See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/291011647

Implant Failures—Diagnosis and Management

Article  in  International Journal of Clinical Implant Dentistry · August 2015

DOI: 10.5005/jp-journals-10004-1034

CITATIONS READS
4 8,397

6 authors, including:

Satyanarayana Raju Sruthima Gottumukkala

Vishnu Dental College Vishnu Dental College
20 PUBLICATIONS   57 CITATIONS    34 PUBLICATIONS   182 CITATIONS   

SEE PROFILE SEE PROFILE

M C Suresh Sajjan
Vishnu Dental College
70 PUBLICATIONS   449 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Dental Research View project

Face bow transfer in dentate individuals View project

All content following this page was uploaded by M C Suresh Sajjan on 17 February 2016.

The user has requested enhancement of the downloaded file.

 ijcid

Implant 10.5005/jp-journals-10004-1034
Failures—Diagnosis and Management
Review Article

Implant Failures—Diagnosis and Management

1
Satyanarayana Raju Mantena, 2Sruthima NVS Gottumukkala, 3Suresh Sajjan, 4A Rama Raju
5
Bheemalingeshwar Rao, 6Meenakshi Iyer

ABSTRACT compromises and complications, which are often very

Despite the high success rates and stability of dental implants, frustrating to the patients as well as dentists. Avoiding
failures do occur. While surgical trauma together with bone those conditions that contribute to poor results, choosing
volume and quality are generally believed to be the most cases that offer ideal surgical and prosthetic circum­
important etiological factors for early implant failures, the stances and scrupulously evading complex clinical chal­
etio­logy of late failures is more controversial. Early detection lenges can improve favorable outcome data substantially.
and treatment of early progressive bone loss around dental
Anticipating and diligently observing for implant fixture
implants by mechanical debridement, antimicrobial therapy,
and regenerative therapy are the keys for saving early failing and restoration failure are the first steps in managing and
implants. The decision-making tree should be aimed at assisting interdicting a declining clinical circumstance. Hence, it is
and simplifying the process of selecting the appropriate alter­ mandatory for every clinician to know, how and why the
native once a failure has occurred. failures occur and how best we can prevent them in order
Keywords: Dental implants, Implant failure, Osseointegration, to give the upcoming branch of dentistry a new horizon.
Risk factors, Smoking.
Implant Cumulative Success Rates
How to cite this article: Mantena SR, Gottumukkala SNVS,
Sajjan S, Rama Raju A, Rao B, Iyer M. Implant Failures— Criteria are required for the definition of implant success
Diagnosis and Management. Int J Clin Implant Dent 2015; vs loosening or failure. Various criteria have been pro­
1(2):51-59.
posed for the evaluation of implant success (Table 1).1-3
Source of support: Nil Cumulative success rates of dental implants are evaluated
Conflict of interest: None in years (Flow Chart 1) and are affected by many
factors.4 These include implant location in the upper or
INTRODUCTION lower jaw and its position in the dental arch, implant
type, diameter and length, prosthetic construction, and
Dentistry has undergone many changes during the past whether they are used for single tooth replacement or in
quarter century; however, no changes have been more an edentulous month.5 In 1978, the National institute of
profound than those in the field of implant dentistry. health recommended the following criteria for removal
As the patient population able to benefit from implant of a dental implant: (1) chronic pain, (2) significant
therapy increases, the clinician is faced with increasingly movement, (3) infection, (4) significant progressive loss
complex options. Though the success rates reported with of supportive bone, (5) intolerable dysthesia (anesthesia
this form of therapy are relatively high, failures do occur. or paresthesia), (6) Oroantral or oronasal fistulae,
Hence, a thorough knowledge regarding the various (7) bone fracture, (8) psychological or other significant
aspects of failure is deemed necessary. medical problems, (9) uncorrectable implant breakdown,
Difficulties can arise in any area of biological func­ (10) possible irreversible damage to adjacent teeth, and
tion; however, implant dentistry has been fraught with (11) cosmetic problems (Flow Chart 2).

