1、2018/9/12,1,Complications and Maintenance in Dental Impant,2018/9/12,2,Introduction,Complications may occur in both the surgical and prosthodontic phases of implant therapy.It is essential to warn patients of the possibility of surgical and postoperative problems.,2018/9/12,3,Introduction,Failure of
2、 osseointegration is relatively rare in well-planned cases, with most failures occurring soon after surgical placement or before loading.,2018/9/12,4,Introduction,Complications in most cases are avoidable by careful attention to diagnosis, treatment planning and good surgical and prosthodontic plann
3、ing, and by following established protocols of individual implant systems.,2018/9/12,5,Surgical complications,The more common, relatively minor complications following surgery include swelling, bruising and discomfort. All patients should be warned of these complications and the anticipated extent o
4、f them before surgery is undertaken.,2018/9/12,6,Surgical complications,As with all minor surgical procedures, surgical complications can be minimised by adequate aneasthesia, gentle surgical manipulation of both hard and soft tissues, pre- and postoperative analgesia, and careful postoperative woun
5、d management, including the use of pressure and ice packs to reduce swelling.,2018/9/12,7,Surgical complications,Haemorrhage may occur at the time of surgery if there is excessive trauma to soft tissue or damage to aberrant vessels within the bony cortex.,2018/9/12,8,Surgical complications,Failure t
6、o establish good primary stability at the time of implant placement may result in early failure.,2018/9/12,9,Surgical complications,Incorrect positioning of implants at the time of surgery, as a consequence of poor planning or lack of necessary skills, knowledge and understanding may result in consi
7、derable difficulties during the restorative phase of treatment.,2018/9/12,10,Surgical complications,It is essential to use surgical guides and templates if positioning problems are to be minimised.,2018/9/12,11,Postoperative Pain,Mild postoperative pain is to be expected. It should, however, be read
8、ily controlled by means of non-prescription analgesics. Severe pain following impalnt surgery is extremely rare.,2018/9/12,12,Postoperative Pain,Patients with pain after 24 hours should be monitored for signs of infection, bleeding and other complications. In such situations there well be an increas
9、ed risk of implant failure.,2018/9/12,13,Postoperative Pain,The routine use of antibiotics pre- and postoperatively will decrease the posibility of infection. The practitioner must,however, be satisfied as to the indications to prescribe prophylactic antibiotics.,2018/9/12,14,Wound Dehiscence,In the
10、 two-stage surgical technique, breakdown of the soft tissue following implant placement may lead to the exposure of the implant and cover screw.,2018/9/12,15,Wound Dehiscence,This may be the result of poor soft-tissue coverage of the implant or trauma from the prosthesis covering the surgical site.,
11、2018/9/12,16,Wound Dehiscence,The diagnosis of the cause of soft tissue breakdown needs to be established when palnning further management of the case. In all cases the surgical sites must be kept clean with antiseptic mouthrinses, such as chlorhexidine, used as indicated clinically.,2018/9/12,17,Pa
12、raesthesia,Paraesthesia may arise following trauma to nerves in the region of the implant site. The trauma may be direct from drilling through, or at least into a structure, or indirect as a result of excess heat generation.,2018/9/12,18,Paraesthesia,Whatever the cause, trauma to sensory nerves may
13、lead to loss of sensation to the lower lip.,2018/9/12,19,Paraesthesia,Permanent loss of sensation may be the result of damage to the inferior dental nerve. This should be avoided through careful radiographic assessment and including a safer margin for possible error in the planning of implant placem
14、ent.,2018/9/12,20,Damage to the incisive branch of the inferior dental nerve may result in patients complaining of paraesthesia or anaesthesia to any remaining lower incisors.,Paraesthesia,2018/9/12,21,Mandibular Fractures,In severely resorbed mandibles multiple implants may weaken the jaw with a re
15、sultant fracture. This is, however, very rare in suitably planned cases.,2018/9/12,22,Complications Following Second-Stage Surgery,Second-stage surgery involves uncovering of the implant, removal of the cover screw, replacing it with a healing abutment and careful suturing of the soft tissues around
16、 the abutment.,2018/9/12,23,Complications Following Second-Stage Surgery,A careful and gentle surgical technique is essential in minimising complications, notably poor, unaesthetic gingival contour.,2018/9/12,24,Failure to Integrate,Mobility of an exposed implant is indicative of failure of the impl
