Detailed description of implaint failures and clinical management of implant failures WITH MANY REFERENCES

1. IMPLANT FAILURES: A dentist’s
nightmare

2. CONTENTS
• Introduction
• Definitions
• Classifications
• Conclusion
• References

3. INTRODUCTION
• An implant is “a graft or insert set firmly or deeply
into or onto alveolar process that may be prepared
for its insertion.”
• Implants are used for single tooth replacements,
partially edentulous arches and for completely
edentulous arches. They are inert, alloplastic
materials most commonly made of titanium or
titanium alloy or vitalinium.

4. • Alternatively, ceramics such as hydroxyapatite,
bioglass, or aluminum oxides can be used.
• Depending on their placement within the bone, they
are classified into epiosteal, endosteal, and
transosteal.
• The most common one is endosteal (screw shaped or
cylindrical).

5. According to GPT9
• implant (1890): to graft or insert a material such as
an alloplastic substance, an encapsulated drug, or
tissue into the body of a recipient

6. • An implant consists of an
implant body which is placed
within the bone, implant screw
placed on the superior surface
of the body to which is attached
the healing cap.
• Abutments are placed over the
implant body which provides
retention to the prosthesis.

8. • The burning problem that all the implantologists are
confronted today is the complications and failures
occurring with the treatment of Osseo integrated
implants.
• In spite of taking many precautions and surgical
precision, implant failures do occur attributing to
certain factors.

9. DEFINITIONS• Implant failure
• • Implant failure is the first instance at which the
performance of the implant, measured in some
quantitative way falls below a specified and acceptable
level.
• Implant failure is defined as the total failure of the
implant to fulfill its purpose (functional, esthetic or
phonetic) because of mechanical or biological reasons.
• Implant failure is the inadequacy of the host tissue to
establish or to maintain ossiointegration.
Prashanti, et al. implant failures. Indian Journal of Dental Research, 22(3), 2011

10. • Iatrogenic failure and biologic failure
• Iatrogenic failure is one characterized by a stable
and osseointegrated implant, but due to
malpositioning it is prevented from being used as
part of the anchorage unit.
• Biological failure can be defined as the inadequacy
of the host tissue to establish or to maintain
osseointegration.

11. • Ailing implants
• An implant that may demonstrate bone loss with
deeper clinical probing depths but appears to be
stable when evaluated at 3−4 months interval.
• Ailing implants are those showing radiographic bone
loss without inflammatory signs or mobility

12. • Failing implants
• • An implant that may demonstrate bone loss,
increasing clinical probing depths, bleeding on
probing, and suppuration. Bone loss may be
progressive.
• Failing implants are characterized by progressive
bone loss, signs of inflammation and no mobility.

13. • Failed implants
• An implant that demonstrates clinical mobility, a
peri-implant radiolucency, and a dull sound when
percussed.
• A failed implant is non-functional and must be
removed.
• Failed implants are those with progressive bone loss,
with clinical mobility and that which are not
functioning in the intended sense.

14. • Surviving implants
• Surviving is a term described by Alberktson that
applies to implants that are still in function but have
not been tested against success criteria.

15. • WHEN TO SAY AN IMPLANT HAS FAILED?
Consideration must be given to evaluating the following
criteria:
• Durability
• Bone loss
• Gingival health
• Pocket depth
• Effect on adjacent teeth

16. • Function
• Esthetics
• Presence of infection, discomfort, paraesthesia or
anesthesia
• Intrusion on the mandibular canal
• Emotional and psychological attitude and
satisfaction of the patient
• Smith and Zarb have reviewed the success criteria
given by different authors.

