In my practice, I begin to see more patients coming in for treatment of their implant complications. Some problems can be easily solved. For example, if a patient developed infection around an implant, then we simply remove it, let it heal and then place a new implant. Sometimes, a bit of bone grafting is needed to replace the lost bone structure. A bit tedious, but nothing too difficult.
However, some cases are a bit more complex. For example, a patient with an implant replacing the upper central incisor that has developed some bone resorption and exposing part of the implant. This is an aesthetic nightmare. It is a difficult problem to solve because the implant is well integrated into the bone and removal requires removing the bone around the implant. However, after the removal of the bone and implant, there will be not much bone left and replacement with another implant will be very challenging. Multiple surgeries will be needed. First, grafting with an autogenous bone graft is done to
The other type of re-treatment cases that is a real challenge are the full arch implant cases. These are cases whereby the patient has six to ten implants placed in one jaw and a fixed prosthesis cemented onto them. When some of the implants develop problems, re-treatment is often an arduous task. The prosthesis needs to be cut out to remove the infected implants. Thereafter, bone grafting is again needed to rebuild the bone before replacing the failed implants. A temporary prosthesis is needed during the treatment period before re-doing a final prosthesis when the new implants have integrated. The process may take 6-12 months to complete.
Re-treatment is always more difficult than the first time. The hard and soft tissues are compromised by the first surgery, making handling more difficult and healing less efficient. As such, it is important to have a team of specialists to manage this. A prosthodontist is needed to design a new plan and to transition the patient through the treatment phase by using a provisional prosthesis. This provisional prosthesis is also a diagnostic prosthesis as it provides information to construct the final definitive prosthesis. An oral maxillofacial surgeon is needed to remove the implants, rebuild the bone and replace the new implants. A good laboratory technician is needed to fabricate the prosthesis based on the design of the prosthodontist.
Some of these problems are preventable, others are not. Treatment philosophies change with time based on the scientific studies that emerge. While we strive to practice based on scientific evidence, not everything can be scientifically proven. A large part of clinical practice is an art. Two different dentists doing the same treatment on similar patients can have very different outcomes. Dentists should continually update themselves on new proven scientific treatment approaches and collaborate as a team to deliver the best outcome. Patients should spend some time to research which dentist or team is best suited for their needs.