RISK FACTORS FOR DENTAL IMPLANTS

1,2,5
Reader, 3Professor and Head, 4Professor, 6Senior Lecturer Dentist-related Risk Factors
1,3-5
Department of Prosthodontics, Vishnu Dental College
Bhimavaram, Andhra Pradesh, India Preoperative Factors
2
Department of Periodontics, Vishnu Dental College, Bhimavaram Various radiographic methods have been used for the
Andhra Pradesh, India diagnostic evaluation of bone quality and quantity as
6
Department of Prosthodontics, JSS Dental College, Mysore well as treatment planning, which include periapical
Karnataka, India radiographs, the panoramic radiographs, computed
Corresponding Author: Satyanarayana Raju Mantena, Reader tomography, and magnetic resonance imaging. However,
Department of Prosthodontics, Vishnu Dental College, Vishnupur it has been reported that conventional intraoral radio­
Bhimavaram-534 202, West Godavari District, Andhra Pradesh
graphs are associated with an approximately 14% magni­
India, Phone: 9492293809, e-mail: [email protected]
fication, and panoramic radiographs with approxi­mately
International Journal of Clinical Implant Dentistry, May-August 2015;1(2):51-59 51
Satyanarayana Raju Mantena et al

Table 1: Criteria for evaluation of implant success Flow Chart 1: Cumulative success rates of dental implants
The US National • Bone loss no greater than one-third
Institutes of of the vertical height of the implant
Health 19781 • Good occlusal balance and vertical
dimension
• Gingival inflammation amenable to
treatment
• Mobility of less than 1 mm in any
direction
• Absence of symptoms and infection
• Absence of damage to adjacent teeth
• Absence of paresthesia or anesthesia
or violation of the mandibular canal,
maxillary sinus or floor of the nasal
passage
• Healthy collagenous tissue without
PMNs
• Provision of functional service for
25% magnification.6 X-ray magnifications may thus lead
5 years in 75% of the cases
to mistakes in planning and in performance of dental
Albrektsson et al • Implants are clinically immobile
19862 • A radiograph not demonstrating implantations, making special methods necessary to
any evidence of peri-implant correct for eventual magnification which will enable
radiolucency recording of exact anatomical measurements (Flow
• Vertical bone loss less than 0.2 mm
annually following the implant’s first Chart 3).
year of service
• Individual implant performance to Peroperative Factors
be characterized by an absence of
persistent and irreversible signs and Overheat, which is produced by friction from high
symptoms, such as pain, infections, torque equipment, damages the implant bone bed and
neuropathies, paresthesia, or
contributes to early-stage failure of implants. About 3.6%
violation of the mandibular canal
• Success rate of 85% at the end of a of implant failures have been estimated to be related to
5-year observation period and 80% surgical trauma.7 Secondly, a non-ideal position for the
at the end of a 10-year period to be dental implant may subject it to non-axial loading during
the minimum criterion for success
mastication. This increases risk for implant fractures
The American • Absence of persistent signs/
Academy of symptoms, such as pain, infection, and peri-implant bone fractures, which usually occurs
Periodontology neuropathies, paresthesias, and in the posterior region that is subjected to a high load,
20003 violation of vital structures in particular if the patient has comparatively low bone
• Implant immobility
• No continuous peri-implant
density in this region. Hollow implants lead to increased
radiolucency implant fracture rates if the implant is too small in
• Negligible progressive bone loss diameter. This usually happens with the use of two-stage
(less than 0.2 mm annually) after
external hex screw-type implant systems. Selection of
physiologic remodeling during the
first year of function too-short implants may also increase the failure rate.7
• Patient/Dentist satisfaction with the Thermally-induced bone necrosis is a rare pheno­
implant-supported restoration menon and is one of the causes of early implant failure.
Flow Chart 2: Implant quality assessment scale