17. • Earlier Concepts
Schnitman and schulman,1979:
• Mobility less than 1 mm in any direction.
• Bone loss no greater than 1/3of the vertical height of the
bone.
• Functional service for 5 years.
Cranin et al.1982:
• In place 60 months or more.
• No signs of bone loss.
• Freedom from hemorrhage.
• Lack of mobility.
• Absence of pain or percussive tenderness.
• No pericervical granulomatosis or gingival hyperplasia

18. • McKinney et al. 1984:
Subjective criteria
• Adequate function.
• Absence of discomfort.
• Patient belief that esthetics, emotional, and psychological
attitude are improved.
Objective criteria
• Bone loss no greater than one third of the vertical height of
the implant
• Gingival inflammation vulnerable to treatment.
• Mobility of less than 1 mm buccolingually, mesiodistally, and
vertically.
Success criterion
• Provides functional service for 5 years

19. REVISED CRITERIA FOR IMPLANT SUCCESS
Albrektsson et al. 1986
• Individual unattached implant that is immobile when tested
clinically
• Radiography that does not demonstrate evidence of peri-
implant radiolucency
• Bone loss 1.2 mm after 1 year of service and less than 0.2
mm annually in subsequent years
• No persistent pain, discomfort or infection
• By these criteria, a success rate of 85% at the end of a 5 year
observation period and 80% at the end of a 10 year period are
minimum levels for success.

20. • 1998 Esposito et al. at 1st European Workshop on
Periodontology
• The success criteria, which were initially targeted for
evaluation as 5 years survival has changed with a
target of 10-year survival rate.

21. Predictors of implant success or failure
( General dentistry 2005, 423-432)
• Positive factors
 Bone type (type 1and 2)
 Patient less than 60yrs old
 Experienced Clinician
 Mandibular placement
 Implant length > 8mm
 FPD with more than two implants
 Axial loading of implant
 Regular postoperative recalls
 Good oral hygiene

22. • Negative factors
• Bone type (type 3 and 4)
• Low bone volume
• Patient more than 60yrs old
• Limited clinician experience
• Systemic diseases
• Auto-immune disease
• Chronic periodontitis
• Smoking and tobacco use Unresolved caries,
• endodontic lesions, frank pathology
• Maxillary, particularly posterior region
• Short implants (<7mm)
• Eccentric loading
• Inappropriate early clinical loading
• Bruxism and other parafunctional habits

23. • Warning signs of implantfailure
(Askary et al ID 1999; vol 8; no2, 173-183)
• Connecting screw loosening
• Connecting screw fracture
• Gingival bleeding and enlargement
• Purulent exudates from large pockets
• Pain
• Fracture of prosthetic components
• Angular bone loss noted radiographically
• Long-standing infection and soft tissue
• sloughing during the healing period of first stage
surgery

24. • Criteria for implant success:
• The individual implant is immobile when tested clinically.
• No radiographic evidence of peri-implant radiolucency
• Bone loss no greater than 0.2 mm annually
• Gingival inflammation amenable to treatment
• Absence of symptoms of infection and pain
• Absence of damage to adjacent teeth
• Absence of parasthesia, anesthesia or violation of the
mandibular canal or maxillary sinus
• Should provide functional survival for 5 years in 90% of the
cases and for 10 years in 85%.
(Albrekfsson T. :int J. Oral Maxillofac Implants 1986; 1:11-25)

25. • Classification Of Implant failures

26. E.S Rosenberg, J.P. Torosian and J. Slots classified as :
• Infectious Failure:
• Clinical signs of infection
with classic symptoms of
inflammation
• High plaque and gingival
indices
• Pocketing
• Bleeding, Suppuration
• Attachment loss
• Radiographic peri-implant
radiolucency
• Presence of granulomatous
tissue upon removal
• Traumatic Failure:
• Radiographic periimplant
radiolucency
• Mobility
• Lack of granulomatous
tissue upon removal
• Lack of increased probing
depths
• Low plaque and gingival
indices

27. nallaswamy
Truhlar
and Tonetti and
Schmid

28. • Marco Esposito, Jan Michael Hirsh, Ulf Lekholm et
al have classified oral implant failures
• according to the osseointegration concept.
1)Biological Failures:
• Early or primary (Before loading)
• Late or secondary (After loading)
2)Mechanical failures:
• Fracture of implants, connecting screws, bridge
framework, coatings etc
3)Iatrogenic Failures
• • Improper implant angulation and alignment, nerve
damage
4)Inadequate Patient adaptation
• • Phonetics, esthetics, psychological problems.

