Dental Implant Rejection

Dental Implants

The rejection rate for high-end dental implants is less than 1%, and for low-cost dental implants it can be as high as 4%. The risk is very small, but it does exist. And no one would want to be included in that statistic. This is something you should factor in before having your dental implant operation in Turkey


What is non-grafting or rejection of an implant


First, we need to clarify the sequence of osseointegration - the adhesion of the artificial root to the jawbone.


Within two to three days after screwing the implant into the jawbone, osteoblasts (newly formed bone cells) begin to grow in the micro-roughened layer of the implant.


By day 4-6, they are connected to trabeculae, the cancellous tissue cells of the alveolar process, and osteons, the compact bone tissue cells. A bone matrix forms around the titanium post and its density increases day by day.


After 3 or 6 months (in the lower and upper jaw, respectively), the artificial root becomes firmly fused to the bone.


We will now clarify the meaning of the following two terms in implantology:


• Non-occurrence, when after being screwed into the bone, the implant does not fuse with the bone for 3 to 6 months ;


• Implant rejection, when after successful integration of the artificial root into the jawbone tissue (3 to 5 years after insertion), it loses its osseointegration bond, becoming mobile.


Thus, in the short term (up to 6 months after insertion), the titanium dental root is said to be non-healing. In the long term (2 to 5 years), it is said to be rejected. To read more about the long and short term durability of implant treatment, check out our post on how long dental implants last?


Symptoms


• Intense and constant pain after the implantation or swelling of the gums on the 4-5th day after the operation;


• Painful sensations when chewing;


• Pus discharge from the post-operative wound (accompanied by bad breath);


• High temperature (over 38C);


• mobility of the titanium post.


Causes of non-healing of implants


Dentist's mistakes


Overheating of the bone tissue: The doctor may use blunt instruments to form the implant bed (the place where the titanium root will be screwed in). Even worse, if he neglects adequate irrigation (water cooling) during the operation. This results in necrosis of the bone area. The artificial root cannot fuse with the fibrous bone tissue.


Unsatisfactory sterility of the oral cavity: Teeth are cleaned of plaque and calculus by ultrasound before the implant is placed. Teeth with caries or pulpitis are treated. Inflammatory pus lesions are treated. The implantologist may overlook something or fail to diagnose an underlying pathology (for example, a cyst near the root of the tooth where the titanium post is placed). Infections left in the mouth can lead to inflammation of the tissue around the titanium post and interfere with its implantation.


Incorrect positioning of the implant: If the titanium post is screwed into an area of the jaw with insufficient bone volume (less than 2 mm), it will loosen in 4 to 6 weeks.


Ignore relative contraindications: The implant may not take root if the implantologist was unwilling to wait and performed the procedure before the temporary contraindication was lifted. For example, he did not wait until the blood sugar level reached normal values (diabetes mellitus).


Patient errors


Violation of aftercare guidelines: After implantation, a patient may violate the red lines of dental implant aftercare: as instructed by the doctor going to the sauna, flying, overexertion, refusing to take medication prescribed by the doctor.


Refusal of preventive examinations: The patient may refuse to partake in preventive examinations to monitor the effectiveness of the osseointegration process, detect periodontal tissue inflammation and other dental diseases in time that may interfere with the normal progress of the implant into the bone.


Causes of implant rejection


Medical errors


Overloading of the implant. A crown placed on an artificial root can lead to an underbite or overbite (dentist's error). During chewing, the titanium root is permanently overloaded, which can lead to rejection.


Errors in the planning of the operation. Peri-implantitis can occur:


• Placement of the titanium post very close to the neighboring tooth or an existing implant;


• Thin gums that cannot act as a natural barrier to protect the implanted area from infection;


• Insufficient gum tissue has been placed around the titanium post (it will become mobile and peri-implantitis is inevitable over time).


• Prosthetic defects. A loose connection of the abutment to the implant or crown leads to infection in the existing micro-spaces. The dentist may also fail to properly remove residual cement after cementing the crown to the implant.


Patient errors


Poor maintenance of implants: Artificial teeth require the same care as your own teeth. Inadequate oral hygiene leads to a build-up of bacteria, especially around the gums. This leads to mucositis, an inflammatory-destructive disease process that can lead to a loss of connection between the implant and the surrounding tissue if not treated in time. At the stage of mucositis, the artificial root can be preserved. However, if it develops into peri-implantitis, when the inflammation affects and destroys the bone, the implant must be removed.


Smoking: Nicotine damages the salivary glands and causes chronic dryness of the oral mucosa. It creates favorable conditions for the active multiplication of pathogenic microflora. It multiplies the risk of inflammation of the gum and bone around the implant, which can lead to peri-implantitis. Nicotine tars also have a constricting effect on the blood vessels, depriving the soft tissue of adequate nutrients.


Leaving the remission phase: Certain systemic diseases are considered relative contraindications. Implantation is possible only after prior preparation, when the disease is in remission. Exacerbation of a chronic disease after surgery may cause rejection of the artificial root. For patients with chronic diseases, it is important to regularly follow up with a specialist to prevent an exacerbation of the disease.


Periimplantitis - what is it and how does it develop


Periimplantitis is an inflammatory process caused by the penetration of pathogenic bacteria into the tissue surrounding the implant. It affects not only the gums, but also the bone tissue.


In the early stages, bone resorption of up to 3 mm is observed. It is still possible to stop the destructive process with conservative therapy. The doctor will start the treatment if the titanium post is still immobile. The slightest movement is a direct indication for removal.


In the intermediate stage, bone loss is diagnosed over almost half of its vertical height. Pus is excreted in the area of the artificial root.


In the final stage, the bone tissue atrophies almost completely. Deep pockets form, which worsen the infection.


Can I have a second implant after a rejection?


Yes, the rejected implant can be replaced by a new one. There are several phases to the operation:


• The crown is removed


• The titanium post is removed


• The cause of the rejection is removed


• Antibiotic treatment is prescribed


• An osteoplasty is performed to fill the resulting bone defect


• Correction of the crown (if the incorrect shape of the crown has caused the implant to be overloaded)


• After the bone material has taken root (1 to 3 months), a new artificial root is placed


Who will pay for the replacement?


If the cause of the rejection is an error by the implantologist or orthopedist, the clinic will replace the implant free of charge under warranty.


The warranty does not apply if the patient:


• Failed to follow oral hygiene practices


• Has not followed the dentist's aftercare instructions


• Suffered trauma that caused the implant to be rejected


• Violated other rules prescribed in the dental implant supply contract (these may differ from clinic to clinic).


How to avoid implant rejection after insertion


First, you must carefully choose the clinic and implantologist who will perform the procedure. A thorough pre-treatment examination, computer-assisted surgical planning, the use of proven implant systems, strict adherence to sterility and surgical protocols - all these elements combine to reduce the risk of rejection to zero.


Second, the patient must strictly follow the doctor's recommendations during the rehabilitation period and ensure good oral hygiene at all times.