52
 ijcid

Implant Failures—Diagnosis and Management

Flow Chart 3: Risk factors for dental implant failure

The frictional heat generated at the time of surgery causes materials leads to implant failure initiated by adverse
a certain degree of necrosis of the surrounding differen­ host tissue responses.11 The implant surface coatings
tiated and undifferentiated cells, thereby representing a comprise titanium oxide (TiO2) coating, ceramic coating,
significant risk for the failure of bone integration. It was or diamond coating.11,12 Biodegradable ceramic coating
established that the temperature threshold level for bone may have the best future prospects. Most dental implant
survival during implant site preparation is 44 to 47°C, materials presently used in clinics are quite biocompatible
and with a drilling time of less than 1 minute.7,8 Since in human tissues in their specific dental application.
then, several studies have been performed both in vivo They are usually made of titanium, titanium-aluminum-
and in vitro for investigating this issue. In vivo studies vanadium (Ti-6Al-4V), cobalt-chromium-molybdenum,
have demonstrated the harmful role of heat production in and more rarely of other alloys.13,14
subsequent bone healing and the critical temperature that Dental implant materials have been remarkably
the bone can tolerate without necrosis.7 In vitro studies improved in the past half century to meet all kinds
have revealed the factors that affect heat generation by of demands. However, research and development are
simultaneously comparing one or two factors.8 However, needed to develop even more biocompatible and func­
few case reports describing implant failure due to bone tional materials to prevent implant failures and to prolong
overheating have been published. implant life in service.

Postoperative Factors Implant Position Related

Improper design and guidance of the crown contribute to The most common type of failure is caused by poor
failure. Too high a cusp or too high an occlusal alignment treatment planning and/or poor surgical execution. The
can increase occlusal loading to an unacceptable level. The incidence of this type of failure has been estimated at 10%;
crown can also contribute to too-wide contact between the however, if more stringent criteria are applied it is likely
counter tooth and the implant, which leads to high occlusal to be higher. This type of failure can easily be avoided
load of the implant in bone. Occlusal forces contribute to with proper treatment planning, proper site development,
implant fractures and peri-implant bone fractures. Crown use of surgical guides and a good understanding of the
width, cusp height, guidance, and occlusal alignment can restorative aspects of implant dentistry by the surgeon.15,16
all be used to control occlusal forces.9 Malposition of the implant can lead to biomechanical
problems to the screw joint, or in severe situations to the
Implant-related Risk Factors implant itself, due to overload.

Dental Implant Material and

Host-related Factors
Surface Characteristics
Host-related factors can be divided into local and systemic
The ideal dental implant material should be: (1) bio-
risk (prognostic) factors.
com­patible, (2) of appropriate rigidity for prosthetic
function, (3) intimately adaptable to both bone and
Local Risk Factors
gingiva surrounding the implant, (4) functionally able
to dissipate forces resulting from occlusal load on the Bone quality and quantity: The most important local patient
prostheses supported by the implant to the underlying factor for successful implant treatment is the quality and
bone, and (5) resistant to the large and diverse peri- quantity of bone available at the implant site. Patients
implant microbial load.10 Use of bioincompatible implant with low quantity and low density of bone were at highest
International Journal of Clinical Implant Dentistry, May-August 2015;1(2):51-59 53
Satyanarayana Raju Mantena et al