29. • Kees Heydenrijik, Henny JA Meijer, Wil A Van
der et al classified to occurrence in time as:
1) Early Failures: Causes attributed are:
• Surgical trauma
• Insufficient quantity or quality of bone
• Premature loading of implant
• Bacterial infection
2) Late Failures:
• Soon late failures: Implants failing during first
year of loading. Overloading in relation to poor
bone quality and insufficient bone volume.
• Delayed late failures: Implant failing in
subsequent years. Progressive changes of the
loading conditions in relation to bone quality,
volume and peri -implantitis.

30. Sumiya Hobo, Eiji Ichida, Lily T Garcia enlisted
various complications occurring in implants as:
Swedish Team ( Branemark
et al)
1. Loss of bone anchorage:
• a. Mucoperiosteal
perforation
• b. Surgical trauma
2. Gingival problems:
• a. Proliferative gingivitis
• b. Fistula formation
3. Mechanical complications:
• a. Fracture of prosthesis,
gold screws, abutment
screws
U.C.L.A team (Beumer, Moy)
• Complications in Stage I
surgery;
• 2. Complications in Stage II
surgery:
• 3. Prosthetic complications

31. Classification by matukas

32. Abdel Salam el Askary, Roland Meffert and terrence griffin
• According to etiology
• Restorative factor
• Host factor
• Surgical factor
• Implant selection factor

33. • According to timing of failure
• Before stage II
• After stage II
• After restoration
• According to origin of infection
• Peri- implantitis(Infective process, bacterial origin)
• Retrograde peri-implantitis (Traumatic occlusion
origin, non infective, forces off the long axis,
premature or excessive loading)

34. • According to failure mode
• Psychological problems
• Lack of osseointegration
• Unacceptable aesthetics
• Functional problems

35. • According to condition of failure
• Ailing Implant
• Failing Implant
• Failed Implant
• Surviving Implant
• According to supporting tissue type
• Soft tissue loss
• Bone loss
• Combination

36. • According to responsible personnel
• Dentist (Oral surgeon,
Prosthodontist,Periodontist)
• Dental hygienist
• Laboratory Technician
• Patient

37. According to etiology
• Host factor
• Restorative factor
• Surgical factor
• Implant selection factor

38. • Host factor
• Medical status : Habits : Oral status

39. • HABITS
1) Smoking:
• Significance
• Causes alveolar vasoconstriction and decreased blood flow
• Impaired wound healing due to compromised
polymorphonuclear leucocytes function, increased platelet
adhesiveness as well as vasoconstriction caused by nicotine.
• Poor bone quality
• In case of poor oral hygiene, smokers have 3 times more
marginal bone loss then non-smokers
Recommendations:
• 1.Obtain a smoking history
• 2.Advice on risks of periodontal breakdown
• 3.Advice on the prognosis .Smoking cessation

40. Parafunctional habits:
• Bruxism is the multidirectional nonfunctional grinding of
teeth. Clenching occurs in one direction (vertically). Bruxism
is more aggressive. Attrition usually appears on the incisal
edges of anterior teeth.
Significance
• Most common cause of implant bone loss or lack of rigid
fixation during the first year after implant insertion.
• Commonly manifests as connecting screw loosening because
of overload.
• Failures are higher in maxilla because of decrease in bone
density.
• Forces are in excess of normal physiologic masticatory load
limit.( upto 1000 psi).