17、ant to integrate. The implant and many associated soft tissue should be removed.,2018/9/12,25,Failure to Integrate,Immediate placement of a larger diameter implant may be considered. It may be prudent, however, to leave the site to heal, with time to replan treatment.,2018/9/12,26,Excessive Bone ove
18、r the Cover Screw,Occasionally the cover screw can be partially covered by bone. This bone needs to be cleared away before attempting to remove the cover screw. Most implant systems supply a bone mill for this procedure.,2018/9/12,27,Bone Growth between the Cover Screw and Implant,If the cover screw
19、 has not been placed directly onto the implant head at the time of first-stage surgery, bone may grow into any gap left between implant head and cover screws.,2018/9/12,28,Bone Growth between the Cover Screw and Implant,Implant systems include a bone mill for the careful removal of bone from the imp
20、lant head and thereby provide a clear path of insertion for the abutment.,2018/9/12,29,Prosthetic Complications,Implant prosthodontics can be relatively uncomplicated when fixture angulation and positioning is ideal.,2018/9/12,30,Prosthetic Complications,In most cases,complications can be avoided by
21、 means of careful preoperative treatment-planning and meticulous attention to detail, both clinically and in the laboratory.,2018/9/12,31,Biomechanical Problems,they may include: fracturing of the prosthesis loosening or fracturing of abutment screws,2018/9/12,32,Biomechanical Problems, loosening or
22、 fracturing of gold screw lute failure in a cement-retained prosthesis fracture or loss of the implant,2018/9/12,33,Fracture of the prosthesis,Fracture of a fixed implant superstructure is often the result of misjudged space, leading to thin sections of materials, errors in technical procedures or t
23、he generation of excessive stresses in poorly placed prostheses.,2018/9/12,34,Fracture of the prosthesis,Partial loss of acrylic or porcelain and fracture of the metal framework is more often than not the result of excessive loading or poor design of the framework.,2018/9/12,35,Fracture of the prost
24、hesis,Long cantilevers can lead to both fracture of the prosthesis and screw-loosening. As with fracture of any restoration, the cause of the failure must be diagnosed before planning remedial treatment.,2018/9/12,36,Loosening or Fracturing of Screws,Overload, poor fit of framework or components and
25、 excess or inadequate tightening are all reasons for the loosening or fracturing of screws.Prescribed protocols must be followed to retrieve and replace fractured screws successfully.,2018/9/12,37,Lute Failure in a Cement-Retained Prosthesis,Excessive loading and poor fit of the superstructure are t
26、he most common causes for this type of failure.,2018/9/12,38,Lute Failure in a Cement-Retained Prosthesis,Remedial treatment may include repositioning the superstructure to improve fit.,Repeated cement failure may necessitate a remake of the prosthesis.,2018/9/12,39,Fracture or Loss of the Implant,B
27、one loss may continue to a level at which inherent weaknesses in the implant result in fracture.Excessive loading may result in loss of integration.,2018/9/12,40,Fracture or Loss of the Implant,Further treatment under such circumstances is highly dependent on the particulars of the case. Removal of
28、a fractured implant may be problematical.,2018/9/12,41,Physiological Problems,Physiological problems may include:soft-tissue inflammation - peri-implant mucositis and peri-implantitisbone loss resulting in implant thread exposure - depending on severity,2018/9/12,42,Physiological Problems,bone loss
29、may necessitate implant replacementloss of integration implant removal and perhaps replacement.,2018/9/12,43,Maintenance,The importance of a carefully planned, fully adhered-to maintenance programme cannot be overemphasized in the long-term management of implant-retained prostheses,2018/9/12,44,Main
30、tenance,In the assessment and treatment-planning of implant cases, it is essential that patients take responsibility for the long-term care of their prostheses.,2018/9/12,45,Maintenance,A degree of dexterity will be needed for the patient to clean the prosthesis adequately, and this must be carefull
31、y assessed at the treatment-planning stage.,2018/9/12,46,Maintenance,Failure or the inability of patients to maintain and look after their implant-retained prosthesis may lead to many varied problems, including failure in clinical service.,2018/9/12,47,Maintenance,It is essential that baseline radio
32、graphs are taken at completion of treatment. Progressive bone loss may be related to excessive loading.,2018/9/12,48,Maintenance,Most implant systems show a small amount of bone loss in the first year after loading, but should remain stable thereafter.,2018/9/12,49,Maintenance,It is therefore recomm