risk for implant loss. Jaffin and Berman,17 in their 5-year Smoking as a Risk Factor for Implant Failure
analysis, reported that as many as 35% of all implant
Studies suggest that smokers have an increased preva­
failures occurred in type IV bone due to its thin cortex,
lence of periodontal diseases, tooth loss and oral
poor medullary strength, and low trabecular density.
cancer.26 There are several studies associating implant
Systemic osteoporosis has also been mentioned as a
failures with smoking.26-29 Bain and Moy suggested
possible risk factor for osseointegration failure. In the that smoking caused both systemic and local injury to
study conducted by Dao et al, local rather than systemic the tissues and is a common contributor to decrease
bone density seemed to be the predominant factor.18,36 tissue oxygenation, which negatively affects wound
Irradiated bone: Implants can be used to provide anchorage healing.28 Nicotine, presenting the main element of
for craniofacial prostheses. Radiotherapy in combination cigarette, reduces proliferation of red blood cells (RBCs),
with surgical excision is the treatment generally macrophages, and fibroblast, which are the main element
employed for malignant tumors in that region, and of healing. 28 It also increases platelet adhesiveness
osteo­radionecrosis is one of the oral effects of radiation which can lead to poor perfusion due to microclots.
therapy. Although radiation therapy is not an absolute It also acts as sympathomimetics by increasing the
contraindication to implant treatment, the reported release of epinephrine and nor epinephrine, and causes
increased vasoconstriction which limits over all tissue
success rate is only about 70%. Long-term studies are
perfusion. These all studies hypothesized that smoking
limited, but Jacobsson et al showed increasing implant
compromises wound healing.
loss over time.19
Bain and Moy were the first to evaluate the influence
Biomechanical occlusal loading: Even well-performed and of smoking on the failure rate of dental implant.28 They
optimally occlusally restored dental implants tend to lead compared the results between smokers and nonsmokers
to peri-implant bone loss. Dental implants lack the stress patients in which implants were placed. They found an
receptors located in the tensional periodontal ligament overall failure rate of 5.92%, and specifically implant
tissue in natural teeth, and their stomatognathic sensor failure in smokers was 11.28% as compared to 4.76%
system is less sensitive than that of healthy teeth.20 in nonsmokers. Bain did a prospective study which
Therefore, due to non-optimal load protection and force- constituted 223 consecutive Branemark implant placed
absorbing and distributing systems, a dental implant is in 78 patients. Patients were divided into three groups:
subjected to implant micromotion ranging from 50 to nonsmokers (NS), smokers cessation protocol (SQ), and
150 micrometers.21 It has been concluded that occlusal smokers who continued smoking (SNQ).30 He found that
loading strains the hard peri-implant bone because there was statistically significant difference between
implants lack the protective periodontal ligament system. failure rate in NS and SNQ group (p < 0.005), and between
The relationship of displacement and implant loading SQ and SNQ group (p < 0.5), but none between NS and
continues to be almost linear, without a smoothing or SQ groups.
break in the curve after the first moving stage, as is seen A study tested the hypothesis that interrupted
in natural teeth. cigarette smoke inhalation would reverse the bone quality
High mechanical loading leads to increased bone around implant and found that smoking may affect bone
resorption. Osteocytes increase their collagenase-1 quality in cancellous bone and smoke cessation could
[Matrix metalloproteinase-1 (MMP-1)] production under result in a return toward the level of control group.31
With only few studies failing to establish a significant
mechanical load, which may initiate bone resorption.22,23
result on the smoking effects on implants, Studies suggest
The MMP-1 degrades bone type I and III collagens, the
smoking as the factor associated with complications
main structural collagen of bone. Tartrate-resistant acid
like marginal bone loss, peri-implantitis, bone quality,
phosphatase and cathepsin K increase in osteoclasts
and quantity, which in turn affect the implant success
during mechanically-induced bone resorption.24 The
rate. In fact, success rate of dental implant is found to be
occlusal overload may result in progressive bone loss
twice in nonsmokers as compared to smokers and that
around the implant, thus leading to the failure of the
too maxillary implant is more affected.28
implant. The implants which suffer from traumatic failure
have subgingival microflora resembling that which is
Para-functional Habits and Bruxism
present in a state of periodontal health, with cocci and
nonmotile rods as the predominant morphotypes, i.e. Para-functional habits and bruxism are very common
Streptococcous and Actinomyces species as the predominant occlusal diseases. Heavy occlusal forces constitute a risk
microflora.25 factor for loosening of dental implants. Metal fatigue and

54
 ijcid

Implant Failures—Diagnosis and Management

implant fractures occur more frequently in these patients osteoporosis by increasing bone resorption via stimulation
than in controls.32 More than 77% of all implant fractures of osteoclastogenesis.39 Other drugs with deleterious
have been reported to occur in patients who have signs effects on bone include chemotherapeutic agents, such as
and a history of chronic bruxism.33 Para-functional habits doxorubicin and methotrexate, which inhibit osteoblasts
are also related to increased peri-implant bone loss.34 and diminish bone formation. Implants are often used in
cancer-surgery patients. In oral cancer patients, however,
Systemic Factors tumor resection is usually combined with irradiation,
Systemic factors affect both the quality and quantity of which locally impairs bone quality and impairs the
bone, which constitute important prognostic factors for prognosis of dental implants in the long-term. In one
dental implant survival. These systemic factors comprise study, irradiation had no effect on implant success rate
poorly controlled diabetes, osteoporosis, osteomalacia, in the short-term.
irradiation and medications.35
Age
Diabetes Mellitus Theoretically, patients with increased age will have
Diabetic lesions involve bone, gingival, and vascular more systemic health problems, but there is no scientific
tissues.35 The disease is thought to suppress collagen evidence correlating old age with implant failure.
synthesis, and it increases the expression of MMPs. The
Parameters Used for Evaluating
activities of MMP-8 and MMP-9 in saliva correlate with
Failing/Failed Implants
clinical periodontal findings, such as gingival bleeding
and pocket depth. The MMP-8 and -9 act cooperatively While it is possible to clearly differentiate between a
in degradation of type I collagen in gingival and bone successful and a failed implant, it still remains difficult
tissues. These conclusions have been confirmed in a rat to identify failing implants. The parameters which have
model. Although most studies of diabetic lesions have been employed clinically to evaluate implant conditions
been focused on periodontitis, diabetes mellitus has were discussed by Esposito et al, with the attempt to
also been considered a risk factor and occasionally even identify the most reliable ones.40 The ideal parameter
a contraindication for performing dental implantations. for monitoring implant conditions should be sensitive
Recently, it has been reported that dental implants in enough to distinguish early signs of implant failure. The
diabetes are successful, at least in the short-term.36 following parameters have, therefore, been proposed.