41. Prevention
• Increased number of implants to be placed
• Avoid cantilevers and occlusal contacts in lateral
excursions
• Use of occlusal splint which is relieved over the
implant.
• Use of wide diameter implant to provide greater
surface area.
• ( By Misch )

42. • ORAL STATUS:
• Suprabony connective tissue fibers
are oriented parallel to the implant
surface
• Susceptible to plaque accumulation
and bacterial ingress
• Spontaneous loss of the perimucosal
seal
• Chances of implant failure increases

43. Prevention
• It is recommended that the patient be recalled
frequently, preferably at a minimum of 3 months
intervals.
• Periodontal indices, bleeding on probing and
radiographic evaluation should be performed,
using plastic tipped probes for checking pocket
depths.
• Soft tissue debridement should be performed by
means of plastic curettes and plastic tips for
ultrasonic scalers, and topical and systematic
antimicrobial drugs should be used

44. • IRRADIATION THERAPY
Significance
• Xerostomia
• Susceptibility to infection
• Osteoradionecrosis
• Endarteritis of vessels causes decrease in oxygen supply
Prevention
• Waiting period of 9-12 month between radiation therapy and
implant treatment.
• Hyperbaric oxygen therapy – 20 treatments of 90 min. each at
2 to 2.4atm before surgery.
• Antibiotic regimen 3 days before (augmentin 500mg every 12
hrs).

46. • Off-axis placement (severe angulation)…
Problem
• Occlusal load lie at an angle
• Shear & tensile forces increases
• Chances of failure increases
Due to…
• A) Alveolar process resorption
• B) Unexperienced surgeon
• C) Improper surgical stent

47. Solutions
1) Prerestoring the implant position by grafting
2) To place the implant with an angulation.
3) To place angulated abutments.

48. • Lack of initial stability
• Due to oversized osteotomy
• Gap develop between implant & bone
• Lack of osseointegration
• In an experimental investigation, gaps in the range of
0.25 mm around CPTi implants healed, but with less
bone contact than the controls.
• When the gap size increased to 0.7mm-1.7mm, a
thin soft tissue layer was found to develop around
the implant

49. Solution
• Remove & reinsert the larger size implant.
• if not possible  remove insert graft
materialroll the implant moistened in blood
& saline & in the particulate slurry until thin
layer of slurry clings to it reinsert the implant

50. • Improper healing & infection because
of improper flap design
• No single flap design is optimal for implant surgery.
• But improper flap design  infection & bacterial
ingress chances of failure increases
• Note: basic surgical procedure, flap design ,
blood supply, visibility, access, primary closure
should be considered.

51. • Overheating the bone and exerting too
much pressure
• Excessive pressure Bone cell damage
Bone loss Connective tissue interface formed
Failure increases
• Inverse relationship b/w speed & heat
production
• Recommended speed- 2000 rpm with graded
series of drill size with external irrigation

52. • Placement of implant in immature bone
grafted site
• Minimum waiting period of grafted site…6-9 mth
• woven bone present before this period, which is
fastest formed bone (partly mineralized
&Unorganized)
• Not suitable for implant-bone integration
• Lamellar boneideal for implant prosthetic support

53. • Contamination of implant body before
insertion
•  non-titanium instrument
by glove powder
by the operatory error
By autoclaving the contaminated implant
• Bake the bacteria on implant surface
• Impossible for phagocytic cell to clean the surface
• No close adaptation to the bone

56. • Length of the implant..
• Misch proposed the range of 10mm-16mm
length.
• The success rate is proportional to the implant
length and the quantity and quality of
available bone. The rate of failure can be
expected to rise proportionately as the depth
of the bone diminishes to less than 10mm.
• The greater the crown implant ratio, the
greater the amount of the force with any
lateral force.
• This means that the implant with unfavorable
crown implant ratio will be more influenced
by lateral forces.
• Therefore, maximum implant length must be
used for the greatest stability of the overlying
prosthesis.

57. Width of the implant…
• Misch recommended that not less than 1 mm of
bone surrounding the fixture labially and lingually
is mandatory for the long term predictability of
dental implants because it maintains enough bone
thickness and blood supply.
• it is advisable to use a large- diameter implant in
accordance with the available bone width because
it offers greater surface area, greater mechanical
engagement of the cortical bone, and initial
rigidity.
• Using a wide implant in a narrow ridge results in
labial or lingual dehiscence that leaves the implant
affected by the damaging shear stresses.

