We were all trained to believe that dental implant treatment is 96-98% successful and that implants last a lifetime…right? On Friday we sit at a lecture and see amazing cases with studies that show implant survival of 97% over 5 years in the hands of a guru. Only to return to practice on Monday morning and see another patient walking in with peri-implantitis, another walking in with a loose cement retained crown, yes its the abutment screw; and yet another one with chipped porcelain.
Why do we get so many complications? Why are WE seeing more complications than everyone else. I always thought I was doing something wrong. I always thought that it was me. Truth is that 98% of implants osseointegrate! Most of the studies showing 97%+ survival are full arches, not single implant retained crowns. Most of the time we think that success is the same as survival but it is not. Our patients care about the position of the tissue, about the comfort of the crown, about food not getting stuck between the implant and the adjacent tooth, about the gums not bleeding when they brush and floss.
We all get complications, we try to pretend they don’t exist, but peri-implantitis appears in 10-25% of implants in the literature, loose abutment screws 2-3%, open contacts 34-60% and these numbers are in fixed cases, removables have a whole slew of other issues. Implants do not last forever, in fact nothing in dentistry does. The sooner we realize this the better our practices become.
Some complications are iatrogenic related to material or technique and those are things we can control. Other complications are patient related, and those we ought to be able to diagnose and correct, some are just things that could happen as a result of a treatment that is applied to a very complex biological system.
There is no shame in it, there is no guilt associated with it and there should be a realization that these things happen to ALL of us. Everybody that is involved in implant therapy sees complications and failures, if they do not they are not doing a large volume of implants in their practices. It’s important to continuously analyse and try to reduce our complication rates, sometimes changing armamentarium and techniques and sometimes learning to select cases more carefully. Dr. Carl Misch, a mentor to me and many others, always stressed that treatment planning for biomechanical stress and treatment planning predictably is the best way to avoid complications.
Treatment planning and doing our work ahead of time can reduce the complication rates and failures, as can selecting the correct materials and techniques for our cases. Finally, life long learning and connecting with like minded doctors that can share their experiences and failures and solutions is really our way of shielding our future practices from the unknown. Learn from the mistakes of others so that you are free to make new ones of your own!
