Tooth implant rejection

Dental implantation is currently the most optimal way to replace lost teeth. More and more people prefer implants instead of classic removable dentures or orthopedic structures on the teeth. This is explained primarily by the high functional stability of implants and the ability to achieve an aesthetic result. Competition in the dental products market leads to the fact that every year implantation becomes more accessible to people. However, in addition to the undeniable advantages of implantation, there are a number of contraindications to this type of treatment. They significantly limit the number of potential patients. Moreover, there are other factors that force people to refuse this type of restoration of the dentition. First of all, these are the financial difficulties that a person faces when he learns the cost of complex treatment. The second reason is the patient's fear of possible implant rejection. As a rule, the issue of financial capabilities is the most common reason for refusing implantation. Fear of rejection is usually observed in a smaller number of people, often in those who have had an unsuccessful experience with implantation. Nevertheless, the issue of implant rejection is currently being actively studied by leading manufacturers of dental equipment. The technologies for manufacturing, processing and coating implants are constantly being improved, which allows increasing the statistics of successful osseointegration. However, the individual characteristics of each organism always create a certain risk on the way to achieving the desired result.

Why is the implant rejected?

There are many reasons why an implant may be lost. Each particular case of unsuccessful implantation has its own unique set of factors that together lead to an unsatisfactory result. However, if we single out the main reason from each situation, the most popular ones will be: peri-implantitis and mucositis, implant rejection itself, allergic reaction, complications associated with the maxillary sinus, implant failure.

Peri-implantitis

Peri-implant is an infectious inflammatory-destructive disease that affects bone structures and soft tissues around the implant. It is worth noting that among all the reasons for unsuccessful implantation, this complication plays a leading role. Consequently, patients are afraid of this complication, which often leads to refusal to perform dental implantation. The trigger for the development of this disease can be many factors. Low-quality implants can be made of cheap alloys, have a coating that does not contribute to the engraftment of the implant. Also, the cause can be an incorrectly performed operation. Errors can include violation of aseptic and antiseptic rules, deviation from bone work protocols (overheating of the bone, incorrect choice of cutters, etc.), fixation of orthopedic structures.

It is also worth paying attention to the level of hygiene after the implantation. Many middle-aged and mature people cannot adapt to a new, longer-term method of oral care. This leads to the appearance of caries on the remaining teeth and the development of inflammatory diseases such as mucositis, gingivitis, periodontitis.

Peri-implantitis can also be caused by the installation of implants in a patient for whom they are contraindicated. Many people prefer not to tell the dentist about their somatic diseases. This happens for various reasons. Some patients do not consider this information necessary for performing an operation in the oral cavity. Others are afraid that the doctor will refuse to perform treatment with implants, and after that they will have to use a removable denture. As a result, a complication arises that can lead to the loss of the implant.

The clinical picture of peri-implantitis resembles an exacerbation of periodontitis. In the affected area, the mucous membrane acquires a bright red hue. When brushing teeth, the gum surrounding the implant may bleed. Often, a sign of peri-implantitis is a fistula that appears on the gum in the projection of the implant. The general condition is not always disturbed, however, an increase in body temperature and the appearance of intoxication symptoms are possible. Implant mobility is observed if peri-implantitis occurs shortly after the implant is screwed in or at advanced stages of the disease.

To diagnose peri-implantitis, it is necessary to analyze the X-ray. Depending on the extent of bone destruction around the implant, the degree of the disease is determined. The first class of peri-implantitis manifests itself as minor horizontal destruction of bone tissue. The second class is characterized by moderate horizontal bone loss and the formation of a unilateral vertical bone defect in the area of the implant. The third class differs from the second in that the vertical defect surrounds the implant on all sides. At this stage, implant mobility may be observed. The fourth stage is characterized by a pronounced degree of bone resorption with destruction of one of the walls of the alveolar process.

Treatment of peri-implantitis should begin as early as possible. Only under this condition is it possible to preserve the implant and avoid negative consequences (implant removal). The method of eliminating the inflammatory-destructive process primarily depends on the stage of the pathological process. Moreover, it is important at what stage of implantation peri-implantitis occurred. If the implant is at the stage of osseointegration, then an incision is made, access to the implant is created and the plug is unscrewed from it. After this, the wound is washed with antiseptic solutions and a gum former is installed. After prescribing drug anti-inflammatory treatment, the symptoms of the disease disappear in 3-4 days. A week after the therapy, the gum former is removed and the plug is screwed in. If all manipulations are performed correctly, the wound closes on its own. The second and third stages require additional manipulations, which consist of introducing bone substance into the resorption zone. The fourth class of peri-implantitis can be treated using the same technique, but the chances of success are minimal. Most often, removal of the implant with reimplantation after 6 months is required.

