As is the case with any medical procedure, complications can occur during or after a dental implant is placed. In this article I will go over potential problems that can be encountered during implant placement surgery. In a future article I will discuss problems that can be encountered during the healing stage of implant surgery.
Placement of a dental implant is a routine procedure for an experienced surgeon. Complications during surgery that a trained surgeon can encounter are mostly due to unforeseen anatomical variations or limitations that present themselves during the surgical implant placement procedure. Many anatomical variations that can be observed in a three dimensional scan, are difficult to visualize in a standard two dimensional panoramic radiograph. Many dentists rely strictly on a two dimensional image, which in most surgical cases is a sufficient way to plan where the implant will be placed, and to determine if any potential obstacles will be encountered.
Even though complications are not common when we look at the overall number of implants that are placed, they do occur. One of the most commonly encountered problems during dental implant placement surgery is perforation of the jaw bone. This can occur due to insufficient thickness of the existing jaw bone, use of an implant that is too wide, or improper angulation of the implant site preparation drill during surgery. The implant needs to have sufficient amount of bone around it to have a good supply of blood. Adequate blood supply allows for proper healing and integration with surrounding bone. To correct the problem, if this complication does occur, the implant should be placed in a more optimal position or completely removed. If the implant is removed the recipient site should be grafted with new bone to allow for future placement of another fixture.
Perforation of the implant into the sinus cavity. Even though this complication can be prevented when a tree dimensional scan is completed, it can occur when a two dimensional image is used as guide for surgery. The floor of the sinus is not always uniform and flat as visible on a two dimensional scan. If the membrane on the floor of the sinus is perforated, antibiotics will usually be prescribed. Planning ahead and the recognition that a sinus lift or sinus graft procedure will be needed before surgery can completely eliminate this complication. If sinus perforation occurs, the implant should be removed and the site grafted with bone and allow to heal completely. The surgery can be repeated after a few months.
Poor quality bone does not provide implant with stability needed for healing. This is one of the most common problems encountered by a surgeon. Predicting the quality of bone with a radiograph can be difficult. The quality of bone is usually observed when the surgeon prepares the bone for implant placement. The type of bone the surgeon encounters is dependent on the age of the patient, family history of bone problems, length of time since teeth were extracted, medical history, or current medications the patient is taking. Depending on the quality of the bone, most of the time the implant will be placed and left in the site but more time may be needed before a restoration is placed. The fixture needs to be immobilized for a few months for proper integration to take place.
Another complication that should be mentioned is overheating of the bone in the implant recipient site during preparation for dental implant placement. This occurrence can burn the surrounding bone, which prevents proper integration of bone with the surface of the implant. The complication can occur if insufficient water is used to cool down the implant drill. The surgeon is usually unaware of the complication and the implant is placed. The implant does not integrate and can fall out within the first few weeks after surgery. Grafting the site with bone and allowing for complete healing will allow the dentist to place another implant in the same spot in future.
Complication during surgery can and do occur. A good and experienced surgeon will know how to deal with unforeseen problems during surgery. Even though most of these problems can be successfully dealt with during or after surgery, they can prolong healing time, which results in a longer period before the dental implant can be restored.