Osteoporosis Clinical Signs of Early/Late Infection

Osteoporosis is a very common disease, with the A progressive marginal infection can lead to implant
number of elderly people affected increasing. The main failure. However, clinical signs of infection, such as
patho­logical features of osteoporosis are low bone hyperplastic soft tissues, suppuration (spontaneous, on
mass and a microarchitectural deterioration of bone probing or under pressure), swelling, fistulation, color
leading to fragility, and then to an increased fracture changes of the marginal peri-implant tissues, etc., are
risk. The multiple pathogenic factors related to osteo­ signs which call for intervention. In the absence of mobility
porosis comprise genetic predisposition and subtle and radiographic changes, these signs indicate more a
alterations in systemic and local hormones, together with complication (amenable to treatment) than a failure.40
environmental influences.37 Currently, research interest Mobelli et al compared clinical and microbiological
is focused on the role of cathepsin K in the degradation finding related to healthy and failing dental implants.
of bone matrix in osteoporosis.37 Both the maxilla and Unsuccessful implant sites were characterized by probing
mandible can be affected by osteoporosis, which has depths 6 mm or greater, suppuration, bone loss, and micro-
been considered a risk factor for implant failures and biota consisting primarily of Gram negative anaerobic
periodontal diseases. The local bone quality of the rods.41 Becker et al reported that failing implants showed
implantation bed is a more sensitive prognostic factor evidence of increased mobility and a high incidence of
in this respect than that of peripheral bone, in general, peri-implant radiolucencies.38
in osteoporosis patients.38 Implants in osteoporosis have
been successful in the short-term, but long-term results Bleeding on Probing
have not been reported. Bleeding on probing has been employed to measure
peri-implant tissue conditions. However, recent findings
Medication and Irradiation Therapy
suggest that it cannot be used to discriminate between
Some medications widely used in clinics cause bone a healthy or diseased peri-implant state and it does not
loss. In particular, glucocorticosteroids cause iatrogenic have a scientific support.40
International Journal of Clinical Implant Dentistry, May-August 2015;1(2):51-59 55
Satyanarayana Raju Mantena et al

