Exodontia.Info
Dental Implant Warnings
Dental implant placement, in its most straightforward
form, is not particularly traumatic.  People obviously
differ in their response to dental implant placement
as they do to any surgical procedure.

It is a surgical procedure so it won’t be painless
afterwards however the post-operative stage won’t be as
sore as if a difficult wisdom tooth has been removed.

The incidence and severity of problems post-op in part
relate to the complexity of the procedure and the
individual’s response to it.

Not all possible complications or risks can be foreseen
in any medical or surgical treatment and this is the case
for dental implant surgery.

These are the commoner risks.  There may be other
unusual risks that have not been listed here.

Please ask your Oral Surgeon if you have any general
or specific concerns.

Common Surgical Consequences:

Pain.  As it is a surgical procedure, there will be
soreness after the implant placement.  This can last for
several days.  Painkillers such as
Ibuprofen,
Paracetamol, Solpadeine or Nurofen Plus are very
effective.  Obviously, the painkiller you use is dependent
on your medical history & the ease with which the dental
implant was placed.

Swelling.  There will be swelling afterwards.  This can
last up to a week.  Use of an icepack or a bag of frozen
peas pressed against the cheek adjacent to the operation
site will help to lessen the swelling.  Avoidance in the first
few hours post-op, of alcohol, exercise or hot foods /
drinks will decrease the degree of swelling as well.

Bruising.  Some people are prone to bruise.  Older
people, people on
aspirin or steroids will also bruise that
much more easily.  The bruising can look quite florid; this
will eventually resolve but can take several weeks (in the
worst cases).

Stitches.  The implant site will be closed with stitches.  
These dissolve and ‘fall out’ within 10 – 14 days.

Limited Mouth Opening.  Often the chewing muscles and
the jaw joints are sore after the procedure so that mouth
opening can be limited for the next few days.  If you are
unlucky enough to develop an infection afterwards in the
operation site, this can make the limited mouth opening
worse and last for longer (up to a week).

Post-Op Infection.  You may develop an infection in the
operation site after the procedure (even if on antibiotics).  
This tends to occur 2 – 4 days later and is characterised
by a deep-seated throbbing pain, bad breath and an
unpleasant taste in the mouth.  This infection is more
likely to occur if you are a smoker, are on the
Contraceptive Pill, on drugs such as steroids and if bone
has to be removed to facilitate tooth extraction.  If
antibiotics are given, they are likely to react with alcohol
and / or the
Contraceptive Pill (that is, the ‘Pill’ will not be
providing protection).

Should the infection develop, you need to contact the
Oral Surgeon post-haste as an infection at the op site
can lead to the implant failing.

Surrounding Teeth.  The surrounding teeth may be sore
after the procedure; they may even be slightly wobbly but
the teeth should settle down with time.  It is possible that
the fillings or crowns of the surrounding teeth may come
out, fracture or become loose.  If this is the case, you will
need to go back to your dentist to have these sorted out.  
Every effort will be made to make sure this doesn’t
happen.

In a worse case scenario, the blood supply of adjacent
teeth may be compromised with the result that these die
off.  If this happens (the tooth may change colour or
become spontaneously painful), they may need
endodontic (root-canal) treatment to salvage them.

Periodontal complications.


Less Common Surgical Consequences:

Numbness / Tingling / ‘Burning’ of the Lip, Chin and / or
Tongue.  The nerves that supply feeling to the tongue,
lower lip and the chin run within the lower jaw, close to
where the root-ends of the lower molar teeth were and
exit onto the gum close to the roots of the
premolars /
bicuspids.  There is a risk that when implants to replace
molars ± bicuspids are placed, these nerves can be
crushed, bruised, compressed by bleeding or stretched
resulting in numbness (at the worse end of the scale) to
altered sensation (at the other end of the scale) in the
region of the lower lip, chin and / or tongue.

If this is apparent after the local anæsthetic has worn off,
you need to contact the Oral Surgeon immediately as
prompt action is needed so that the nerve damage is not
permanent.  If it occurs, the nerve damage is often
temporary but normal sensation can take quite a few
months before it returns.

Bony Flakes.  Occasionally, bony flakes (sequestra) from
the sockets of the extracted teeth can work their way
loose and through the gums.  These can be quite sore.  
They often work their way loose without any problems
but may need to be teased out or even smoothed.

Bleeding into Cheeks / Lips / Floor of Mouth.  Swelling
that does not resolve within a few days may be due to
bleeding into the cheek / lips / floor of mouth.

The cheek swelling will feel quite firm.  Coupled with this,
there may be limitation of mouth opening and bruising.  If
an implant is being placed in the front of the mouth, there
is a chance of bleeding into the lips.

Also, if an implant is being placed in the lower jaw, there
is a chance of bleeding into the floor of the mouth.  This
can look and feel quite alarming.  In a worst-case
scenario, swelling of the floor of the mouth secondary to
bleeding can compromise the patient’s breathing.  This
scenario needs to be respected and the patient should
have a low threshold to contact the Oral Surgeon, should
this happen.

Both the swelling, bruising and mouth opening will resolve
with time.

Mouth-Sinus Communications.  The floor of the
(
maxillary) sinus can often been in close proximity to the
upper jaw; this is more likely if upper
molars and
pre-molars have not been present for awhile (i.e. the
sinus expands).  Hence, when upper implants are placed,
the level of the sinus floor has to be checked to see if
there is enough bone (height) to place an implant.  If
there is not, certain stubby types of implants can be used
or if, there is not enough bone height even for these,
bone has to be placed in the area to provide the bone
height for the implants.

