Tooth implant rejection

Dental implantation is by far the most optimal way of replacing lost teeth. More and more people prefer implants instead of classical removable prostheses or orthopedic structures on teeth. This is primarily due to the high functional stability of the implants and the possibility of achieving an aesthetic result. Competition in the market of dental products 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 abandon this type of restoration of dentition. First of all, these are 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 opportunities is the most common reason for refusing implantation. Fear of rejection is usually observed in fewer people, often in those who have had unsuccessful experience with implantation. And yet, the issue of implant rejection is now being actively studied by leading manufacturers of dental equipment. The technologies of manufacturing, processing and coating of implants are constantly being improved, which makes it possible to increase 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 loss may occur. In each particular case of unsuccessful implantation, there is a unique set of factors that together lead to unsatisfactory results. However, if the main cause is identified from each situation, the most popular ones will be: periimplantitis and mucositis, implant rejection proper, allergic reaction, complications associated with the maxillary sinus, breakage of the implant.

Peri-implantitis

Periimplant is an infectious inflammatory-destructive disease in which bone structures and soft tissues are affected around the implant. It is worth noting that among all the reasons for unsuccessful implantation, this complication takes a leading role. Consequently, this complication is also feared by patients, which often leads to a failure to perform dental implantation. The trigger mechanism in the development of this disease can serve many factors. Substandard implants can be made from cheap alloys, have a spray that does not promote engraftment of the implant. Also, the cause may be an incorrect operation. Errors can consist in violation of aseptic and antiseptic rules, deviation from the protocols of working with bone (bone overheating, improper selection of mills, etc.), fixation of orthopedic structures.

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

The cause of peri-implantitis can also be the installation of implants to a patient to whom they are contraindicated. Many people prefer not to tell the dentist about their physical illnesses. 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 refuses to carry out treatment with the help of implants, and after that they will have to use a removable prosthesis. As a result, there is a complication that can lead to 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 color. When brushing the teeth, the gum surrounding the implant can bleed. Often, a sign of peri-implantitis is a fistula that appears on the gums in the implant projection. The general condition is not always violated, however, an increase in body temperature and the appearance of symptoms of intoxication are possible. The mobility of the implant is observed if the peri-implantitis occurs a short time after screwing in the implant or in advanced stages of the disease.

For the diagnosis of peri-implantitis, an analysis of the radiograph should be made. Depending on the extent of bone destruction around the implant, the degree of disease is determined. The first class of peri-implantitis manifests itself in the form of a slight horizontal destruction of bone tissue. The second class is characterized by a moderate horizontal loss of bone tissue and the formation of a one-sided vertical bone defect in the implant area. The third class differs from the second in that a vertical defect surrounds the implant from all sides. At this stage, the mobility of the implant can be observed. The fourth stage is characterized by a pronounced degree of bone resorption with the destruction of one of the walls of the alveolar process.

Treatment of peri-implantitis should begin as soon as possible. Only with this condition, it is possible to preserve the implant and avoid negative consequences (removal of the implant). The method of eliminating the inflammatory-destructive process primarily depends on the stage of the pathological process. Moreover, the significance at which stage of implantation a peri-implant appeared. If the implant is at the stage of osseointegration, then a cut is made, the implant is accessed and the plug is unscrewed from it. After this, the wound is washed with antiseptic solutions and the gingiva former is installed. After the appointment of a medicamental anti-inflammatory treatment, the symptoms disappear after 3-4 days. A week after the therapy, the gingiva former is removed and screwed in. With proper execution of all manipulations, the wound closes itself. The second and third stages require additional manipulations, which consist in introducing bone substance into the resorption zone. The fourth class of peri-implantitis can be treated by the same method, but the chances of success are minimal. Most often, the extraction of the implant with reimplantation is required after 6 months.

Mucositis and hyperplasia of the mucosa

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

The clinical picture of mucositis is manifested by redness, cyanosis, swelling in the affected area. People can complain of pain, itching, burning, saliva viscosity, discomfort in the mouth. Around the implant is sometimes determined by the growth of granulations, which indicates the presence of hyperplasia. On the radiographic picture, changes are not determined.

Treatment of mucositis reduces to eliminating the cause of its occurrence. For this, the doctor performs professional cleaning of teeth, prescribes antiseptic and anti-inflammatory drugs, corrects the technique of cleaning teeth. In the presence of granulations in the implant area, a thorough curettage is performed with the imposition of periodontal dressings.

Promotion of the implant in the maxillary sinus

The implant in the maxillary sinus is a rare phenomenon, but this complication gives the person many significant problems. The reason for the localization of the implant in the maxillary sinus is, first of all, the wrong planning of treatment. Some clinics, trying to reduce the price for their services, refuse to comply with the inherent principles of implantology. For example, the correct planning of treatment involves the implementation of a computer tomogram, its careful analysis and digital simulation of implantation. The last point allows you to determine with accuracy millimeter the location of the future implant, as well as its required size, diameter and shape. Thanks to a computer tomogram, you can see the borders of the maxillary sinus, consider the need to perform a sinus-lifting. If these stages are missed, implantation becomes unpredictable. For example, incorrectly selected length of the implant can lead to perforation of the maxillary sinus. As a result, the implant can fall completely into the sinus cavity. A significant risk of this complication is a significant atrophy of the jaw. In this case, the area of fixation of the implant is too small, and the artificial bone after a sine-lifting for a long time is in a soft state. As a result, the implant can go deeper into the maxillary sinus.

