Dental Implant Failure

By

Mahmoud Ramadan
BDS MUST 2003
HDD Mans. Univ. 2007
MDS Mans. Univ. 2011
President of 4Dent Int. Community
DK Syndicate Ass. Secretary

Definition

Implant failure is defined

as the total failure of the
implant to fulfill its
purpose (functional,
esthetic or phonetic)
because of mechanical or
biologic reasons.

Etiology of Failure
I.
II.
III.
IV.

Improper patient selection.

Improper surgical placement.
Improper implant selection.
Prosthetic problems.

I . Improper patient selection

A.

Patients with compromised medical status:

1)

3)

Osteoporosis, Pagets diseases and Fibrous Displasia.

Uncontrolled diabetes.
Psychological problem.

B.

Patients with destructive habits:

1)
2)

Parafunctional habits (Bruxism and Clenching).

Smoking.

C.

Intraoral Condition:

1)

Poor oral hygiene.

Irradiation Therapy.

2)

2)

II. Improper surgical placement

1)

Lack of initial stabilization:

Poor bone quality.

Faulty hand positioning.
Disengaging a locked drill.

2)

Implant angulation:

Occlusal load (Axial Lateral).

Angulation not more than 25.
Options: Bone Graft Angulated implant - Angulated abutments.

3)

Improper flap design:

Wound Healing and early infection.

Basic surgical procedures, blood supply, visibility and access.

4)

Bone overheating and exerting extra pressure:

Bone cell death at temp. 47 C and higher for 1 min.

Drill speed not more than 2000 rpm + graded drill series +
external irrigation
Excessive pressure cause bone cell necrosis (C.T. interface).

5)

Inter-implant space:

Recommended space 4 7 mm bet. Implants:

( good blood supply better access for hygiene).
Recommended space 3 mm bet. Implant and
neighboring tooth.
-

6)
-

Placing implant in immature grafted sites:

Premature loading of implant before maturation of bone graft from
woven to lamellar bone.
Waiting period of grafted bone site (6 9 months).

7)
-

Implant placement in an infected socket or a

pathological lesion:
Placement of fixture (infected socket pathological lesion).
Infection from neighboring tooth.
To reduce chance of contamination (debridement of the socket
use of antibiotics 2 days preoperative and 10 days postopererative
using of wider implant to reach fresh bone).

Implant contamination
(before insertion):

8)

Reasons of contamination ( Manufacturer non

titanium instruments bacteria glove powder)
- Autoclaving contaminated implants.
-

III. Improper Implant Selection

1)
-

2)

Implant type Vs. Bone type:

Titanium screw implants for ant. mandible (type I bone) depth 20
mm.
HA coated screws for ant. maxilla & post. mandible (type II & III
bone) depth 10 mm.
HA coated cylinders for post. maxilla (type IV).
Self tapping designs for soft bone in maxilla.

Implant length:

Sorter implants have less bone contact

and less mechanical support.
- Crown implant ratio (lateral forces).
-

3)
-

4)
-

5)
-

Implant diameter:
Large diameter implant (greater surface area mechanical
anchorage initial rigidity).
Wide implant in narrow ridge (less than 1 mm bone buccal and
lingual) affect blood supply, dehiscence and failure.
Narrow implant in wide ridge (stress concentration).

Implant number:
Increase implant no. reduce implant failure.

Implant design:
Solid implants better than hollow implants. (dead space)
Cylindrical and screw implants better than conical implants. (stress)
Press fit design (ease of placement in difficult access locations).
Surface treatment.

IV. Prosthetic problems

1)
-

2)

Abutment fit:
Misfit leads to screw joint failure.
Clinical and radiographic exam. before impression making.

Passive prosthetic fit:

Reduce long term stresses in super structure, implant components

and bone adjacent to implants.
- C.P.: pain & discomfort in short term.
implant loosing or fracture in long term.
-

3)
-

Pier abutment:
Change the situation into total implant supported or using stressbreaking designs.

4)
-

5)
-

6)
-

Connecting implant to natural abutment:

Natural tooth intrusion.
Non rigid connection between natural teeth and implants.

Excessive cantilever:
Result in (fracture of prosthesis loss of osseointegration bone
fracture).
Cantilever and bone type.
Cantilever and biomechanics.

Bad esthetics:
Improper implant placement.
Improper soft tissue management.

7) Traumatic occlusion:
- More offensive than natural teeth (lack of proprioception).

8)
-

9)
-

Over load:
Caused by (leverage bruxism).

Premature load:
Stress free healing period (3 6 months) is recommended for
osseointegration.
Role of temporary implants to support temporary prosth. to prevent
stresses on defintive implants.
Immediate loading reports early failure 7 times higher than delayed
cases.
Time of loading depends on (Bone quality implant characteristics).

10) Torqueing:
- Preloading of implant components was introduced
to apply a fixed load not more than (20 N) using torque
wrenches.

Stage of failure
A.

Healing period failures:

1)

4)

Implant placement in infected sockets,

pathlogical lesions,
immature augmented bone or
contaminated implants.

B.

Loading failures:

Due to excessive torquing during abutment placement into bone.

C.

Post loading failures:

After loading due to occlusal trauma.

2)
3)

Signs of failure
1)
2)
3)
4)
5)
6)
7)
8)

Connecting screw loosening.

Connecting screw fracture.
Gingival bleeding and enlargement.
Purulent exudate from large pockets.
Pain.
Fracture of prosthetic components.
Angular bone loss (radiographically).
Long standing infection and soft tissue sloughing.

Reducing failure risk

Review the causes of implant failures.

Form teamwork for all cases involving different
specialties.

Thank You