Probing Depths to implant failure. Adell et al determined that the mean

bone loss for Branemark osseointegrated implants is 1.5 mm
Probing depths around teeth is an excellent proven means
for the first year, followed by a mean bone loss of 0.1 mm
to assess the past and present health of natural teeth, but
per year.1 This value was confirmed by Cox and Zarb with
it may be of little diagnostic value, unless accompanied by
their 3-year report showing a mean bone loss of 1.6 mm
signs (e.g. radiographic radiolucencies, purulent exudate,
for the first year and a mean of 0.13 mm in subsequent
bleeding) and/or symptoms (e.g. discomfort, pain). The
benefit of probing the implant sulcus has been challenged years.11 There can be two well-distinct radiographic
in the literature, because sound scientific criteria are pictures: a thin peri-fixtural radiolucency surrounding
lacking. Increasing probing depths over time may the entire implant, suggesting the absence of a direct
indicate bone loss, but not necessarily indicate disease bone-implant contact and possibly a loss of stability, and
for an endosteal implant. an increased marginal bone loss. Since, the distinction
Sulcus depths greater than 5 to 6 mm around implants between the two radiographic pictures is not always clear,
have a greater incidence of anaerobic bacteria and may when a suspected peri-fixtural radiolucency or excessive
require intervention in the presence of inflammation marginal bone loss is observed, it is recommended
or exudate (e.g. surgery, antibiotic regimens). Probing to remove the prosthetic construction and cheek the
not only measures pocket depth, but also reveals tissue implants for stability. Clinically discernible mobility
consistency, bleeding, and the presence of exudate. It is after bridge removal can confirm the presumptive radio­
of benefit to probe and establish a baseline measurement graphic diagnosis of implant failure.
after the initial soft tissue healing around the permucosal
Dull Sound at Percussion
aspect of the implant. Increases in this baseline measure­
ment over time most often represents marginal bone loss. It has been suggested that a subdued sound upon percus­
sion is indicative of soft tissue encapsulation, whereas a
Pain or Sensitivity clear crystallization sound indicates successful osseointe­
Subjective findings of pain or tenderness associated with gration.40 Although it is a rather subjective test without
an implant body are more difficult to assess than these a solid scientific background, it can provide a useful
conditions with natural teeth. Once the implant has indi­cation to the examiner.
achieved primary healing, absence of pain under vertical
or horizontal forces is a primary subjective criterion. Methods of Implant Removal
Pain should not be associated with the implant after A mobile implant may easily be removed by rotating it
healing. When present, it is more often an improper fitting counter clockwise using a driver, counter-torque ratchet
prosthetic component, or pressure on the soft tissue from technique (CTRT), or forceps. Rotating with minimum
the prosthesis. Percussion and forces up to 500 gm (1.2 psi) luxation allows reduced trauma and damage to the
may be used clinically to evaluate implant pain or surrounding bone and soft tissue. Methods of immobile
discomfort. Pain during function from an implant body is implant removal include: use of counter torque ratchets,
a subjective criterion that places the implant in the failure screw removal devices, piezo tips, high-speed burs,
category. Sensitivity from an implant during function elevators, forceps and trephine burs.
may place the implant in the survival criteria, and may The CTRT is the least invasive technique for removing
warrant some clinical treatment. an implant without damaging surrounding structures.
The use of CTRT should be considered only if the implant
Clinical Discernible Mobility
is able to be engaged and reverse-torqued until mobile.
Mobility is always a clear sign of failure. Once the clini­ The reverse screw technique (RST) is indicated in the
cian has distinguished between the mobility of a poorly removal of a fractured implant when the connection is
connected abutment and the mobility of the underlying damaged or in the removal of an external connection
implant, the implant must be suspected to be surrounded implant when the ratchet cannot be engaged to use the
by a fibrous tissue capsule. Occasionally, clinically discer­ CTRT. Piezo tips and high speed burs can be used in
nible mobility can be present without distinct radio­ conditions where CTRT and RST are not useful to loosen
graphic bone changes. Therefore, mobility is the cardinal the abutment (Flow Chart 4).
sign of implant failure.40
Treatment Alternatives Following Removal of
Radiographic Signs of Failure Failed Implants
There seems to be unanimous consensus that progressive The literature pertaining to treatment alternatives follow­
marginal bone loss is a pathological sign, which can lead ing the loss of dental implants could best be descri­bed as

56
 ijcid

Implant Failures—Diagnosis and Management

Flow Chart 4: Methods of implant removal

negligible. The decision as to which of these alternatives failures, the etiology of late failures is more controversial.
should be selected is complex and involves both biologic Early detection and treatment of early progressive bone
and mechanical considerations, as well as psychological loss around dental implants by mechanical debridement,
aspects with financial considerations being a silent partner. anti­microbial therapy, and regenerative therapy are the
The treatment of choice should be a team decision with keys for saving early failing implants.
the surgeon, restoring clinician and patient having an A lost dental implant constitutes an ever-growing
equal say in the final outcome (Flow Chart 5). problem in clinical practice, one which is likely to inten­
sify in the coming years since, the number of implants
placed annually is still growing. The decision-making
CONCLUSION
tree should be aimed at assisting and simplifying the
Despite the high success rates and stability of dental process of selecting the appropriate alternative once a
implants, failures do occur. While surgical trauma toge­ther failure has occurred. Failure of dental implants should
with bone volume and quality are generally believed to be perceived as part of the overall risk and consequences
be the most important etiological factors for early implant of modern dentistry.
Flow Chart 5: Treatment alternatives following removal of failed dental implants