There is a chance, with upper jaw implant surgery, that a
hole can be created from the mouth to the sinus.  This is
sometimes is not evident at the time of operation but may
develop several weeks afterwards.  If this ’hole’ persists
or is left un-repaired, every time you drink, fluid can come
out of the nose and you may develop a marked sinusitis.  
This ‘hole’ if small enough, can spontaneously close.

Dental Implants in the (Maxillary) Sinus.  Whilst placing
implants in the upper jaw, the implant can end up in the
sinus.  If this happens, then it needs to be retrieved as it
represents a ‘foreign object’ in the sinus and the sinus
responds to its presence.  
The removal of the implant, if
deemed necessary, may entail making a bony window in
the upper jaw to remove the implant.  It is quite possible
that a chronic sinusitis will result that can take awhile to
settle.

Dental Implants in the Nasal Floor.  Whilst placing
implants in the upper jaw especially atowards the front of
the mouth, there is a small chance that the implants may
perforate through the floor of the nasal cavity.  If this
happens, then it needs to be retrieved as it represents a
‘foreign object’ in the sinus and the sinus responds to its
presence.  The removal of the implant, if deemed
necessary, may entail making a bony window in the
upper jaw to remove the implant.  It is quite possible that
a chronic sinusitis will result that can take awhile to settle.

Oro-Nasal Communications.  

Incisive Neurapraxia.  


Early Surgical Failure:

Implant Failure.  Even though implants have a high
success rate, they can still fail.  The failure can be due to
a number of factors including medical conditions (such as
uncontrolled
diabetes, smoking, bisphosphonate use,
steroid use, osteopetrosis), infection, poor quality bone
(especially in the upper jaw), the wrong position (leading
to stresses and strains that the dental implants aren’t
designed to cope with), bone death due to being
overheated when the implant was placed and the wrong
implant components.

Peri-Implantitis.  Peri-implantitis, due to poor hygiene or
excessively thick soft tissue interface and pre-exisiting
perio problems

Peri-Implant Abscess.

Wrong Position.  Improper implant positioning, causing
prosthetic compromise.

Bone Augmention.  This is done by grafting or
supplementation.  

Gum Recession.

Loss of Interdental Papilla.  This can result in inter-
proximal ("black triangles" between teeth) spaces due to
tissue deficiencies and incisions and reflection of the
tissues

Infection (acute or chronic).

Lower Jaw / Mandibular Fracture.

Loss of Bone Graft / Augmentation Material.  This can
result in implant failure.

Implant not restorable.

Hyperplastic Soft Tissue Response.

Idiopathic Generic Failure.


Late Surgical Failure:

Implant Failure.  See above in Early Surgical Failure.

Peri-Implant Abscess.  See above in Early Surgical
Failure
.

Peri-Implantitis.  See above in Early Surgical Failure.

Crestal Bone Loss.  This is due to inadequate available
crestal bone, dehiscences at the time of surgical
placement, or exceeding of the load threshold

Gum Boil / Parulis Formation.  This is due to loose
restoration, inadequate hygiene or cement entrapment

Fenestrations / Dehiscenes of Facial Bone.  This is due
to
labial plate collapse after tooth extraction, to re-
sorption
after implant placement or to anatomic labial
concavities
.

Unstable Dental Implant.

Excessive vertical and horizontal bone loss.

Infection (acute or chronic).  See above in Early Surgical
Failure
.

Lower Jaw / Mandibular Fracture.  See above in Early
Surgical Failure
.

Loss of Bone Graft / Augmentation Material.  See above
in
Early Surgical Failure.

Implant not restorable.  See above in Early Surgical
Failure
.

Hyperplastic Soft Tissue Response.  See above in Early
Surgical Failure
.

Idiopathic Generic Failure.  See above in Early Surgical
Failure
.


Restorative Complications:

Implant unrestorable.

Æsthetic Compromise.  This is usually due to tissue
deficiencies, poor alignment or trajectory of implant or
poor prosthetics.

Discolouration of Gum.  Supra-gingival (above the gum)
visibility of portions of the implant or abutment, due to
crestal bone loss or gingival recession.

Implant / Implant Component Fatigue.  Loose
restorations related to loose or fractured abutment
screws, due to inadequate tightening of screws.

Overdenture Clip / Attachment Loosening.

Overdenture Fracture.

Opposing Prosthesis Fracture.

Æsthetic Complication with Prostheses.

Disproportionate Size of Restoration compared with
Adjacent Teeth
.  This occurs due to tissue deficiencies.


Useful Websites:

Association of Dental Implantologists UK

British Society of Oral Implantologists


Useful Articles:

Dental Update 2002.  Implant Complications and Failures
- The Fixed Prosthesis

BDJ 2008.  Endoscopic Trans-Nasal Removal of
Migrated Dental Implants

J Oral Maxillofac Surg 2009.  Characteristics of Early
Versus Late Implant Failure - A Retrospective Study

J Oral Maxillofac Surg 2009.  Inflammatory Implant
Periapical Lesion. Etiology, Diagnosis & Treatment —
Presentation of 7 Cases

J Oral Maxillofac Surg 2010.  Occurrence of a Pyogenic
Granuloma in Relation to a Dental Implant
Last Updated 12th January 2011