article - review

Question 1

situations that could increase implant failure rate

Answer 1

• low insertion torque of implants that are planned to be immediate or early loading
• inexperienced surgeons
• implants insertinginto maxilla
• implants in posterior regions
• heavy smokers
• into bone qualities of type III and IV
• small bone volumes
• shorter length implants
• greater # placed in patient
• lack of stablity
• non-threading / cylindrical implants
• prosthetic rehabilitation with implant supported over dentures

Question 2

following situations
may be correlated with an increase in the implant
failure rate

Answer 2

• non-submerged technique
• immediate loading
• implant insertion into fresh extraction sockets
• smaller diameter

Question 3

two major contribting factors to loss / failure irrespective of placement protocol

Answer 3

smokers and short implants

Question 4

Marginal bone loss has been demonstrated to be

initiated by

Answer 4

poor clinical handling, use of poor
implant designs or by treating complicated patients.

a later stage patient disease, rapidly changing loading situations or reactions to cement particles accidentally embedded in the soft tissues represent other
reasons for start of bone loss

Question 5

T/F osseointegration is a foreign body reponse

Answer 5

true

• and long term clinical function is dependent on tissue equilibrium

Question 6

effects of antibiotic pre medication before implant placement

Answer 6

From the results of these studies, it can be concluded that there is some evidence suggesting that
pre-operative antibiotics significantly reduce failures
of dental implants placed in ordinary conditions, but
it is still unknown whether post-operative antibiotics
are beneficial.

some that gave prior - showed statistically significcant survival rates compared to placebo and others didnt show

Question 7

pre- op antibiotics in smokers?

Answer 7

beneficial because smoker NOT given pre operative antibiotics were almost 3x more likely to have implant failures than those provided preoperative antibiotic coverage

Question 8

immediate placed implants and post - surgical amoxilcillin use?

Answer 8

if unable to use amoxicillin = 3.4 x more likely to experience implant failure as patients who recieved it

Question 9

studies exist to support flapless surgerues can have higher failure rates?

Answer 9

yes - shown by sennerby et al

Question 10

torque to provide osseointegration?

Answer 10

To achieve osseointegration,
it was found that an insertion torque above 32 Ncm
was necessary. It was observed that the insertion torque was associated with the risk potential, which can
be decreased by 20% per 9.8 Ncm added. The authors
suggested that, in cases of early loading, an appropriate initial insertion torque must be applied to decrease
the implant failure rates.

more failure seen in lower torqued implants - especially if immediatley loaded

Question 11

fresh exrtaction sockets vs healed sites

Answer 11

Some studies showed that there is a greater risk of
implant failures with insertion in fresh extraction sockets compared with placement in healed sites (77–82).
On the other side, few studies showed that there is a
greater risk of implant failures with an early insertion
(within 6–8 weeks after tooth loss) (8

Question 12

implants placed by inexperienced surgeons (less than 50 implants) failure rate?

Answer 12

3.5% – failed TWICE AS OFTEN as those placed by experienced surgeons

especially in the first 9 implants placed

Question 13

location conditions

Answer 13

most studies show maxilla having more failure rates (less favorable bone texture + lower density in thin cortical plates)

+ shorter implants in posterior leading to more failures

Question 14

patient conditions

Answer 14

male vs female - inconclusive

age - not the age but rather the bone quality

Question 15

smoking

Answer 15

does contribute to failure

Question 16

bone quality effect - in general

Answer 16

. Bone quality is believed to be one of the
most important aetiological factors for early implant
failures

Question 17

type I - iv bone

Answer 17

i = homogenous cortical bone

ii= thick cortical bone with marrow cavity

iii = thin cortical bone with dense trabceuluar bone of good strength

iv = very thin cortical bone with low density trabecular bone of poor strength

Question 18

increased failure rate when placed into ___ bone

Answer 18

type iii and iv

Question 19

implant length

Answer 19

implants as possible of maximum length should be used. Advantages of increased
implant length include increased initial stability, longterm resistance to bending moment forces, expedited
healing and a decreased risk of movement at the
interface

Question 20

width of implant

Answer 20

better to have wider

Question 21

occlusal vs non occlusal loading

Answer 21

Inconclusive

Question 22

initial stability

Answer 22

Primary implant stability is determined by the bone
density, the implant design and the surgical technique. These studies show a correlation between
implant stability and implant survival and probably
reflect the importance of an undisturbed healing to
achieve adequate osseointegration.

