Complications

in Implant Therapy
Dr. Abdullah Alkeraidis
BDS, Prostho (cert), Msc, Dental Implant (Cert),Fellowship
of Clinical Research (NYU) .
Consultant in Prosthodontics & Dental Implant.
Program Director of Implant Fellowship in RDC.
King Saud Medical Complex Riyadh.
Director of Dental Center.

 Etiology:
1-Complication related to technical problems.
2-Complication related to healing:
A-local factors:
* Infectious, occlusal and soft tissue.
B-Systemic complicating factors:
C-environment factors:
*Smoking and stress.
3-complication related to anatomy:
Vertical bone deficiency, horizontal deficiency
and bone quality.

2-Complication related to healing:

A-local factors
Infectious, occlusal and soft tissue
B-Systemic complicating factors:
C- environment factors:
*Smoking and stress.

3-complication related to anatomy:

Vertical bone deficiency, and
Horizontal deficiency
Bone quality.

4-Complication related to poor treatment planning.

Placement of implant in bad position
because of un accurate surgical stint
Less number of implant to the proposed
prosthetics
The use of cantilever in high functional
stress area
Un adequate vertical space

Complications in implant therapy: timing

1-Complication occurring during the implant
surgery.
2-Complication occurring during the early
post-operative period.
3-long term complications

4-Fracture of the alveolar bone (fenestration or

dehiscence)
5-Preoperative bleeding .
6-Poor implant placement.
7-lack of primary stability: poor bone qualit,.
Wobbling of the drill ,stripping of the threads ,
implant loss.
8-Instumrnt dropping , swallowed or inhaled .
9-Fracture of the mandibule.

2-Complication occurring during :the early

post operative period
Infection
Dehiscence of the flap
Loosening of the sutures
Foreign body
Traumatization of the tissue

Interference with the dento-alveolar

nerve.
Detection of the mental foramen on radiograhs:

On panoramics: detected in 94% of the

case.
For clear visibility tilt the patients head 5 degree
downward to reduce the chance of structure
superimposition.

On

periapical :

1-found in 46-75 % of the case due to:

-Difficulty in differentiating the foramen from
the trabecular bone.
-Thin mandibular bone no XR contrast.
-Thic lingual cortical plate.
-Dark radigraphs.

On CT scan :
more accrate
Give you 3 dimension for exact location
Give you better view for the loop

Detection of the anterior loop

-Detected on surgical dissection in 24-88% of the case.
-Weak correlation between X-Ray detection and surgical
exposure.
70% of anatomically detected loop did not appear
on periapical films
- Loops varied from ,5- 2.95 mm (mardinger 2000)

Do a thorough radiographic analysis before

starting with surgery .
If the nerve is clearly seen on a RA-XR or the
OPG, no need for adntascan.
Occasionally, the nerve is not clearly defined
even on a scan.
To see the nerve clearly: follow its course on
the coronal sections starting from its
emergency in the mental foramen area.

prevalence of altered sensation associated with

implant surgery.
36% - 23% transient
13% persistent.
lip 54% - chin 58% - gingiva 45% - tongue 16%.

15%permanent changes
More conservative approach-less sensory

changes.

No persistent sensory changes in case of

short implant placed in the posterior
mandible with limited bone height

Basic neurosensory
*light touch.
*brush direction discrimination.
*two-point discrimination.
*no ciciptive discrimination .
*thermal discrimination.

Seddons classification of nerve injury

*based on the extent of anatomic injury recovery time and
prognosis.

1-neuropraxia:
result from mild injury cased by compression or prolonged
traction .the nerve axonal pathway is intact. Injury result
in temporary failure of conduction (4W)
*compression my caused damage to vessels with bleeding
into the canal that results in compartment-like syndrome
or the formation of a traumatic neuroma

2-Axonotmesis:
more severe injury caused by excessive traction or
compression. Loss of continuity of some axons.
General structure of the nerve remains intact.
Sensation returns after 5-11 W. improves in the
next 10-12 months.
However recovery is less than normal
(Hypoesthesia,dyesthesis)

3-Neurotomesis:
*desruption of neural sheath-block of conduction
impulses. need for surgery, recovery poor.
*total numbers 12 weeks: suggests severe injury
with disruption of the nerve sheath.
Repair process occurs during the first 1-2 months .
After this ,distal neurotubules and the showan cells
begin to atrophy and replaced by scar tissue

Early removal of the implant my

result in decompression and better
recovery

Guide line to avoid nerve injuries in the

mental foramens region.
-Leave a 2mm safety zone above the nerve.
-Locate the neurovascular structures using a
CT scan when nerve canal is close to the
anticipated osteotomy depth.
-If anterior loop is detected radio graphically
corroborate its presence surgically.

Guide line to avoid nerve injuries in the

mental foramens region.
- If nerve is close to the alveolar crest, place
the incision more lingually.
- Placing implant anterior to the mental
foramen longer than the safety zoneprobe of anterior loop.

Allow 2mm mesial to the foramen for surgical

error !(Greenstein & tarrow JP 2006)
Avoid direct trauma to the mental nerve by

tissue retractor.

Limit flap elevation if an necessary.

Aim for short rather than for longer implant.

Management of transient or persistent

1-Identify the problemthe as soon as possible.
2- if the implant is interfeing with nerve ,
retrieve the implant and replace it with a
shorter one.
3-parasthesia caused by elongation or
compression usually disappears in the
following 3-4 weeks. wait 4 months final
diagnosis of persistent parasthesia .

Management of transient or persistent

4-in case of more serious damage to the nerve ,
expect permanent problem of various
intensity.
Microneurosurgery is indicated if no recovery or
improvement occur 4 months following injury.

The clinical significance of sinus membrane

perforation during augmentation of the
maxillary sinus.Ardekian etal J OMF surg 2006
Tow groups of patients
group 1 :membrane perfored during surgery
group 2 :no perforation .
Success Rate in group 1 : 94.4%
Success Rate in no perforation group 2 : 93.9%.
perforation occurs more frequently in case of small
height of the residual alveolar bone.

Peri-implant pathology caused by periapical

lesion of an adjacent natural tooth :a case
report tseng at al IJOMI 20:632 2005
.Case of implant removal because of periapical
pathology.
.Apical surgery and GBR at the implant site were
done. followed by the replacement of the lost
implant