Study suggests dentists cause implant failure
LOMA LINDA, Calif., USA: The indications and versatility of dental implants have increased, and so have complications. Researchers from the Loma Linda University School of Dentistry in the U.S. have suggested that, regardless of patient risk factors like bruxism, successful long-term outcomes significantly depend on the experience of the clinician performing the procedure.
By reviewing the records of patients who had received full-arch maxillary and/or mandibular supported fixed complete dentures over a period of ten years, the researchers found that 12 percent of implants failed when clinicians had less than five years of experience in the field. Implants were also twice as likely to fail if the surgeon had performed less than 50 implantations in his career, they report.
Other contributors to implant failure were identified as being related to the patient rather than the implant. Almost every third patient with diabetes or a history of bruxism had experienced implant failure.
Other risk factors commonly associated with implant failure like the type of prosthesis used, smoking or implant location were found to have less impact on long-term success, according to the researchers. They stated that the absolute rate of success was found to be 90 percent.
Overall, the records of 50 patients treated with 297 implants at the school were reviewed.
(Response to Dental Tribune International article, ‘Study suggests dentists cause implant failure’
A brief news item in the online publication Dental Tribune International, titled “Study suggests dentists cause implant failure,” was based on a misunderstanding of an article in the Journal of Oral Implantology, Special issue, 2012, titled “Immediate Loading of Maxillary and Mandibular Implant-Supported Fixed Complete Dentures: A 1-to 10-Year Retrospective Study,” by Ting-Jen Ji, DDS, MSD, Joseph Y. K. Kan, DDS, MS, Kitichai Rungcharassaeng, DDS, MS, Phillip Roe, DDS, MS, and Jaime L. Lozada, DMD.
The Journal of Oral Implantology article, a retrospective study conducted at the Center for Implant Dentistry, Loma Linda University School of Dentistry, Loma Linda, Calif., assessed the success rates of 50 full-arch maxillary and/or mandibular immediate loaded implant-supported fixed complete dentures, after a mean follow-up time of 42.1 months.
Variables associated with failure rates documented by Ting-Jen Ji, et al, included bone loss, type of prosthesis (provisional or definitive prosthesis), surgeons’ surgical experience (>5 years or <5 years), and the surgical site where the implants were placed.
Other studies, short- and long-term studies, involving full-arch immediately loaded maxillary and/or mandibular ISFCDs, have reported success/survival rates of 92.7 to 100.0 percent. This study showed a lower cumulative implant success rate of 85.2 percent and an absolute success rate of 90.6 percent.
The implant failure rate for two surgeons involved in the study (with >5 years of surgical experience) was 2.4 percent (two of 85 implants), whereas the remaining 18 surgeons (those with <5 years of surgical experience) incurred an implant failure rate of 12.2 percent. This particular observation can be explained by the fact that the 18 less experienced surgeons were graduate students with minimal implant surgical experience.
Also in this study, a higher implant failure rate was reported in patients with bruxism (29.3 percent) compared with patients without bruxism (4.6 percent).
Another interesting finding was that a higher implant failure rate was observed in patients with diabetes (28.6 percent) vs. patients who did not have diabetes (8.5 percent), while comparable failure rates were observed in both smokers (9.7 percent) and nonsmokers (9.4 percent).
We are looking for clarification of what our retrospective study showed: “Dentists with minimal experience placing dental implants can potentially increase the failure rate of implants placed during the immediate loading of full arch prosthesis.”
Dentists generally do not cause implant failure. But implants placed in immediate loading protocols for completely edentulous patients by inexperienced dentists experience higher failure rates.
Prof. Jaime Lozada, Director, Graduate Programs, Restorative Dentistry, Oral Implant Dentistry, Loma Lima University)