ITI Treatment Guide, Vol.

6
7.1 Causes of Complications
7.2 Prevention of Complications
p.194~201


7.1 Causes of Complications
7.1.1 Introduction
Growth in the number of implants over the past 10
to 15 years
Implants placed by dentists with varying levels of
knowledge, experience and skills
Dentists undertaking treatment beyond their
capabilities
Implants placed at compromised sites
Agressiveness of implant placement and loading
protocols
7.1.1 Introduction
Non evidence-based information presented at
meetings may be misleading
Poor risk assessment or understanding of risks
Lack of experience in handling problems during
implant surgery
7.1.1 Introduction
Malposition of implants is a major cause of
complications

7.1.2 Risk Factors for
Complications Reported in the
Literature
Systemic conditions and treatments as risks for
implant therapy
History of treated periodontitis and smoking as
risks for implant therapy
Mechanical and technical risks
Local risk factors
Systemic conditions and
treatments as risks for implant
therapy
Patients who could benefit from implant treatment
in the esthetic zone may present with concomitant
systemic disease
The most substantial body of reports on systemic
risks is available for diabetes mellitus, osteoporosis,
and radiotherapy
Cases involving recent irradiation therapy may
require at least a treatment delay
History of treated periodontitis
and smoking as risks for implant
therapy
History of treated periodontitis
Patients with a history of periodontitis are at greater risk for
peri-implantitis than are patients without a history of
periodontitis (reported odds ratios ranged from 3.7 to 4.7)
It is important that periodontal disease be treated prior to
implant placement
Smoking
Smokers have an increased risk of peri-implantitis (reported
odds ratios ranged from 3.6 to 4.6) and radiographic marginal
bone loss (reported odds ratios ranged from 2.2 to 10)
Some evidence for a dose effect cigarette smoking
History of treated periodontitis
and smoking as risks for implant
therapy
History of treated periodontitis and smoking
Some evidence for an increased risk of implant failure
and bone loss in smokers compared to nonsmokers with
a history of treated periodontitis
Mechanical and technical risks
Implant-related mechanical and technical risk
factors
Abutment-related mechanical and technical risk
factors
Superstructure-related mechanical and technical
risk factors
Survival defined as presence of the implant,
abutment, or superstructure in its original and
extended position with or without complications at
any of the follow-up period
Success was defined as presence of the implant
abutment, or superstructure without any
mechanical or technical complications during the
entire follow-up period
Local risk factors
Implant malposition is presumably the greatest risk
factor for unfavorable (esthetic) treatment
outcomes in the anterior maxilla
7.2
General Modifiers
Clinical Competence and Experience
The experienced clinician possesses the skill,
competence and knowledge to manage the complex
case and deal with the complications should they arise
Compromised Patient Health
General Modifiers
Growth Considerations
Relative infraocclusion and/or palatoversion of the
implant
Postponed in young individuals until craniofacial/skeletal
growth is complete
Individuals with short or long face type may
demonstrate further eruption of teeth adjacent to
implants after the age of 20 years
Iatrogenic Factors
Sub-optimal planning
Less-than-desirable outcomes in preceding treatment
procedures