International Journal of Clinical Implant Dentistry, May-August 2015;1(2):51-59 57

Satyanarayana Raju Mantena et al

REFERENCES bone. Histologic and clinical study. Ann Otol Rhinol Laryn­
gol 1988;97:377-340.
1. National institutes of health consensus Statement. Dental 20. Wiskott HW, Belser UC. Lack of integration of smooth
Implants: Benefit and Risk. 1978 Available from: http:// titanium surfaces: a working hypothesis based on strains
consensus.nih.gov/1978/1978DentalImplants003html.htm. generated in the surrounding bone. Clin Oral Implants Res
2. Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long- 1999;10(6):429-444.
term efficacy of currently used dental implants: a review and 21. Mühlemann HR. Tooth mobility: a review of clinical aspects
proposed criteria of success. Int J Oral Maxillofac Implants and research findings. J Periodontol 1967;38(6):686-713.
1986;1(1):11-25. 22. Redlich M, Reichenberg E, Harari D, Zaks B, Shoshan S,
3. Iacono VJ, Committee on research, science and therapy, the Palmon A. The effect of mechanical force on mRNA levels
American academy of periodontology. Dental implants in of collagenase, collagen type I, and tissue inhibitors of
periodontal therapy. J Periodontol 2000;71(12):1934-1942. metallo­proteinases in gingivae of dogs. J Dent Res 2001;80(12):
4. Smith DE, Zarb GA. Criteria for success of osseointegrated 2080-2084.
endosseous implants. J Prosthet Dent 1986;62(5):567-572. 23. Holliday LS, Welgus HG, Fliszar CJ, Veith GM, Jeffrey JJ,
5. O’Roark WL. Improving implant survival rates by using a Gluck SL. Initiation of osteoclast bone resorption by inters­
new method of at risk analysis. Int J Oral Implantol 1991; titial collagenase. J Biol Chem 1997;272(35):22053-22058.
8(1):31-57. 24. Kurata K, Uemura T, Nemoto A, Tateishi T, Murakami T,
6. Abouzgia MB, James DF. Temperature rise during drilling Higaki H, Miura H, Iwamoto Y. Mechanical strain effect on
through bone. Int J Oral Maxillofac Implants 1997;12(3):342-353. bone-resorbing activity and messenger RNA expressions of
marker enzymes in isolated osteoclast culture. J Bone Miner
7. Ericsson I, Nilner K. Early functional loading using Brane­
Res 2001;16(4):722-730.
mark dental implants. Int J Periodontics Restorative Dent
25. Hultin M, Gustafsson A, Hallström H, Johansson LA,
2002;22(1):9-19.
Ekfeldt A, Klinge B. Microbiological findings and host
8. Albrektsson T. Is surgical skill more important for clinical
response in patients with peri-implantitis. Clin Oral Implants
success than changes in implant hardware? Clin Implant
Res 2002;13(4):349-358.
Dent Relat Res 2001;3(4):174-175.
26. Lin TH, Chen L, Cha J, Jeffcoat M, Kao DW, Nevins M,
9. O’Mahony A, Bowles Q, Woolsey G, Robinson SJ, Spencer P. Fiorellini JP. The effect of cigarette smoking and native bone
Stress distribution in the single unit osseointegrated dental height on dental implants placed immediately in sinuses
implant: finite element analyses of axial and off-axial loading. grafted by hydraulic condensation. Int J Periodontics Resto­
Implant Dent 2000;9(3):207-218. rative Dent 2012;32(3):255-261.
10. O’Sullivan D, Sennerby L, Meredith N. Measurements 27. Palma-Carrio C, Maestre-Ferrin L, Penarrocha-Oltra D,
comparing the initial stability of five designs of dental Penarrocha-Diago MA, Penarrocha-Diago M. Risk factors
implants: a human cadaver study. Clin Implant Dent Relat associated with early failure of dental implants. A literature
Res 2000;2(2):85-92. review. Med Oral Patol Oral Cir Bucal 2011;16(4):514-517.
11. Santavirta S, Nordstrom D, Ylinen P, Konttinen YT, 28. Bain CA, Moy PK. The association between the failure of
