Dental implants: Failure risks and promising developments
What causes implants to fail in some patients but not others? Periodontitis plays a role, as do lifestyle choices. New antimicrobial coatings could offer improved outcomes. Read more from Maria Perno Goldie, RDH, MS.
Dental implants are now used widely around the globe. However, questions about patient risk assessment prior to placing the implants still abound. What causes implants to fail in some patients but not others?
The placement of implants in a patient with periodontal disease would be one relevant concern. Researchers from Sweden performed a systematic review to determine if persons with periodontitis are more susceptible to peri-implantitis. (1) The scientists included 22 randomized and non-randomized clinical human studies. The conclusion was that an increased susceptibility for periodontitis may also confer an increased risk for implant loss, loss of supporting bone, and postoperative infection. They also state that the study results should be considered cautiously due to confounding uncontrolled factors. As dental implant placement concepts change, we should all be aware of the clinical implications of studies such as this one.
A recently published study discussed the effectiveness of implant treatment in a large patient population nine years after treatment. (2) They used a large and randomly selected patient sample, and concluded that patient characteristics and implant features affect results. They discovered that smokers and patients with an initial diagnosis of periodontitis were at higher risk of implant loss. Those with implants shorter than 10 mm and implants using particular brands of products also showed increased risk.
As a number of implants will develop crestal bone loss and peri-implantitis, varying treatments have been used to treat this condition, including surgically guided bone regeneration (GBR). The use of the laser has been purported to decontaminate implant surfaces. A recent research review in Clinical Advances in Periodontics asked: “In patients with endosseous dental implants that demonstrate peri-implantitis, does surgical bone augmentation with adjunctive laser implant surface disinfection have an effect on implant survival rates, and do these rates differ based on laser treatment modality?” (3)
The authors studied the effectiveness of lasers on implant survival rates. They wrote a report highlighting four articles. Results showed an improvement in clinical and radiographic outcomes for failing implants treated with both laser and GBR treatments. The articles used showed treatment with different laser protocols, making conclusions about the effectiveness of individual laser types not possible.
As mentioned in many previous RDH eVillage Focus newsletters, smoking has been proposed as a risk factor for implant failure. A 2014 study confirmed that placement of implants in smokers pointedly affected implant failure rates, the risk of postoperative infections, and marginal bone loss. (4) However, some good news is on the horizon. Scientists at the Leibniz Institute for New Materials (INM) have created antimicrobial, abrasionresistant coatings that kill bacteria and affect their adherence to surfaces, such as textiles and surfaces. (5) The coatings have substantivity and contain silver and copper colloids. The scientists demonstrated that the double microbicidal and biofilm-inhibiting action worked—“The new material can be applied to a variety of substrates such as plastic, ceramic or metal using conventional techniques such as spraying or dipping, and cures thermally or photochemically.” (6) Selective variation of the individual components allows the developers to react to the particular and different needs of potential users. Perhaps one day this coating can be used for dental implants!
READ MORE | Smoking gun
1. Chrcanovic BR, Albrektsson T, Wennerberg A. Periodontally compromised vs. periodontally healthy patients and dental implants: a systematic review and meta-analysis. J Dent. 2014;42:1509-27.
2. Derks J, Håkansson J, Wennström JL, Tomasi C, Larsson M, Berglundh T. Effectiveness of implant therapy analyzed in a Swedish population: Early and late implant loss. 2015;94(3 Suppl):44S-51S.
3. Geisinger ML, Holmes CM, Vassilopoulos PJ, Geurs NC, Reddy MS. Is laser disinfection an effective adjunctive treatment to bone augmentation for peri-implantitis? A review of current evidence. Clinic Adv Periodontics. 2014;4:274-9.
4. Chrcanovic BR, Albrektsson T, and Wennerberg A. Smoking and dental implants: a systematic review and meta-analysis [published online ahead of print March 14 2015]. J Dent. 2015. doi: 10.1016/j.jdent.2015.03.003.
5. INM - Leibniz-Institut für Neue Materialien gGmbH. Anti-microbial coatings with a long-term effect for surfaces. ScienceDaily. http://www.sciencedaily.com/releases/2015/01/150120085813.htm. Published January 20, 2015. Accessed March 30, 2015.
6. Anti-microbial coatings with a long-term effect for surfaces – presentation at nano tech 2015 in Japan. Leibniz Institute for New Materials website. http://www.inm-gmbh.de/en/2015/01/anti-microbial-coatings-with-a-long-term-effect-for-surfaces-presentation-at-nano-tech-2015-in-japan/. Published January 20, 2015. Accessed March 30, 2015.
Maria Perno Goldie, RDH, MS, is the editorial director of RDH eVillage FOCUS.