10 factors influencing long-term success dental implants

As Mr Koray explained in his previous article, the long-term success of any dental implant is reliant upon both the patient’s medical and dental history and the good level of hygiene care they maintain post-treatment. There are, however, a multitude of small steps that a dental practitioner also needs to address correctly when the dental implant treatment is being carried out.

Dr Koray Feran, implant and restorative dental surgeon from London, lists the important steps that dentists should follow that contribute to the long-term success of their patient’s dental implant and explains realistically how long a patient should expect their new teeth to last.

Treatment factors that influence long-term implant success

The most important steps for the dental practitioner providing dental implants include the following:

• Patient suitability

Ensuring that the patient’s medical condition is well controlled and the patient suitably informed if they are in a high-risk group so that their expectations may be realistic. Implants can and do fail and patients must be aware that whilst implants can last for decades, they will require maintenance on a very regular basis.

• Patient hygiene

To ensure that the patient’s mouth is clean and healthy and that all residual disease has been treated before elective dental implant treatment is carried out. Implants perform poorly in mouths that are otherwise diseased and where bacterial plaque is present.

• Planning and patient clarity

The treatment must be well planned and well thought out with the objectives of treatment being clear at the beginning. The patient should be clear on what guarantees are given and what cannot be guaranteed in their own particular situation. They should be aware that treatment may need to be repeated a decade or two down the line if they are in a high-risk group.

• Bone volume and consistency

There must be adequate volume and consistency of bone into which an implant can be placed. If this is inadequate, then it should be augmented with recognised methods. Implants placed into minimal bone and where there is insufficient thickness of soft tissue invariably suffer much more frequently with long-term gum and bone recession and peri-implant disease. Additionally, implant placement surgery should respect the bone and the soft tissues and associated structures and not cause damage beyond that required for safe placement of the implant.

• Recovery time

Adequate time must be given for healing and maturation of the tissues, including the bone and the gum. Treatment should never be rushed and the healing period must always be kept under strict review.

• Access to cleaning

The dental prosthesis (crown, bridge or denture) that is placed onto the implant should be designed in such a way that every aspect of the gum is accessible for cleaning by the patient and by the dental hygienist. Good instruction as to how implants can be kept clean should be given right at the start of treatment and good habits adopted by the patient. When cement is used, it should be thoroughly removed. Residual dental cement around implants is a recognised cause of inflammation around implants.

• Patient daily care

The patient must be aware that dental implants, like natural teeth, require a high level of daily care including brushing, flossing and use of other dental cleaning aids and very regular checkup and hygiene appointments. There is an excellent correlation between the longevity of dental implants and the frequency of good quality hygiene care. Conversely, there is also an excellent correlation between the prevalence of implants with severe problems and lack of follow-up care after treatment.

• Complications

Dental implants may require a level of maintenance that may cost far more time and money than the original treatment if complications arise. Such complications should be diagnosed and treated promptly without delay. Investing in regular high quality, documented dental hygiene maintenance is the single best way of limiting complications.

• Materials

The restorations placed on dental implants are manufactured using high-quality materials. Low-quality materials and poorly manufactured third-party components that may be used to cut costs will compromise the longevity of the treatment and may cause irreparable damage to the precision machining inside an otherwise successful dental implant. Therefore, a good quality implant system with good quality componentry and laboratory work is mandatory for long-term success. However, nothing lasts forever and the prostheses on the implants will also often require revision and maintenance periodically due to natural wear and tear over the years. All of this has an associated cost.

• Low-cost treatments

As with anything in life, low-cost treatment and poor maintenance will often lead to problems that cost many times more than the savings achieved. Patients should beware of having treatment that is substantially cheaper than the average.

So, should I have dental implants?

It is always best to keep one’s own natural teeth wherever possible. Patients should think carefully before allowing healthy natural teeth to be extracted for the placement of dental implants where they may otherwise serve well for several more years.

But, if teeth have to be lost, dental implants, together with routine bone and gum augmentation, are undoubtedly the best method of replacement. If carried out correctly and looked after to a high standard, most implants will provide many years of trouble-free service that cannot be easily replicated by any other treatment modality.

How long will my implants last?

It is difficult to assure a patient that a dental implant will be permanent. Realistically, a dental implant may require replacement in the next 10 to 20 years. Experienced implant dentists will make provision for the fact that their work may need to be repeated in the future during their planning to make the impact of any failure less of a problem.

However, the statistics suggest that with the numbers of implants being placed and the percentage of dental implants that have progressive problems, the dental profession will be spending considerably more time on the remedial aspects of implant treatment that have already been carried out. Therefore, patients should be aware that whilst modern implantology has a great deal to offer and can provide immense confidence to restore function and appearance, dental implants are a long-term commitment and have their fair share of complications that should not be underestimated.

Dr Koray Feran is both a consultant dental surgeon and the Clinical Director at The London Centre for Implant and Aesthetic Dentistry. To make an appointment with him, visit his Top Doctors profile and check his availability.