Earlier this summer, I attended the International Symposium on Periodontics and Restorative Dentistry (ISPRD), a 4-day conference with some of the top clinicians and researchers in dentistry. It was inspiring to see beautiful patient cases being presented and learn about new techniques. Many of the lectures focused on dental implant therapy, a treatment for the replacement of missing teeth with a success rate of over 95% as reported in literature. On the surface, 95% inspires a lot of confidence. It seems nearly…foolproof…and pretty much every patient who gets a dental implant should expect to look and feel and function like it’s their own natural tooth…right??
The reality is, there is a growing body of evidence and day-to-day clinical encounters that attest to the contrary: the dental implant often falls short of fulfilling the look, feel, and function of the natural tooth that it was designed to replace.
The dental implant is usually made of three components: the implant body, abutment, and crown. The implant body resembles a small screw that is surgically placed into the jaw bone and acts like the replacement root. The abutment usually screws into the implant, and helps to support the crown which is what patients see as the replacement “tooth” in the mouth.
One important area where the implant doesn’t quite behave like a natural tooth is in the transition between the titanium implant body that is integrated in the bone, and the prosthetic abutment and crown. The challenge lies in the naturally occurring resorption of bone as soon as the tooth is extracted. Surgeons have developed various ways to graft bone and soft tissue to compensate for some of the loss of structure, and the restorative dentist can also try to compensate through the shape and design of the prosthetic abutment and crown, but rarely do we achieve a true replica of nature.
The result is that sometimes patients experience “complications” that aren’t really considered in the definition of success when we talk about dental implants as being 95+% successful. These complications can range from small annoyances like increased food collection around the implant crown, some degree of esthetic compromises, to long term inflammation of the gum or bone loss around an implant. In the 2011 article* “Success Criteria in Implant Dentistry: A Systematic Review”, the authors looked closely at 25 studies with at least 5 years of follow-up to see how these studies measured clinical success of implant treatment. Of course, osseointegration is the basic criteria, but most studies do not consider success at the prosthetic level, esthetics, or take into account patient satisfaction.
The bottom line is, it is necessary to have a thoughtful discussion with patients about potential complications of dental implant therapy, and provide realistic expectations of what a dental implant can and cannot achieve. On the provider side, it is important to have good communication and collaboration between surgical and prosthetic team members to ensure the best outcome for the patient. Better techniques and materials are being developed to make dental implant therapy more predictable, but in the meantime, we must understand the risks and how failure happens, when it happens, to try and prevent or manage these complications.
Papaspyridakos P1, Chen CJ, Singh M, Weber HP, Gallucci GO. Success criteria in implant dentistry: a systematic review. J Dent Res. 2012 Mar;91(3):242-8. doi: 10.1177/0022034511431252. Epub 2011 Dec 8.
Dr. Sharon Jin
Prosthodontist, Bedford and Needham offices