Complications,
Maintenance and Care
As with every
surgical procedure, complications may arise with any step of the entire
implant reconstruction sequence. This can range from immediately postoperative
complications to ones that surface many years after the implants have already
been in function. Either way, often we can resolve some of these problems if
we diagnose them early and initiate appropriate corrective measures. In order
to avoid complications once the implant is in function (with a prosthesis
on top) proper maintenance and care on the patient’s side is a must.
Complications:
Complications can
usually be divided into three different categories:
- Post Surgery
Complications
- Integration Time
Complications
- Post Prosthetic
Complications
Post Surgery
Complications are complications that occur within the first few days
after the placement of implants or a grafting procedure. These usually include
swelling, pain, nausea, bleeding,
possible infection, or partial numbness in
certain areas. Swelling, pain, nausea and some minor bleeding are, to a
certain extent, fairly normal responses to general surgical invasion of
tissues. Pain can usually be reduced with proper medication. Swelling
will usually dissipate after a few days, although one can use ice packs
immediately post-surgery to reduce the swelling somewhat. Nausea
is usually a side effect of medications (usually narcotic in nature) given
I.V. during surgery or taken post-operatively. Minor Bleeding
can be controlled with moderate pressure to the area utilizing gauze pads (one
can also wrap a moist tea bag into the gauze pads–the tannic acid in the tea
will help constrict some of the blood vessels). Infections
are usually not a big occurrence, because most patients are on an antibiotic
regimen for some time after surgery. If an infection persists nevertheless,
your doctor will usually pursue more aggressive methods of infection control. Partial
Numbness can sometimes occur after surgery in the lower jaw. This
usually involves the lower part of the lip and chin area or one side of the
tongue. This can be very short lived or extend over long periods of time (may
even be permanent, depending on the procedure). This is usually due to either
temporary fluid pressure on the nerve or some form of mechanical
manipulation of the nerve.
Integration Time
Complications are usually not very extensive and for our purposes we will
only mention two: Exposure of surgical site (implants,
grafts, membranes, etc.) and Rejection of the implant.
Exposure of
the surgical site needs to be distinguished between the gradual
showing of the top of the implant through the gums or the exposure of
a grafted site. If you see the top of the implant coming through your gums
after a while, it is usually not a problem at all (although you should have
your doctor check it to make sure), since many times implants are actually
placed and left exposed through the gums immediately post surgery. This
usually eliminates the Uncovery procedure.
If, on the other hand a graft site becomes exposed this may pose a more
dangerous problem and you should contact your doctor immediately.
Rejection of
the implant statistically happens approximately one out of twenty
times. The true reason for this is sometimes not known, however, there are
several etiologic factors that we know may be responsible for that. The most
prevalent is disturbance of the implant during the healing time. Try to baby
the implant as much as possible during the first four weeks. If your doctor
advises you to not wear certain removable appliances (dentures, partials,
etc.) during that time, you must follow his advice, or you may risk loosing
the implant. Also, smoking increases the chance of rejecting the implant. The
reason for this is still unclear, but it is hypothesized that the nicotine,
being a fairly strong vasoconstrictor,
limits blood supply to the surgical site and thus compromising the healing and
osseointegration process. Lastly, poor
surgical technique (overheating the bone during preparation, etc.) may
sometimes be the cause.
Post-Prosthetic
Complications encompasses everything that happens to either the implant
or the prosthesis after the implant is in function. However, before I
elaborate on that it should be mentioned that sometimes everything can go
well with the surgery and healing and, as you can see below, the making
of a final prosthesis can be the beginning of a long-lasting nightmare.
To the left you can see how a patient
presented to our office for the reconstruction of an implant placed somewhere
else. No matter what tricks we pull out of our sleeve, prosthetically,
this case could never be restored satisfactorily to the patient’s
expectations of esthetics.
This can usually be avoided by doing your research about the doctor(s) placing
and/or restoring your implants (See the Related
Links section for more details on Implant Organizations). Assuming, that
the implant(s) is (are) successfully connected to a prosthesis, things might
still go wrong in the future. The implant(s) may experience extensive bone
loss over a certain period of time. This can be due to excessive load on the
implant. Chewing or grinding too heavily on the implant crown(s) spells
disaster for the future survival of the implant. Beyond the potential bone
loss around the implant(s) this can also fracture some of the components, if
not the implant itself. If this is the case, the crown(s) need to be adjusted
and/or a night guard should be worn. Compromised oral hygiene may also be a
factor, although this seems to be less and less an etiologic factor, according
to latest research (which does not mean one can neglect oral hygiene around
implants all together–on the contrary).
All other problems
are usually linked to the prosthesis on top of the implant(s). This may
include screw loosening, fracture of porcelain or acrylic, etc. These problems
can usually be corrected, since most implant systems are based on a
screw-retained platform, which makes the prosthesis usually retrievable (but
not necessarily repairable). This however does not endanger the implant
fixtures. On a good note, decay or cavities will never be a problem.
Maintenance
and Care:
As already mentioned
above, care of your implants is an important factor. Oral hygiene should be
performed on a daily basis, as explained to you by your dental professional.
Usually it does not involve any more care than your natural teeth need.
Forceful water picks and harsh tooth brushing should be avoided.