58. Number of implants…
• Misch stated that the use of more implants
decreases the number of pontics and the
associated mechanics and strains on the
prosthesis, and dissipates stresses more
effectively to the bone structure.
• It also increases the implant bone interface and
improve the ability of the fixed restoration to
withstand forces.
• Contrary to this Smith et al correlated between
the increased number of implants and the high
failure rate caused by wound contamination
that might occur because of the long operating
time.

60. Excessive cantilevers
• Used implant-supported prosthesis.
• Mesial C. > Distal C
• Cantilever extensions cause load magnification and
overloading of the implant next to the cantilever extension,
which in turn leads to bone loss
• With occlusal forces acting on the cantilever, the implant
becomes a fulcrum and is subjected to rotational forces

61. • Amount of force increases if…
• Length of cantilever
• distance between implants
• crown height
• direction of force
• position of arch
Opposing arch
• ideally a denture
• no lateral forces on cantilever
• Not preferred ----moderate to severe
parafunctional habits

62. • Connecting implants to teeth
• Not preferred…
• Difference b/w implant & tooth movement in
vertical & lateral direction

63. • Solution…
• increase no. of implants
• improve stress distribution by splinting additional abutment
until 0 clinical mobility is observed.
• non-rigid connection – but chances of intrusion of the tooth
• Criteria…
• 1) no observable clinical mobility of natural abutment.
• 2) no lateral force should be designed on prosthesis.

64. Pier Abutments…
Main complication d/t difference of mobility of tooth &
implant
2 situations arise
…Tooth act as living pontic or
pontic with a root
…stress breaker –not indicated
Act as class 1 lever
Non rigid attachment

65. No passive fit
• One of the most critical elements affecting the
longterm success of a multiple implant restoration is
the passive fit between the framework and the
underlying fixtures.
• A passive fit reduces long term stresses in the
superstructure, implant components, and bone
adjacent to the implants.
• A poorly fitting implant framework can cause
mechanical complications such as loose screws or
fractured components.

66. • Improper fit of abutment…
• Improper locking b/w abutment-fixture interface
• Increased microbial population &
• increased strain on implant component
• Bone loss
• Rapid screw-joint failure

67. Improper occlusal scheme
• Important guidelines to follow
• Infraocclusion upto 30 microns of implant
supported restoration
• No balancing contacts on cantilevers.
• No guidance on single implants.
• Freedom in centric.
• Occlusal table directly proportional to implant
diameter.

68. • Narrow occlusal width.
• Implant length: crown-root ratio ideal – 1:2 , Acceptable –
1:1 for removable denture.
• Avoidance of cantilever length. Maximum 10 to 15 mm is
advised. 7 mm is optimum .
• Shallow central fossae with tripodal cuspal contacts.
• No contact in lateral excursion.
• Slight contact in centric occlusion.

69. • According to timing of failure

71. Injury to neurovascular bundle
• The posterior mandible in particular presents
significant challenge when severe atrophy leaves
little, if any bone superior to inferior alveolar
canal.
• The solution to limited space for posterior
mandible fixture placement includes detailed
initial treatment planning and careful surgery to
unroof the canal and move the neurovascular
bundle inferiorly prior to fixture installation

76. • According to failure mode
• Lack of Osseointegration
• Unacceptable Aesthetics
• Functional Problems
• Psychological problems

77. • Lack of Osseointegration……
• Adell et al proposed that lack of osseointegration
can be due to……
• Surgical trauma
• Perforation through covering mucoperiosteum
during healing
• Repeated overloading with microfractures of the
bone at early stages

78. • Functional problems……
• Proper function of the implants is dependent
on two main types of
• anchorage related and prosthesis related.
Anchorage related factor…
• Osseo integration
• Marginal bone height
Prosthesis related factor…
• Prosthesis design
• Occlusal scheme

79. • Aesthetic problem……
• Aesthetic outcome is affected by four factors:
• Implant placement
• Soft tissue management
• Bone grafting consideration
• Prosthetic consideration
• Psychological problems
• high expectations of the patient.

