Dental Implant Complications Etiology, Prevention, and Treatment

Dental implants have become one of the most popular and rapidly growing techniques for replacing missing teeth. While their predictability, functionality, and durability make them an attractive option for patients and clinicians alike, complications can arise at any stage from patient assessment to maintenance therapy. Dental Implant Complications: Etiology, Prevention, and Treatment, Second Edition, updates and expands the hallmark first edition, which was the first comprehensive reference designed to provide clinicians of all skill levels with practical instruction grounded in evidence-based research. Featuring cases from a variety of dental specialties, the book covers the most commonly occurring implant complications as well as the unique.

Dental Implant Complications: Etiology, Prevention, and Treatment, Second Edition, is organized sequentially, guiding the reader through complications associated with the diagnosis, treatment planning, placement, restoration, and maintenance of implants at any stage. Complications associated with various bone augmentation and sinus lift procedures are also discussed in detail with emphasis on their etiology and prevention. Each chapter utilizes a highly illustrated and user-friendly format to showcase key pedagogical features, including a list of “take home tips” summarizing the fundamental points of each chapter. New chapters include discussions of complications from drug prescribing, implant naturalization, cemented restorations, loose implant restoration syndrome, and craniofacial growth. Readers will also find more case presentations to see how complications have been managed in real-world situations.

Dental Implant Complications: Etiology, Prevention, and Treatment, Second Edition, brings together contributions from leading experts in the field under the superior editorship of Dr. Stuart Froum. With its pragmatic approach to preventing and managing implant complications, this expertly crafted text continues to serve as an indispensable clinical reference and guide for all dentists placing or restoring implants.

Stuart J. Froum, DDS, is a Diplomate of American Board of Periodontology, Clinical Professor Department of Periodontology and Implant Dentistry, New York University Krieser Dental Center, Director of Clinical Research at the Department of Periodontology and Implant Dentistry, NYU Dental Center, and maintains a Private Practice limited to Periodontics & Implant Dentistry in New York City. Dr. Froum is Past President of the American Academy of Periodontology. He lectures nationally and internationally, has authored over 100 published research articles, and has authored and contributed to several books related to periodontics and implant dentistry.

List of contributors xiii

Foreword xvii

Myron Nevins

Introduction xix
Stuart J. Froum

1 Implant complications: scope of the problem 1
Stuart J. Froum

Introduction 1

Etiology 1

Prevention and treatment 6

Acknowledgments 7

References 8

2 Implant complications associated with systemic disorders and medications 10
Louis F. Rose and Brian L. Mealey

Introduction 10

Etiology 10

Prevention 24

Treatment 36

Take-home hints 41

References 41

3 Complications of drug prescribing in implant therapy 49
Mea A. Weinberg

Introduction 49

Etiology of drug prescribing complications 49

Types of drug and drug prescribing complications 49

Prevention of drug prescribing complications 51

Antibiotic prescribing in dental implant therapy 52

Analgesic prescribing 60

Steroid prescribing 63

Conclusions 63

Take-home hints 64

References 64

4 Complications associated with implant planning: etiology, prevention, and treatment 68
Hans-Peter Weber and Panos Papaspyridakos

Introduction 68

Etiology 68

Prevention through careful diagnosis and risk assessment 71

Prevention of complications through careful treatment planning 81

Take-home hints 98

Acknowledgments 98

References 99

5 Implant complications associated with two- and three-dimensional diagnostic imaging technologies 102
Scott D. Ganz

Case 1: Complications due to scanographic templates 103

Case 2: Long-term complications due to nerve perforation 104

Case 3: Sinus augmentation complications diagnosed by three-dimensional imaging 109

Case 4: Complications related to improper surgical technique, diagnosis, and free-hand implant placement 118

Case 5: Complications in the mandibular symphysis – related to diagnostic imagery 122

Conclusions 129

Take-home hints 129

References 129

6 Implant fractures: etiology, prevention, and treatment 132
Steven E. Eckert, Thomas J. Salinas, and Kivanç Akça

Introduction 132

Incidence 132

Etiology 133

Treatment of the fractured implant 142

Conclusion 142

Take-home hints 143

References 143

7 Implant naturalization: restoring osseointegrated dental implants with damaged platforms and connections 145
Dennis E. Waguespack and Brian C. Butler

Introduction 145

Etiology and prevention 145

Etiology 147

Treatment 149

Take-home hints 152

Acknowledgments 152

References 152

8 Implant failure: prevalence, risk factors, management, and prevention 153
J. Kobi Stern, Emily E. Hahn, Cyril I. Evian, Jonathan Waasdorp, and Edwin S. Rosenberg

