Dental Implants Singapore - what can go wrong?

Dental implant surgery is an elective procedure. Patients opt for dental implants because of the benefits of having fixed teeth compared with removable dentures. The improvement in quality of life is immeasurable especially for patients who are wearing a complete lower denture. However, before proceeding with dental implants, a patient should also understand what are the potential downside of doing and having dental implants.

First, we need to bear in mind that regardless of how minor the surgery is, dental implant surgery involves some injection of local anesthetic, some cutting and drilling. As such, it is expected that there will be some post-operative discomfort and swelling. These can be well controlled with the use of painkillers for a couple of days. These are things that will happen, when things go right. They are the normal sequelae of surgery which will resolve gradually as the body recovers.

Complications are what happen when things go wrong. Fortunately, for implant dentistry, extensive research and practice has rendered it one of the most successful implants placed in the body. Most studies report a success rate of about 98%. That means that there is about 2% of implants that do fail. How does that happen?

1. Biological problem

A dental implant is a titanium screw that is placed in the jaw bone. The uniqueness of this titanium screw is that it allows bone cells to attached directly to it as if it is part of the bone. Other materials such as stainless steel, will elicit a fibrous encapsulation which is not firm enough to support biting forces in the long run. However, due to the biological nature of the bond, it can be disturbed by a variety of factors. Patients who are smokers or who are diabetic may have a higher risk of non-healing. Infection may also disturb the biological bonding between the bone cells and the implant surface. Biological failure can also be due to poor technique used in placing the implant. Under preparation of the implant site may lead to over-compression of the bone by the implant which may cause the bone cells to die and hence able to bond. Over preparation, on the other hand, may result in a loosely fitting implant which also disturbs the bone bonding process.

2. Mechanical problem

A dental implant has to sustain biting forces everyday. Even when not eating, there are thousands of light contacts on the teeth daily whenever we swallow. Over time, the fatigue on the implant and the prosthetic component builds up and parts may breakdown. Usually, the parts that break are the small abutment screws that connect the implant to the crown. These can be replaced without much trouble. Sometimes, the implant itself can break and that will require surgery to remove and replace.

3. Functional problem

This happens when an implant is not placed in an optimal position and angulation to support the mastication of food. Ideally, an implant should be placed in a position that allows crown to sit squarely on it. However, due to uneven resorption of bone that follows after an extraction, the implant is sometimes placed where the bone is abundant but not where the future crown should be. In such situations, fixing a crown onto the implant may be compromised.

4. Aesthetic problem

Twenty years ago, when I first started doing dental implants, success is defined by having a implant that integrates with the bone and is able to support biting of food. Today, a lot more attention is focused on the aesthetic outcome as well, especially for the front teeth. It is no longer sufficient to have a tooth replacement that enables you to eat well. We have come to expect this replacement to look like a real tooth. However, to make a combination of titanium and porcelain into a structure that looks like a tooth and function like a tooth requires a good mixture of scientific knowledge as well as artistic talent. Today, it is possible to achieve that but there is no magic. It requires a protocol that involves multiple surgeries, including bone grafting, gum grafting, recontouring, etc, Is it really necessary? It depends on the patient’s aesthetic demand. Some patients have high aesthetic demand and having a functional implant may not be sufficient. In consultation, I try to get an understanding of the patient’s aesthetic expectation and then explain that to achieve a high level of aesthetics, multiple surgeries over several months is usually needed and see if they are prepared to go through a protracted treatment period. At the restorative phase, one or two provisional prosthesis may be needed before doing the final one.

Ultimately, while dental implants have a high success rate, it is not without problems. Dental implant manufacturers are constantly developing new products to overcome the various challenges presented. However, even with a perfect product, if one exists, a 100% success can never be guaranteed. The dentist factor and the patient factor cannot be guaranteed. The better trained and more experience dentist will give a better result. A healthy patient with no abnormal biting habits will likewise have a better chance of a problem free implant. The patient should choose his dentist carefully when considering dental implants. Similarly, a dentist should also know which patient is not suitable for dental implants.