Silvennoinen T, Rokkanen P. Biocompatibility of hydroxy­ dental implants and cigarette smoking. Int J Oral maxillo­
apatite-coated hip prostheses. Arch Orthop Trauma Surg facial Implants 1993;8(6):609-615.
1991;110(6):288-292. 29. Balshe AA, Eckert SE, Koka S, Assad DA, Weaver AL.
12. Aspenberg P, Anttila A, Konttinen YT, Lappalainen R, The effects of smoking on the survival of smooth‑.and
Goodman SB, Nordsletten L, Santavirta S. Benign response rough‑surface dental implants. Int J Oral Maxillofacial
to particles of diamond and SiC: bone chamber studies of new Implants 2008;23(6):1117-1122.
joint replacement coating materials in rabbits. Biomaterials 30. Bain CA. Smoking and implant failure‑benefits of a smoking
1996;17(8):807-812. cessation protocol. Int J Oral Maxillofac Implants 1996;
11(6):756-759.
13. Lacefield WR. Hydroxyapatite coatings. Ann N Y Acad Sci
31. Cesar-Neto JB, Benatti BB, Sallum EA, Nociti FH Jr. Bone
1988;523:72-80.
density around titanium implants may benefit from smoking
14. Lumbikanonda N, Sammons R. Bone cell attachment to
cessation: a histologic study in rats. Int J Oral Maxillofac
dental implants of different surface characteristics. Int J Oral
Implants 2005;20(5):713-719.
Maxillofac Implants 2001;16(5):627-636.
32. Wahlström M, Sagulin GB, Jansson LE. Clinical follow-up
15. Salama H, Salama MA, Li TF, Garber DA, Adar P. Treatment of unilateral, fixed dental prosthesis on maxillary implants.
planning 2000: an esthetically oriented revision of the Clin Oral Implants Res 2010;21(11):1294-1300.
original implant protocol. J Esthet Dent 1997;9(2):55-67. 33. Engel E, Gomez-Roman G, Axmann-Krcmar D. Effect of
16. Garber DA. The esthetic dental implant: letting restoration occlusal wear on bone loss and periotest value of dental
be the guide. J Am Dent Assoc 1996;22(1):45-50. implants. Int J Prosthodont 2001;14(5):444-450.
17. Jaffin RA, Berman CL. The excessive loss of Branemark 34. Misch CE. The effect of bruxism on treatment planning for
fixtures in type IV bone: a 5-year analysis. J Perio­dontol dental implants. Dent Today 2002;21(9):76-81.
1991;62(1):2-4. 35. Roberts WE, Simmons KE, Garetto LP, DeCastro RA. Bone
18. Dao TT, Anderson JD, Zarb GA. Is osteoporosis a risk factor physiology and metabolism in dental implantology: risk
for osseointegration of dental implants? Int J Oral Maxillofac factors for osteoporosis and other metabolic bone diseases.
Implants 1993;8(2):137-144. Implant Dent 1992;1(1):11-21.
19. Jacobsson M, Tjellstrom A, Thomsen P, Albrektsson T, 36. Olson JW, Shernoff AF, Tarlow JL, Colwell JA, Scheetz JP,
Turesson I. Integration of titanium implants in irradiated Bingham SF. Dental endosseous implant assessments in a

58
 ijcid

Implant Failures—Diagnosis and Management

type 2 diabetic population: a prospective study. Int J Oral 39. Canalis E, Delany AM. Mechanisms of glucocorticoid action
Maxillofac Implants 2000;15(6):811-818. in bone. Ann N Y Acad Sci 2002;966:73-81.
37. Lazner F, Gowen M, Pavasovic D, Kola I. Osteopetrosis and 40. Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological
osteoporosis: two sides of the same coin. Hum Mol Genet factors contributing to failures of osseointegrated oral
1999;8(10):1839-1846. implants. II. Etiopathogenesis. Eur J Oral Sci 1998;106(3):
38. Becker W, Hujoel PP, Becker BE, Willingham H. Osteoporosis 721-764.
and implant failure: an exploratory case-control study. J 41. Mombelli A, Long NP. The diagnosis and treatment of peri-
Periodontol 2000;71(4):625-631. implantitis. Periodontal 2000 1998;17:63-76.

International Journal of Clinical Implant Dentistry, May-August 2015;1(2):51-59 59

View publication stats