The Science Behind Dental Implant Loss
Dental Implant Failure: Understanding the Causes and Risk Factors
Dental implants have become increasingly popular in recent years as a solution for missing teeth, though sometimes they do not work as expected. This is called dental implant failure, and it’s a growing concern among dental professionals. Despite the increasing usage of dental implants, our understanding of why implants are lost has not progressed. Implants can be lost an an early stage or a late stage. In regard to early implant loss, there are as many proposed explanations as there are practitioners with no consensus. In regard to late implant loss, the diagnosis is almost always “peri-implantitis” with no consideration given to potential causes other than bacterial. This lack of a clear diagnosis of implant loss at any time frame has prevented the dental profession from changing what can be done differently in order to predictably reduce the frequency of implant loss.
Relevant Studies on Dental Implant Failure
Fortunately, major health institutions have performed detailed data collection and analysis to determine what produces the best treatment outcomes and identify what variables can be controlled to avoid failures. When a healthcare institution collects data to determine what works and what contributes to failure in the treatment of a specific disease, every possible factor is evaluated: all pre-existing conditions, all medications, all patient specifics, down to the age training and experience of the surgeons! These variables are evaluated without bias to find out what works and what doesn’t. Two major health institutions, the Mayo Clinic and a large Chinese health institution, performed independent studies on dental implant failure. The Mayo Clinic study found that the only cause of early implant failure was socket grafting with cadaver bone grafts. The Chinese health institution study found that early implant failure was significantly associated with implants placed in the back of the upper jaw, with specific surface modifications, and in previously grafted sites. Both studies found that socket grafting with cadaver bone grafts was the only factor responsible for early implant loss.
The Mechanism Behind Dental Implant Failure
The mechanism behind these “implant failures” is the failure of the cadaver bone grafts, which leads to marginal bone loss. Studies that were analyzing effects of osteoporosis and bone resorption have shown that the only statistically significant factor associated with marginal bone loss was socket grafting using cadaver bone graft. Often, the term “physiological bone remodeling” is used to imply that there is something normal about marginal bone loss after implant placement. These studies make it clear that there is nothing normal about marginal bone loss because it only occurs when cadaver bone grafts are used. Rather than using the term “physiological bone remodeling”, the more appropriate term is bone graft failure.
The Medical Literature
There are no published studies that evaluated the long-term success rates of implants placed in sockets grafted with either allograft or Bio-Oss. The most common bone grafting procedure in dentistry is ridge preservation with cadaver bone grafts. This procedure is done thousands of times each day with no scientific support to justify the procedure. It is our contention that the studies have been done but not published because the results were not acceptable to the authors.
Conclusion
Dental implant failure is a growing concern among dental professionals. Studies have shown that socket grafting with cadaver bone grafts is the only factor responsible for early implant loss and marginal bone loss. It is important for dental professionals to consider these factors when performing dental implant procedures and should seek alternatives to cadaver bone grafts.
Unfortunately, cadaver bone grafts are researched and taught in all US dental schools. Most all dental lecturers promote the use of cadaver bone grafts in various clinical applications. This is the current paradigm in the United States, so its effectiveness cannot be questioned, regardless of the medical literature. If a procedure is performed using a cadaver bone graft and it fails, then the blame is placed either on the operator or the patient because the paradigm teaches dentists that it cannot possibly be the material that fails. In dentistry, research into bone and bone graft biology has not been sufficient, which explains the damage a paradigm can do to a profession.
This blog post was summarized from an article intended for a professional audience of clinicians with a science and/or medical background. To read the article yourself, follow this link:
References
- Early Implant Failure Associated With Patient Factors, Surgical Manipulations, and Systemic Conditions. J Prosthodont. 2019 Jul;28(6):623-633. doi: 10.1111/jopr.12978. Epub 2018 Oct 22.
- The risk factors of early implant failure: A retrospective study of 6113 implants. Clin Implant Dent Relat Res. 2021 Jun;23(3):280-288. doi: 10.1111/cid.12992. Epub 2021 Mar 16.
- Relationship Between Osteoporosis and Marginal Bone Loss in Osseointegrated Implants: A 2-Year Retrospective Study. J Periodontol. 2016 Jan;87(1):14-20. doi: 10.1902/jop.2015.150229. Epub 2015 Sep 3.
- Crestal bone resorption in augmented bone using mineralized freeze-dried bone allograft or pristine bone during submerged implant healing: a prospective study in humans. Clin Oral Implants Res. 2016 Feb;27(2):e25-30. doi: 10.1111/clr.12512. Epub 2014 Nov 10.
- Successive Reimplantation of Dental Implants Into Sites of Previous Failure. J Oral Maxillofac Surg. 2020 Mar;78(3):375-385. doi: 10.1016/j.joms.2019.10.001. Epub 2019 Oct 13.
- Comparison of three different types of implant-supported fixed dental prostheses: A long-term retrospective study of clinical outcomes and cost-effectiveness. Clin Oral Implants Res. 2019 Apr;30(4):295-305. doi: 10.1111/clr.13415. Epub 2019 Mar 29.
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