33、ended that all patients be seen three months after the completion of treatment, when careful clinical examination is indicated. This should include: assessment of the prosthesis examination of the soft tissues radiographic examination to assess bone height.,2018/9/12,50,The Prosthesis,Clinical exami
34、nation of the prosthesis should in addition to checking fit, stability, occlusal relationship and patient acceptability focus on the sufficiency of the patients oral hygiene.,2018/9/12,51,The Prosthesis,There are numerous aids that can be used to clean around the prosthesis and implant abutments.,20
35、18/9/12,52,The Prosthesis,These range from conventional to electric toothbrushes, floss and super floss and various interdental brushes and related devices.,2018/9/12,53,The Prosthesis,The patient should be encouraged to maintain a high level of oral hygiene around the prosthesis and receive detaile
36、d oral hygiene instructions.,2018/9/12,54,The soft tissues,Evaluations of soft tissues surrounding implant abutments should be both systematic and detailed.,2018/9/12,55,The soft tissues,Gentle probing should not result in bleeding or exudate. A standard periodontal probe may be used to evaluate pro
37、bing depths. This will depend on the thickness of the original mucosa.,2018/9/12,56,The soft tissues,Any overgrowth of soft tissue or any loss of attachment that may have occurred will result in increased probing depths.,2018/9/12,57,The soft tissues,Most inflammatory conditions can be managed by ca
38、reful attention to oral hygiene, aided and supported by professional advice and assistance.,2018/9/12,58,The soft tissues,Any deposits that have built up must be removed by the practitioner or by a trained hygienist. There are numerous instruments available on the market to aid removal of any hard d
39、eposits around implants.,2018/9/12,59,The soft tissues,These may be of plastic or carbon-reinforced designs. The use of ultrasonic and metal-tipped scalers is contraindicated.,2018/9/12,60,The soft tissues,Long-cone radiographs should be taken: at baseline on completion of treatment at three months
40、and one year postoperatively.,2018/9/12,61,The soft tissues,If there is radiographic evidence of bone loss during the first year in clinical service, subsequent radiographs should show very little change.,2018/9/12,62,The soft tissues,Progressive bone loss is not usually associated with implant-reta
41、ined prosthesis.Any progressive bone loss should be cause for concern and encourage the practitioner to assess the sufficiency of the prosthesis.,2018/9/12,63,The soft tissues,Soft-tissue inflammation(mucositis) is sometimes seen around poorly maintained and loose prosthesis. If the prosthesis is lo
42、ose it will be necessary to remove it, clean it in an ultrasonic device and securely replace it in the mouth.,2018/9/12,64,The soft tissues,Soft-tissue proliferation may occur around poorly designed and ill-fitting superstructures.If such proliferation dose not respond to local oral hygiene measures
43、 it may be necessary to excise the unwanted tissue, possibly as part of remedial treatment to replace the superstructure with an appropriately designed, well-fitting prosthesis.,2018/9/12,65,The soft tissues,Peri-implantitis a peri-implant inflammatory condition resulting in progressive bone loss is
44、 a rare occurrence in well executed and maintained cases. Diagnosis of peri-implantitis may be confirmed by means of long-cone radiographs.,2018/9/12,66,The soft tissues,Bone loss is usually circumferential, resulting in gutter bone loss . The cause of peri-implantitis is not fully understood, but i
45、t may be a combination of excess of or inappropriate occlusal forces in the presence of pathogenic bacteria in an unfavourable oral environment.,2018/9/12,67,The soft tissues,The management of peri-implantitis involves: careful assessment of the occlusion in the intercuspal position and eccentric mo
46、vements examination and cleaning of exposed implant surfaces. If there has been tissue proliferation around the implants, this may need to be removed,2018/9/12,68,The soft tissues,removal, cleaning and servicing of the restorations as may be indicated clinically instruction of the patient in effecti
47、ve oral hygiene procedures monitoring and further oral hygiene and prosthesis maintenance instruction as necessary.,2018/9/12,69,The soft tissues,If peri-implantitis persists and progresses despite the above measures, the case should be critically reviewed and, if required, the patient referred for
48、specialist care.,2018/9/12,70,Conclusions,Complications are rare fall into two main groups surgical and prosthodontic. The practitioner should be fully aware of any possible complications prior to treatment and inform the patient accordingly.,2018/9/12,71,Conclusions,The cause of prosthodontic complications should be carefully assessed, diagnosed and rectified. The maintenance of implant patients should include regular reviews involving radiographic examinations.,