Mucositis and hyperplasia of the mucous membrane

Mucositis is a less dangerous complication than periimplantitis. This is primarily due to the fact that the pathological process affects only the soft tissues around the implant. If we draw a parallel with classic dental diseases, mucositis can be compared to gingivitis, and periimplantitis to periodontitis. However, despite the relative insignificance of mucositis, it should be taken seriously, because it can be complicated by periimplantitis. Most often, the cause of this disease is acute trauma with infection on the wound surface, chronic trauma and violation of oral care rules.

The clinical picture of mucositis is manifested by redness, cyanosis, swelling in the affected area. People may complain of pain, itching, burning, viscosity of saliva, discomfort in the mouth. Around the implant, granulation growth is sometimes determined, which indicates the presence of hyperplasia processes. No changes are determined on the X-ray image.

Treatment of mucositis is reduced to eliminating the cause of its occurrence. To do this, the doctor performs professional teeth cleaning, prescribes antiseptic and anti-inflammatory drugs, and adjusts the technique of teeth cleaning. In the presence of granulation in the implant area, a thorough curettage is performed with the application of periodontal dressings.

Advancing the implant into the maxillary sinus

An implant getting into the maxillary sinus is a rare occurrence, but this complication causes a lot of significant problems for a person. The reason for the localization of the implant in the maxillary sinus is, first of all, improper treatment planning. Some clinics, trying to reduce the price of their services, refuse to comply with the essential principles of implantology. For example, proper treatment planning involves performing a CT scan, its thorough analysis and digital modeling of implantation. The last point allows you to determine the location of the future implant, as well as its required size, diameter and shape with millimeter accuracy. Thanks to a CT scan, you can see the boundaries of the maxillary sinus, consider the need for sinus lifting. If these stages are missed, the implantation becomes unpredictable. For example, an incorrectly selected implant length can lead to perforation of the maxillary sinus. As a result, the implant can completely fall into the sinus cavity. Also, a risk factor for this complication is significant jaw atrophy. In this case, the implant fixation area is too small, and the artificial bone remains soft for a long time after sinus lifting. As a result, the implant may deepen into the maxillary sinus.

The clinical picture of implant movement into the maxillary sinus is quite unpredictable. For example, a foreign object that gets into the maxillary sinus can cause an inflammatory process (sinusitis). There are also known cases when the implant comes out through the nasal passages when sneezing. This suggests that when an implant gets into the maxillary sinus, it is quite difficult to predict the outcome.

Treatment of this complication involves performing surgical intervention and removing the foreign object. The operation involves creating access through the lateral wall of the maxillary sinus by cutting out a fragment of it. After removing the implant, the cut out section of the wall is put back in place and sutured. Repeated implantation and its tactics are determined after establishing the cause of the complication and the condition of the maxillary sinus.

Allergic reaction

Titanium is one of the key metals in modern medicine. It is the optimal material for the production of artificial joints, fixing elements and dental implants. Today, titanium is considered a bioinert material, that is, it is neutral to biological tissues. It is this property that allows implants to successfully integrate into bone matter. However, its biological properties have not been fully studied. Some researchers claim that titanium can cause an allergic reaction. But most experts do not share this opinion. They believe that an implant can cause an allergy, but it is not titanium that is to blame, but impurities of other substances. The fact is that it is technologically very difficult to produce pure titanium. While large companies can afford it, manufacturers of cheap implants use far from pure titanium. As a rule, the alloy contains titanium itself, iron, nickel, silicon, carbon and other elements. Their share in the alloy may vary depending on the technological and economic capabilities of the manufacturer. However, if we talk about allergies, it would be logical to assume that it is the impurities that cause a reaction to the implant. This is argued by the fact that these substances do have allergenic properties. But this theory is also at the research stage, so scientists cannot give a specific answer yet.

The clinical picture of an allergy to an implant can be called classic. A person is bothered by dry mouth, burning, and itching of the gums. For diagnosis, an allergy test should be performed, which will allow the allergen to be accurately identified and eliminated.

Allergy treatment should be based on an individual clinical picture. Of course, the ideal method would be to replace the implant with a zirconium one. However, not every patient is ready to start the whole treatment over again. Therefore, first of all, antiallergic therapy should be carried out. Only after that, if there is no improvement, the structure will have to be removed and replaced with a zirconium one. But if there is an improvement, then the condition of the implant should be closely monitored for some time.

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Implant failure

Most implants are made of a very strong material - titanium. However, as stated earlier, many manufacturers cut corners on research and technological stages. This allows them to compete with larger companies and offer consumers cheaper products. As a result, many implant systems of rather low quality enter the market, which leads to unexpected complications after dental rehabilitation.

An implant fracture is a rather rare and dangerous complication. In addition to the fact that the entire treatment result is reduced to zero, the person and the doctor get serious problems. Firstly, the broken implant becomes mobile. Consequently, pathogenic microorganisms can get into the fracture gap and provoke an inflammatory disease. It should also be noted that the implant fragments must be completely removed. And removing an implant fused with the bone is not an easy task even for an experienced surgeon.

If the implant was broken as a result of a severe injury, the task is complicated by the fact that a large amount of human bone tissue is lost along with the structure.