Introduction 153

Definition and classification of implant failure 153

Incidence of implant failures 155

Etiology and risk factors 156

Prevention of implant failures 162

Treatment for implant failure 162

Take-home hints 167

References 167

9 Peri-implantitis: etiology, pathogenesis, prevention, and therapy 170
Niklaus P. Lang and Maurizio S. Tonetti

Etiology 170

Microbiological aspects 170

Pathogenesis of peri-implant diseases 172

Diagnostic aspects 175

Prevention: prophylactic procedures 178

Treatment: therapeutic strategies 179

Conclusions and clinical implications 183

Take-home hints 184

Acknowledgments 184

References 184

10 Complications related to cemented implant restoration 187
Chandur P.K. Wadhwani

Introduction 187

Advantages of the cement-retained implant restoration 187

Problems associated with cemented implant restorations 187

Cementing restorations onto teeth versus implants – why the difference? 188

Etiology 193

Prevention 197

Treatment 201

The future of cement-retained implant restorations 203

Take-home hints 206

Note 207

References 207

11 Esthetic complications due to implant malpositions: etiology, prevention, and treatment 209
Stephen T. Chen and Daniel Buser

Introduction 209

Etiology 210

Prevention of implant malposition 217

Treatment of esthetic complications due to implant malposition 223

Conclusions 230

Take-home hints 230

References 231

12 Prosthetic-related dental implant complications: etiology, prevention, and treatment 233
Charles J. Goodacre and Mathew T. Kattadiyil

Introduction 233

Etiology and timing of complications and failure 233

Mechanical complications 234

Phonetic complications 245

Esthetic complications 245

Biologic complications attributable to the prosthesis 253

Conclusions 256

Take-home hints 257

References 257

13 The loose implant restoration syndrome 259
Harel Simon

Introduction 259

Scenario 1: Loose implant restoration emergency 259

Etiology of the loose implant restoration syndrome 263

Treatment protocol 263

Scenario 2: Loose screw-retained crown 263

Scenario 3: Loose cement-retained posterior crown 269

Scenario 4: Loose cement-retained anterior crown 272

Scenario 5: Loose anterior implant crown: screw-retained or cement-retained? 275

Scenario 6: Loose screw-retained fixed partial denture 280

Treatment considerations 284

Contributing factors and prevention of screw loosening 288

Take-home hints 295

References 295

14 Management of complications associated with single-implant esthetics 298
Oswaldo Scopin de Andrade, Dario Adolfi, Maristela Lobo, and Maurício Contar Adolfi

Introduction 298

Possible failures, prevalence, and etiology 299

Targeted strategies for implant success in the esthetic zone 300

Tooth extraction: an important factor in avoiding complications 301

Key elements in implant placement and resolving esthetic complications 302

Case report: step-by-step clinical procedures to resolve an implant complication in the esthetic area 305

Conclusions 312

Take-home hints 313

Acknowledgments 313

References 313

15 Esthetic complications with adjacent implant restorations 316
Dennis P. Tarnow, Sang-Choon Cho, Stephen J. Chu, and Stuart J. Froum

Complications 316

Etiology 317

Prevention 318

Treatment 320

Case report 322

Conclusions 326

Take-home hints 330

References 330

16 Complications of autogenous bone grafting 332
Craig M. Misch

Introduction 332

Donor sites 332

Recipient site complications: early healing complications 344

Recipient site complications: late healing complications 350

Take-home hints 357

References 358

17 Complications in guided bone regeneration 362
Filippo Fontana, Isabella Rocchietta, and Massimo Simion

Introduction 362

Literature review 363

Prevention of complications: surgical technique 364

Clinical management of GBR complications 370

Conclusions 379

Take-home hints 380

References 380

18 Avoiding complications of alveolar segmental osteoperiosteal flaps 383
Ole T. Jensen

Alveolar distraction osteogenesis 383

Sandwich osteotomy 386

Alveolar width distraction 388

Island osteoperiosteal flap 390

Book bone flap 392

Major orthognathic distraction procedures 393

Summary 395

Take-home hints 395

References 395

19 Complications in lateral window sinus elevation surgery 396
Stephen S. Wallace and Tiziano Testori

Introduction 396

Intraoperative complications 396

Take-home hints 399

Take-home hints 413

Postoperative complications 413

Take-home hints 421

Conclusion 423

References 424

20 Complications with transcrestal sinus floor elevation: etiology, prevention, and treatment 427
Michael Toffler and Paul S. Rosen

