WHAT IS IMPLANT SUCCESS?

This is the start of a blog series on dental implants, where we'll share knowledge from over 50 years of clinical experience. We're here to help new and less-experienced dentists avoid the pitfalls that can come with this demanding procedure.

A patient does not walk in the dental office because they want to buy an implant. They expect to look and eat better, without experiencing pain or discomfort, for the rest of their life. If the patient is dissatisfied with any of his or her wants, the treatment has failed the patient.

According to dental literature, dental implant success is defined by a combination of factors:

· Aesthetics: The final restoration should look natural and blend seamlessly with the patient's other teeth and facial features. A successful implant contributes to a pleasing smile and a restored facial profile.

· Functionality: The implant must be able to withstand the forces of chewing and provide adequate support for the final dental prosthesis (e.g., a crown, bridge, or denture). The patient should be able to chew comfortably without pain or discomfort.

· Absence of Pathology: There should be no signs of infection, pain, nerve damage, or persistent inflammation (peri-implantitis) around the implant site. The gums and tissues around the implant should be healthy.

· Patient Satisfaction: The patient must be satisfied with the outcome of the treatment. This includes their comfort, the appearance of the implant, and their ability to function normally, which ultimately improves their quality of life.
From the standpoint of the dentist, dental implant "failure" is defined by failure of the bone to initially fuse with the implant, or loss of that attachment afterwards, leading to mobility of the implant and its removal. Persistent pain or severe discomfort, infection, bleeding or pus discharge, swelling, inflammation, or redness of the gums around the implant, loose implant, or visible bone loss on a dental X-ray or other severe symptoms may also necessitate implant removal.

In essence, a dental implant is considered successful not just if it stays in the jaw, but if it remains healthy, functional, and aesthetically pleasing for the long term, fulfilling the patient's needs and expectations.

The dental literature repeatedly states that in 19 out of 20 patients (or 95 - 98%), will experience "success" with their dental implant for at least five years (the 5-year success rate).

Based upon the definitions defined by both the dentist and the patient, almost all dental implants start to fail the moment an implant is inserted into the bone. In reality, an implant begins a battle against failure from the moment the patient walks into a dental office for an assessment. There are many reasons why an implant should fail; and probably fail, sooner than expected. This is not difficult to understand once you are aware of certain facts.

The short and long-term success of dental implant treatment hinges on proper patient assessment, knowledgeable treatment planning, atraumatic surgical placement of the implant and comprehensive follow-up by the dental provider. More than 1 in 4 dental implants (>25%) fail in unrecognized, medically compromised patients.

The long-term success of dental implant treatment is also dependent upon proper brushing and flossing to prevent plaque and tartar to build up, the main cause of peri-implant disease. 1 out of 5 smokers will need to have second operation for its removal within the first five years. Heavy alcohol consumption significantly increases the risk of complications and implant failure, especially during the crucial recovery period. These causes are all patient related.

But “them’s the facts folks”, that you don’t hear about. I often wonder if an unaware patient would choose dental implants as an option if they realized the odds, the pain, discomfort and ongoing cost, only to face a second operation for the implant’s removal.

I look forward to hearing from all of you. My next blog will be about the seven major causes of implant failure ... And don’t forget to pass this on to anyone interested in dental implants.

Thank you, Dr. Harold Bergman, DDS, Dipl.OS&A, MScD(Path)