Implant dentistry has become extremely predictable. However, we must pay attention to some very non-forgiving principles if we hope to create stable, long lasting results for our implant patients. I call these the “Seven Deadly Sins”. Each one, on its own, can jeopardize even the best implant surgery.
Site Selection and Guided Surgery
It has been shown that the quality and quantity of bone available at the implant site determines it’s success. CBCT permits more than diagnosis, it facilitates guided placement. Guided placement is quickly becoming the standard of care. It provides the protection needed to insure the long term health of a well chosen implant site.
Patient Related Factors
Patient related factors such as smoking, diabetes, susceptibility to periodontal disease and oral hygiene can all contribute to marginal bone level changes. The type of tissue that surrounds the implant is equally important. Implants emerging through keratinized attached tissue are better prepared to resist peri-implantitis.
The restorative dentist should be leading the implant treatment planning. The collective effort of the implant team always comes back to the restoring dentist. Failing to plan with the end in mind for every implant restorative procedure can undermine success and make it impossible to recover.
Inadequate Restorative Space
This knowledge clearly falls in the hands of the restorative dentist. He is responsible for the final restoration and it’s long term success. Not having enough restorative space to accomplish the desired restoration is clearly one of the deadly sins of implant failure.
The internal connection of abutments to the implant have greatly increased our ability to close the micro-gap and reduce the incidence of the abutment working loose over time. Don’t limit success by choosing aftermarket or clone abutments. Stay within the implant company's recommended components and avoid unseen error. It could result in premature failure to the abutment connection or even worse, cause implant fracture.
Residual cement is responsible for peri-implantitis or even implant failure. Screw retained restorations are becoming the standard of care because of this one deadly sin. If you choose to go cement retained you must have exact protocols and be a meticulous operator or your implant cases will suffer the consequences of overlooked residual cement.
Occlusal loading of an fully integrated implant can be the point of success or failure long term. Implant stability can quickly be lost if not introduced into a healthy occlusal environment: an environment where stress is minimized by good anterior guidance, posterior disclusion and good centric stops. Light occlusal stops on implant teeth need routine adjustment to maintain proper occlusal timing with the natural dentition. Occlusal overload and lateral interferences will quickly show signs of bone loss around the implant.
There are many ways implants can fail.
We have the best chance for success when the implant team is fully engaged and planning together. Collaboration allows us the opportunity to remind ourselves not to fall victim of these “Seven Deadly Sins”. Remember, we are always better together!