Incidence 427

Etiology 430

Prevention 437

Management 445

Take-home hints 450

References 451

21 Implant complications related to immediate implant placement into extraction sites 457
Barry D. Wagenberg and Stuart J. Froum

Introduction 457

Etiology and prevention 457

Immediate tooth replacement (non-occlusally loaded) at the time of extraction of the natural tooth 463

Procedures to prevent failure using the immediate implant placement protocol with a non-loading provisional 467

Treatment of maxillary molars with the IIP protocol 468

Treatment of mandibular molars 470

Prevention 474

Treatment of complications 478

Take-home hints 479

References 479

22 Complications associated with flapless surgery 481
Thomas G. Wilson, Jr.

Introduction 481

Definition of flapless surgery 481

Goals of therapy 481

Etiology 481

Prevention 482

Treatment 490

Summary 493

Take-home hints 493

Potential conflicts of interest 493

References 493

23 Complications related to immediately loaded dental implants 495
Jeffrey Ganeles and David Grossberg

Failure to achieve osseointegration 495

Surgical complications related to immediate loading 499

Esthetic complications 502

Implant malposition 511

Restorative complications 513

Guided surgery and prefabricated restorations 518

Summary 532

Take-home hints 532

References 533

24 Prosthodontic complications related to non-optimal dental implant placement 539
Lyndon F. Cooper

Introduction 539

Etiology 540

Implant location 541

Prevention 547

Treatment 553

Take-home hints 557

References 557

25 Prosthodontic management of malpositioned implants and implant occlusion complications 559
Avinash S. Bidra

Introduction 559

Etiology of malpositioned implants 559

Prevention 562

Treatment 563

Etiologies of implant occlusion complications 565

Prevention of implant occlusion complications 566

Treatment 568

Conclusion 569

Take-home hints 570

References 570

26 Craniofacial growth in adults and its implications for implant reconstruction 572
Fereidoun Daftary, Ramin Mahallati, Oded Bahat, and Richard M. Sullivan

Introduction 572

Etiology 573

Prevention and treatment 575

Take-home hints 583

References 583

27 Implant complications encountered during maintenance therapy 585
Paul S. Rosen, Stuart J. Froum, Scott H. Froum, and Chris Salierno

Introduction 585

Diagnosis 585

Prevention 587

Treatment 594

Take-home hints 597

References 597

28 Medicolegal issues related to implant complications 600
Edwin J. Zinman

Etiology of malpractice litigation 600

Etiology of implant-related legal claims 603

Take-home hints 616

References 617

Appendix 28.1: Example of an informed consent form 620

Appendix 28.2: Release of liability form 625

29 Management of implant complications by the experts (part 1) 626

Introduction 626

Case 1: Treatment of midbuccal recession in the esthetic zone 627
Pamela K. McClain

Case 2: Treatment of buccal soft tissue recession on a restored central incisor implant 629
Jeffrey R. Lemler

Case 3: Repair of failed esthetic implant case 632
Bobby Butler

Case 4: Treatment of an osseous defect associated with an immediately placed implant 635
Donald S. Clem

Case 5: Treatment of bone loss from an acute abscess around a dental implant 639
Bradley S. McAllister

Case 6: Replacement of a failed implant in the esthetic zone 643
Abd Elsalam Elaskary

Case 7: Treatment and replacement of a malpositioned implant in the esthetic zone 646
Scott H. Froum

Case 8: Corrective treatment for a malpositioned implant in the esthetic zone 653
J. Daulton Keith

Case 9: Treatment of implant malposition in the esthetic zone 658
Burton Langer and Laureen Langer

Case 10: Treatment of a malpositioned implant in the esthetic zone 661
Stuart J. Froum and Jeffrey R. Lemler

30 Management of implant complications by the experts (part 2) 666

Case 1: Long-term retention of a “hopeless” implant 666
Kirk Pasquinelli

Case 2: Treatment of implant malposition in the esthetic zone 671
Burton Langer and Laureen Langer

Case 3: Examples of esthetic implant complications – soft tissue repairs 676
Bobby Butler

Case 4: Treatment of peri-implantitis due to residual cement around an implant 681
Pamela K. McClain

Case 5: The importance of occlusion in success of implant-supported restorations 685
Farhad Vahidi

Case 6: Nonsyndromic oligodontia interdisciplinary approach: challenges and possible complications 688
Farhad Vahidi

Case 7: Successful replacement of a failed dental implant: 5-year follow-up 692
William Becker

Case 8: Management of a failed implant in the esthetic zone 695
Donald S. Clem

Index 701

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