If we look at short-term failure, I think short term is initially lack of integration.
And so to work with a good specialist, to work with someone who is putting them in very well if you are not, is critical. A lot of times, we will take an X-ray and it looks like good integration, but we cannot see 360 degrees. So that is, I think, a reason for initial short-term failure.
Other reasons include:
- Poor bone quality
- Lack of initial healing
- Harmful forces can cause an implant to fail, either short-term or long-term
- Lack of adequate attached tissue
I just saw a patient this week where the extraction and the bone graft healed well, but there is not enough attached tissue. So we are going to have to follow up with a periodontal grafting procedure to get good attached tissue. I do not want to put an implant into movable tissue.
A lot of long-term failures are due to cement.
And so, at this point in time, I rarely cement an implant prosthesis, whether it is a single unit or whatever. I am doing screw-retained prosthesis, screw-retained units to prevent that.
Occlusal forces, obviously, are a reason for failures.
Utilizing a T-Scan to make sure that the force on the teeth is not excessive, either directly down or laterally. So to be sure that we have good occlusion, good disclusion and lateral excursions, and that the forces are the way we want them for the implant. I want my implant to come in at a little less timing than the teeth.
So on a T-Scan, you will see the teeth come in initially, and then the implant will come in a little later. And that is my ideal situation at this time with the knowledge I have and the studies we have. We have not quantified how much later, so I just use that to come in a little later. They can still hit as hard as the teeth when they squeeze really hard, but until then, I want it to follow the teeth.
Another reason for long-term failure would be just the general health of a patient.
Sometimes patients' health change and that can cause issues with long-term maintenance and long-term success of an implant. And then also hygiene maintenance. Patient have to understand they still need to come in for cleanings. They still need to come in regularly to maintain that and keep the healthiest mouth possible. So when I look at those kinds of things relative to implant failure, that is what I am always being careful of in my planning.