Complications Associated With Implant Dentistry: A Review. Journal of Periodontology, 79(8), 1317-1329. https://doi.org/10.1902/jop.2008.070067
  3. Dutta, S. R., Passi, D., Singh, P., Atri, M., Mohan, S., & Sharma, A. (2020). Risks and complications associated with dental implant failure: Critical update. National Journal of Maxillofacial Surgery, 11(1), 14-19. https://doi.org/10.4103/njms.NJMS_75_16
  4. Kihara, H., Hatakeyama, W., Kondo, H., Yamamori, T., & Baba, K. (2022). Current complications and issues of implant superstructure. Journal of Oral Science, 64(4), 257–262. https://doi.org/10.2334/josnusd.21-0534
  5. Zheng, X., & Mo, A. (2019). Immune system-related diseases and dental implant treatment. Dental Implant Treatment in Medically Compromised Patients, 129–147. https://doi.org/10.1007/978-3-030-28557-9_7
  6.  Nimbalkar, S., Dhatrak, P., Gherde, C., & Joshi, S. (2020). A review article on factors affecting bone loss in dental implants. Materials Today: Proceedings, 43, 970-976. https://doi.org/10.1016/j.matpr.2020.07.428
  7. Pacheco, K. A. (2018). Allergy to surgical implants. Clinical Reviews in Allergy & Immunology, 56(1), 72–85. https://doi.org/10.1007/s12016-018-8707-y
  8. Poli, P. P., De Miranda, F. V., Polo, T. O., Santiago Júnior, J. F., Lima Neto, T. J., Rios, B. R., Assunção, W. G., Ervolino, E., Maiorana, C., & Faverani, L. P. (2020). Titanium Allergy Caused by Dental Implants: A Systematic Literature Review and Case Report. Materials, 14(18), 5239. https://doi.org/10.3390/ma14185239
  9. Mishra, S., & Chowdhary, R. (2019). PEEK materials as an alternative to titanium in dental implants: A systematic review. Clinical Implant Dentistry and Related Research, 21(1), 208-222. https://doi.org/10.1111/cid.12706
  10. Bassir, S. H., Kholy, K. E., Chen, Y., Lee, K. H., & Intini, G. (2019). Outcome of early dental implant placement versus other dental implant placement protocols: A systematic review and meta-analysis. Journal of Periodontology, 90(5), 493-506. https://doi.org/10.1002/JPER.18-0338