Advancements in medical technology has helped dental implant surgery become safe, effective and replicable; suitable for many patient profiles. Implants are now a very popular and mainstream dental procedure, being a form of teeth replacement that enables the surgeon to restore both the aesthetics as well as the function of a tooth. The 10 year success rate of a dental implant hovers around 97% for some implant brands. https://pubmed.ncbi.nlm.nih.gov/22897683/

However, dental implant surgery does come with some risks. Some of my patients are considered to be ideal candidates for dental implant surgery; they are healthy individuals who have a combination of good gum and bone health with no pre-existing medical or dental conditions. However, other patients who do not have such a clean bill of health might find that opting for dental implant surgery might expose them to some potentially hazardous medical situations.

Firstly, what can cause dental implant failure?

Before discussing whether or not a patient belongs in a high risk group, we should first understand why dental implants fail in the first place.

So what are some of the most common reasons for dental implant failure?

  • Infection of the treatment area (post surgical infection)
  • Dental implant failing to fuse successfully to the bone
  • Excessive biting force breaking or dislodging the dental implant

While some of these reasons for failure are linked to external factors (such as excessive bite force), the main reasons for implant failure are usually related to patients who are in the high risk group due to health, medication or other lifestyle factors. Only a proper and thorough consultation with your dental surgeon can adequately determine whether or not you are a good candidate for a dental implant.

So, what are some patient related factors that could cause a patient to be at high risk of dental implant failure?

Having pre-existing medical conditions

Before you even consider getting dental implants, it is important for your periodontist or dental surgeon to understand your current bill of health. If you have pre-existing medical conditions like diabetes, rheumatoid arthritis or other forms of autoimmune diseases, you may not be a suitable candidate for implants. These conditions reduce the body’s natural ability to heal, which is imperative in helping the dental implant fuse well to your bone.

Having pre-existing dental conditions like gum disease

Please do not get your implants placed if you have active gum disease. Having an untreated periodontal condition can increase your risk of infection as well as presenting you with an increased risk of dental implant failure. https://pubmed.ncbi.nlm.nih.gov/30391683/ One of the primary causes of gum disease is bacteria. When bacteria is still present in the pockets of unhealthy gums, they can track to the newly placed dental implants and cause an infection of the implants.

That being said, dental implant treatment will still be successful for those patients who have undergone gum treatment and are motivated to keep their teeth very clean. https://pubmed.ncbi.nlm.nih.gov/32127095/ Its just as important to see your dentist regularly even after your gums are treated to make sure the gum disease does not recur dues to inadequate brushing!

Current medication

The use of certain types of medications can also contribute to dental implant complications. It’s very important to be honest and thorough with your dental surgeon about what medications you’re currently taking so that the surgeon can give you the green light to continue taking them safely. Certain anti-depressant and heartburn medications have been found by studies to reduce bone growth, which can impair the body’s ability to fuse the implant successfully into the jaw bone (1). Other medications used for treatment of osteoporosis may also reduce blood supply to the jaw bone and affect the implant success rate. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005105/

Having insufficient or unhealthy jaw bone

The jaw bone is an important foundation in supporting dental implants. Without sufficient or healthy jaw bone, the dental surgeon won’t be able to insert and anchor the implant. The implant also runs an increased risk of becoming dislodged or knocked out of place when eating if the jaw bone is not inherently strong and stable.

This means that for patients that are suffering from degenerative bone diseases like severe osteoporosis, dental implants may not be a viable solution for them. Patients with osteoporosis suffer from a lack of bone density, which means their fragile bones run an increased risk of becoming fractured or damaged during or after the surgery. Point to note through: new and improved implant surfaces has reached a point where it is still possible to place implants in patients with osteopenia (stage just before osteoporosis) or mild osteoporosis. You just need to inform your dental surgeon of your condition and we can make a decision on the likelihood of implant success based on the severity of the osteoporotic condition.

There are other oral diseases that might cause bone deterioration in one’s mouth, so it is important that there are no conditions left untreated before embarking on dental implant surgery.

Smoking

Smoking is a lifestyle choice that has clear negative effects on your dental health. The literature surrounding smoking and dental health suggests that smoking causes a higher rate of plaque accumulation and increased chance of gingivitis or periodontitis(2)

On top of that, smoking exposes your gums and teeth to heat as well as certain additives like nicotine, carbon monoxide and hydrogen cyanide, which will impair the body’s ability to heal while also leaving the gums more susceptible for complications and implant failure. In order to give your implant the best chances of not being rejected, you are usually advised to stop smoking cigarettes at least 7 days prior to your surgery as well for up to 2 months post-dental implant surgery (3).

Overall, for patients who are going for their first dental implant surgery, thinking of the risks involved can sometimes be stressful due to the fact that it is “surgical” in nature. However, it is important to remember that dental implant surgery is a safe and well established procedure and the success for many patients who undergo it is generally very high. It is important to choose a dental surgeon who works closely with you to ensure you remain calm and reassured throughout every step of the way of your dental implant journey.

References

  1. https://www.healthline.com/health/dental-implant-problems#success-factors
    What to Know About Dental Implant Complications and Failure
  2. https://journals.lww.com/implantdent/fulltext/2005/12000/the_effect_of_cigarette_smoking_on_dental_implants.11.aspx
    Levin, Liran DMD*; Schwartz-Arad, Devorah DMD, PhD. The Effect of Cigarette Smoking on Dental Implants and Related Surgery. Implant Dentistry: December 2005 – Volume 14 – Issue 4 – p 357-363
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894084/
    V. Kasat and R. Ladda1. Smoking and dental implants. J Int Soc Prev Community Dent. 2012 Jul-Dec; 2(2): 38–41.
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