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Symptoms of implant rejection

Implant rejection is a disease that is accompanied by an inflammatory process in the bone around the implant. The difference between this process and peri-implantitis is that with peri-implantitis the bone is only resorbed, and in this case it is the focus of the inflammatory process. In fact, implant rejection can be called local osteomyelitis.

The clinical picture of implant rejection can manifest itself in several ways. Granulation tissue may appear at the border of the bone and the implant. The reasons for its formation are often overheating of the bone during the preparation of the implant bed. Also, a trigger factor can be a non-sterile surface of the implant, which contains pathogenic microorganisms. In addition, do not forget about the immune and hormonal systems of the body, which ensure the process of implant engraftment. If these systems do not work correctly, then the integration of the implant is initially impossible.

Symptoms of implant rejection are as follows: pain, swelling and redness of the gum in the area of the implant. If the operation was performed using a one-stage technique (when the intraosseous part and the abutment are one piece), then the person may feel the mobility of the structure. Moreover, in case of rejection, the dental implant is often removed by the patient himself due to excessive mobility. If dental rehabilitation was performed using a two-stage technique, then the intraosseous part is independently pushed out under the pressure of granulation tissue. After this, the inflammatory process is significantly reduced. The radiograph shows a zone of bone tissue destruction around the entire perimeter of the implant, about 1 mm wide. Treatment of this condition consists of removing the implant and anti-inflammatory therapy. Repeated implantation can be performed no earlier than after 6 months.

The second type of clinical picture of implant rejection is characterized by the formation of a sequestrum, which contains the implant and the surrounding bone. As a rule, this pathological process is provoked by significant overheating of the bone during its preparation, or by implantation in an area with low blood supply to the bone tissue. A few days after the operation, a person feels aching pain in the area of implantation. Painkillers act only temporarily, and anti-inflammatory drugs do not have the desired effect. In the first 14 days, pathological processes are not determined on the radiograph, however, during this time, the implant may become mobile. Treatment of this form of implant rejection consists of removing the implant, stopping the inflammatory process and eliminating the resulting bone defect.

Preventing complications after implantation

Prevention of complications should be thought out at the treatment planning stage. Careful diagnostics, weighing the indications and contraindications, motivation of the person, his profession - all this is important for predicting the result. You should also always listen carefully and follow the doctor's instructions. Even if you know perfectly well how to properly perform hygiene procedures, receiving this information again will only improve the result. After implantation, do not forget that the probability of periimplantitis and implant rejection always exists. And their trigger can be somatic pathology. Therefore, you should get rid of bad habits and practice a healthy lifestyle. This will prevent many unpleasant diseases that are associated with all body systems. When playing sports, you should always use protective equipment. Compliance with safety regulations will extend the service life of implants for many years.

Is it worth getting implants?

Implantation is a complex and comprehensive type of dental rehabilitation. It has both advantages and disadvantages. After reviewing the various complications of implantation, the question may arise: "Is it worth installing implants at all?" Only you can make the decision. However, if you have the financial ability to undergo a course of implantation, then you should definitely take this step. The fact is that dental implants are the pinnacle of dentistry today. It has many advantages and is highly effective. With the help of implants, you can replace one tooth or all the teeth of the upper and lower jaw. Restorations on implants look very aesthetically pleasing and natural. A beautiful smile gives a person so much self-confidence that successful implantation will stimulate a person to communicate more with people. This will open up new prospects in work, family and friendly relationships.

It is worth remembering that after implantation, a person's speech defects can be corrected. If the diction disorders were associated with the absence of teeth or their incorrect location, then implantation will allow a person to speak more seriously and impressively.

Normal chewing function is one of the most important factors in the health of the gastrointestinal tract. In the absence of teeth, food is not ground properly. As a result, the digestion process is less productive. Restorations on implants are characterized by an ideal anatomical shape, which allows for highly efficient chewing of food.

Durability

The service life of implants is calculated in tens of years. This is due to the high strength of the structure and uniform distribution of the load and teeth. When using dental bridge prosthetics, the optimal service life is 10-15 years. It is worth noting that this option is quite good, if we are talking about dental prosthetics. However, many people have dental bridges installed at a young age. Therefore, if a person undergoes prosthetics at 30, then most likely at 45 he will already be left without a bridge prosthesis and supporting teeth. If implantation was performed, then with proper care, the implant and supporting teeth will be preserved. Moreover, a prosthesis on an implant can stand for life. Removal of an implant after five or more years is most often associated with the appearance of general somatic pathology.

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Financial benefit

At first glance, it seems that implants are a very expensive type of treatment. However, their service life fully justifies their cost. For example, classic complete removable dentures need to be redone every 5 years. That is, in 20 years, you need to undergo prosthetics four times. To this should be added the cost of the fixing paste, which will most likely be needed to fix the lower denture. As a result, over 20 years, the amount spent on removable prosthetics will be no less than the cost of implantation. And if you compare the quality of life with removable prosthetics and implantation, the latter option is more preferable and rational.

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