Question 23

threaded vs cylinrical implants

Answer 23

some showed greater failure with cylindrical implants

Question 24

number of implants placed per patient

Answer 24

One may hypothesise that placing multiple implants
requires more mucoperiosteal stripping, compromising
blood supply, more operating time and more contamination of the wound, all of which may contribute to
the increased complication rate

Question 25

implant surface

Answer 25

Statistically significant difference was observed in
comparisons of implant failure rates between
HA-coated and non-HA-coated implants (favouring
HA-coated) (223), turned and TPS (favouring TPS) (253),
turned and anodised (favouring anodised) (37, 188, 254),
turned and ‘rough’ (favouring rough) (20, 184)

Question 26

cement versus screw retained implants

Answer 26

Cement remnants may indeed cause marginal bone
loss due to a foreign body on another foreign body
reaction, but failure rates will increase first after many
years in situ

Question 27

see effects of left over cement when?

Answer 27

many years IN SITU afterwards –

Question 28

splinted implants indicated when?

Answer 28

splinted implants are usually indicated in clinical situations where there is a risk of mechanical overloading to reduce the forces on implants and surrounding tissiues

It has
been suggested that splinting implants helps to distribute functional loads and therefore decrease the
implant failure rates

Question 29

cylindrical implants without threads

Answer 29

more likely to fail

Question 30

factors to consider with marginal bone resorption

Answer 30

type of implant
clinical handeling
state of the patient

Question 31

• main importance for failure

Answer 31

human factor – not everyone is a good surgeon - even if he or she has had proper clinical training and experience

Question 32

Albrektsson (342)
investigated the clinical outcome of all implants placed
at the Branemark clinic in 1986 and found that one
surgeon was alone
responsible for the majority of failures?

Answer 32

yes - due ot inexperience

and most had marginal bone resorption as well

Question 33

oral hygeines role

Answer 33

Another threat to implant survival related
to clinical handling may come from inexperienced clinicians (6). It is also important that the whole team
could plan and design a prosthetic suprastructure in a
way that it will be possible for the patient to perform
an adequate routine oral hygiene. For example, nonconnected implants are generally considered to facilitate optimal oral hygiene by the patients because of
superior accessibility.

Question 34

T/ F There are, in fact, very little if any
evidence of a true connection between periodontitis
and the start of marginal bone loss around oral
implants. F

Answer 34

true - pdl vs ankylosis in implant with low blood ciculation and an almost total lack of interfacial nerves

Question 35

marginal bone loss and perio implantitis

Answer 35

does not start with the pathogens

has to do with forign body equilibrium

. More severe
marginal bone resorption will lead to peri-implantitis
that may start as an aggravation of the inflammatory
response inevitable to any foreign body such as an oral
implant

Question 36

need what in future studies

Answer 36

longer

look at 10+ years

Question 37

conclusion
it may be suggested that
the following situations are correlated to increase the
implant failure rate:

Answer 37

the following situations are correlated to increase the
implant failure rate: a low insertion torque of implants
that are planned to be immediately or early loaded,
inexperienced surgeons inserting the implants, implant
insertion in the maxilla, implant insertion in the posterior region of the jaws, implants in heavy smokers,
implant insertion in bone qualities type III and IV,
implant insertion in places with small bone volumes,
use of shorter length implants, greater number of
implants placed per patient, lack of initial implant stability, use of cylindrical (non-threaded) implants and
prosthetic rehabilitation with implant-supported overdentures