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

Treatment of this complication consists in performing surgical intervention and extracting a foreign object. The operation involves the creation of access through the side wall of the maxillary sinus with cutting out its fragment. After removal of the implant, the cut out portion of the wall is laid in place and sutured. Repeated implantation and tactics of its carrying out is determined after the cause of the complication and condition of the maxillary sinus has been established.

Allergic reaction

Titanium in modern medicine is one of the key metals. It is the optimal material for the manufacture of artificial joints, fixation elements and dental implants. To date, titanium is considered a bioinert material, that is, it is neutral to biological tissues. It is these properties that allow the implants to successfully integrate into the bone substance. However, its biological properties are not fully understood. Some researchers argue that titanium is capable of causing an allergic reaction. But most experts do not share this opinion. They believe that the implant can cause allergies, but it's not the titanium, but the impurities of other substances. The point is that it is technologically very difficult to produce pure titanium. If large companies can afford it, the manufacturers of cheap implants use far from pure titanium. As a rule, the composition of the alloy is actually titanium, 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 the impurities cause a reaction to the implant. This is argued by the fact that these substances do have allergenic qualities. But this theory is also at the research stage, so scientists can not give a concrete answer yet.

The clinical picture of an allergy to an implant can be called classical. A person is worried about dry mouth, burning, itching of the gums. For the diagnosis should be an allergic test, which will accurately identify the allergen and eliminate it.

Treatment of allergies should be based on an individual clinical picture. Of course, the ideal method is to replace the implant with zirconium. However, not every patient is ready to start all treatment again. Therefore, antiallergic therapy should be given first of all. Only after this, in the absence of improvements, the design will have to be removed and replaced with zirconium. But, if improvements have occurred, then for a while you should carefully monitor the condition of the implant.

[1], [2], [3], [4]

Damage to the implant

Most implants are made of a very durable material - titanium. However, as mentioned earlier, many manufacturers save 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.

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

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

[5], [6]

Symptoms of implant rejection

An 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, rejection of the implant can be called a local osteomyelitis.

The clinical picture of rejection of an implant can be manifested in several variants. On the border of the bone and the implant, granulation tissue may appear. The reasons for its formation, often, is the overheating of the bone during the preparation of the implant bed. Also, the non-sterile surface of the implant, which contains pathogenic microorganisms, can become a trigger factor. In addition, do not forget about the immune and hormonal system of the body, which provide the process of engraftment of the implant. If the system data does 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 gums in the area of the implant. If the operation was carried out in a one-step procedure (when the intra-osseous part and the abutment are a single whole), then the person can feel the mobility of the structure. Moreover, with rejection, the dental implant is often extracted by the patient himself because of too much mobility. If dental rehabilitation was carried out in a two-step procedure, then the intraosseous part under pressure of the granulation tissue is independently pushed out. After this, the inflammatory process is significantly reduced. On the roentgenogram, the zone of destruction of bone tissue is determined along the perimeter of the implant with a width of about 1 mm. Treatment of this condition consists in extracting the implant and performing anti-inflammatory therapy. Repeated implantation can be performed no earlier than 6 months later.

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 a significant overheating of the bone when it is prepared, or by implantation in a site with low blood supply to the bone tissue. A few days after the operation, a person feels aching pain in the implantation area. Anesthetics are only temporary, and anti-inflammatory drugs do not have the proper effect. In the first 14 days on the roentgenogram, pathological processes are not determined, however, during this time the implant may become mobile. Treatment of this form of implant rejection consists in extracting the implant, stopping the inflammatory process and eliminating the formed bone defect.

Prevention of complications after implantation

Preventive maintenance of complications should be thought over at a stage of planning of treatment. Careful diagnosis, weighing of indications and contraindications, motivation of a person, his profession - all this is important for predicting the result. Also, always listen carefully and follow the doctor's instructions. Even if you know perfectly well how to properly perform hygiene procedures, retrieving this information will only improve the result. After the implantation, one should not forget that the probability of peri-implantitis and implant rejection always exists. And their starting factor can be somatic pathology. Therefore, one 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, always use protective equipment. Compliance with safety regulations will extend the life of implants for years to come.

Should I put implants?

Implantation is a complex and complex type of dental rehabilitation. It has both advantages and disadvantages. After acquaintance with various complications of implantation, the question may arise: "Is it worthwhile to put implants at all?" The decision is made only by you. However, if you have the financial opportunity to undergo an implantation course, then definitely this step should be taken. The fact is that dental implants are the top of dentistry to date. It has a lot of advantages and high efficiency. With the help of implants, you can replace one tooth or all teeth of the upper and lower jaw. Restorations on implants look very aesthetically and naturally. A beautiful smile gives a person so much confidence that successful implantation will encourage a person to communicate more with people. This will open new perspectives in work, family and friendships.

Do not forget that after implantation, a person can correct speech defects. If violations of diction have been associated with lack of teeth or their incorrect location, implantation will allow a person to talk 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, the grinding of food occurs poorly. As a result, the process of digestion is less productive. Restorations on implants are characterized by an ideal anatomical shape, which allows chewing food with high efficiency.

Durability

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

[7], [8], [9]

Financial benefits

At first glance it seems that implants are a very expensive kind of treatment. However, the term of their service fully justifies their cost. For example, classical complete removable dentures need to be reworked every 5 years. That is, for 20 years you need four times to undergo prosthetics. To this should be added the cost of the fixing paste, which is most likely needed for fixing the lower denture. As a result, for 20 years the amount spent on removable prosthetics will not be less than the cost of implantation. And if you compare the quality of life with a removable prosthesis and implantation, the latter option is more preferable and rational.

[10], [11]