80. According to supporting tissue type
• Soft tissue problems
• Bone loss
• Both soft tissue and bone loss

81. • Soft tissue problems
• Gingival loss leads to continuous recession around the
implant with subsequent bone loss. This will lead to a soft
tissue type of failure.
• Significance of attached gingiva surrounding implants
• facilitates impression making.
• provide tight collar around the implant.
• prevent recession of marginal gingiva.
• prevent spread of inflammation to deep tissue.

82. • Ono,Nevin,Cappetta classified
keratinized gingiva based on
reflection of quantity & location in
mucogingival surgery during
implant placement
• Type 1- flap can be apically
positioned to increase the zone of
keratinized gingiva on facial side
• Type 2-minimum keratinized tissue
on ridge but little on facial aspect

83. • Type 3- no attached gingiva on the ridge or facial
aspect.
• A gingival graft which is apically postioned to
increase the Zone of attched gingiva.

84. Bone loss
• Bone functions as a support for the implant and that
any disturbance in its function may lead to eventual
loss of the implant
• Loss of marginal bone occurs both during the
healing period and after abutment connection
• Bone loss in mandible is higher during the healing
period.
• In maxilla, bone loss is higher after abutment
connection

85. • Factors that contribute to marginal bone loss:
• Surgical trauma such as detachment of the
periosteum and damage cased during
drilling
• Improper stress distribution caused by
defective prosthetic design and occlusal
trauma
• Physiological ridge resorption
• Gingivitis, which if allowed to progress
will lead to ingression of bacteria and their
toxins to the underlying osseous structures.

86. • Both soft tissue and bone loss
• If failure starts from soft tissue, then it usually is
considered to be due to a bacterial factor.
• However, if failure starts at the bone level, then it is
considered to be due to a mechanical factor.
• Both bone and soft tissue may be involved together.

87. PERI-IMPLANTITIS
• Progressive peri-implant bone loss in conjunction
with a soft tissue inflammatory lesion is termed
periimplantitis.
• Pathological changes of the peri-implant tissues can
be placed in the general category of peri-implant
disease. (Lang et al 1994)
• Two primary etiological factors
• 1. Bacterial infection
• 2. Biomechanical overload
• (Newman et al 1988, 1992, Rosenberg et al 1991)

88. • …Slight Horizontal bone
loss with minimal Peri-
implant defects.
• TREATMENT…Initial
therapy for removal of
etiological factors.
• Surgical therapy includes
cleaning the implant
surface, Pocket elimination
via Apicalpositioning of flap
• Moderate horizontal bone
loss with isolated vertical
defects.
• TREATMENT
• Initial therapy for removal
of etiological factors
• Surgical therapy includes
cleaning the implant
surface pocket
• Elimination and adjunctive
treatment using systemic
antimicrobials

89. • Moderate to advanced
horizontal bone loss with
broad, circular bony defects.
• TREATMENT
• …Initial therapy for
removal of etiological
factors
• …Surgical therapy includes
cleaning the implant surface
• …pocket elimination via
osseous regeneration and
adjunctive antibiotic
treatment
• Advanced horizontal bone loss
with broad circumferential
vertical defects as well as loss
of buccal and lingual bony
wall.
• TREATMENT
• .Initial therapy for removal of
etiological factors
• Surgical therapy includes
cleaningthe implant
surface,pocket elimination via
bone regeneration techniques,
possibly autologous bone
transplants with adjunctive
antibiotic therapy.

90. Fractured abutment screw
• Tip of the explorer is placed on the top portion of
the fractured abutment screw.
• With slight apical pressure and a counterclockwise
circular motion, the fragment can often be
unscrewed.
• Care must be taken not to damage the internal
threads of the implant.
• When Screw Fragment removed ,replace with
appropriate new abutment and screw. Verify
seating with a radiograph prior to final torque.
• Replace prosthesis and secure with new retention
screws.

91. Loose healing abutment
• Radiographic evaluation of a loose healing abutment.
• Removal of healing abutment Indicates a distorted screw
• Treatment: Replace with new healing abutment

92. Loose bars
• Radiograph confirms poor seating abutment.
• Clinical evaluation after removal of bar indicates
loose abutment screw.
• Diagnosis- possible loose or fractured abutment
screw

93. • Treatment:
• Retorque abutment screw.
• Abutment screw is tightened with abutment driver.
• Bar is then replaced and prosthetic screws are
torqued with appropriate screw driver.

94. LOOSE RESTORATION
• Radiographic Evaluation: Small
opening at abutment-implant
interface
• Diagnosis:Loose abutment screw
• Treatment:Loosen screw and remove
restoration
• inspect the implant hex for damage
• inspect the restoration for damage

95. (A) No Damage to fixture or restoration
• replace restoration and secure with
the same screw.
• Verify seating with radiograph prior
to final torque.
• Recheck occlusion
(B) Damaged fixture hex and or
restoration
• replace restoration and secure with
appropriate new screw.

96. Fixture loss
• (Must differentiate b/w “failing” and “failed”)
• Failing Implant
Clinical signs: progressive bone loss
• :soft tissue pockets and crestal bone loss
• :bleeding on probing with possible purulence
• :tenderness to percussion or torque forces
Causes: overheating of bone at the time of surgery or lack of
initial stability.
• :inadequate screw joint closure
• :functional overload
• :periodontal infection (peri-implantitis)
Treatment: Interim: remove prosthesis and abutments
• :irrigate with Peridex
• :ultrasonic and disinfect all components
• :reinsert assuring proper screw torque
• :recheck passive fit of framework and occlusion

97. Failed implants
• Clinical signs:
• Mobility…verify fixture mobility by removing
any abutments and superstructures first.
• A “Dull” percussion sound has been associated
with a failed implant.
• Peri-implant radiolucency can be a radiographic
finding often this is not evident on an X-ray

98. Causes:
• :surgical compromise (overheating bone and
initial lack of stability).
• :Inadequate screw joint closure
• :Too rapid initial loading
• :Functional overload
• :Periodontal infection (“peri-implantitis”)
Treatment
• :removal of the implant

99. Fractured implant fixture head
• Treatment:Eventual implant removal

100. Accidental swallowing or inhalation of
components and /or instruments
• Many implant components are as small as are
the instruments used for their manipulation.
• When coated with saliva a component may
escape the clinicians grip and fall into the
oropharynx, reflex swallowing may take the
component out of site almost immediately.
• Prevention
• Manual screwdrivers and similar instruments
should always be equipped with a safety line
of dental floss.(Minimum length of 10mm)

101. CONCLUSION
• Failure of implant is a multifactorial
occurrence.
• A combination of causes leads to ultimate
failure of implant. Every dentist needs to
identify the cause to treat the present
condition.
• Proper data collection, patient feedback,
and accurate diagnostic tools will help
point out the reason for failure. An early
intervention is always possible if regular
checkups are undertaken..

102. • The treatment strategy for complications
and failing implants is influenced by the
identification of the possible etiologic
factors.
• When a diagnosis is established and
possible etiologic factors identified, the
causative agent should be eliminated and
treatment attempted as soon as possible

103. REFERENCES
• Misch : Contemporary implant dentistry
• Failures in implant dentistry.W. Chee and S.
Jivraj. British Dental Journal 202, 123 - 129
(2007)
• Prashanti, et al. implant failures. Indian
Journal of Dental Research, 22(3), 2011.
• Kate MA, Palaskar S, Kapoor P. Implant
failure: A dentist's nightmare. J Dent Implant
2016;6:51-6.
• DCNA –Implant failures , Dent Clin N
Am.2015