Compromised Healing After a Dental Implant

What can compromise healing after getting an implant? There are a variety of causes, said Dr. Robert Schoor, DDS, a Clinical Associate Professor and Academic Director at New York University’s College of Dentistry. “Chief among these causes include the soft plaques that, if allowed to accumulate, can increase the risk of infection and periimplantitis. The number two villain is diabetes,” said Dr. Schoor.

Researchers believe that early failure rates are more common than later failures because of the risks inherent in the early-stage healing process. Researchers estimate that about 1.2 to 3 percent of all implants fail in this early period, as compared to late failures with rates of 0 to 1.8 percent. Interestingly, more implants tend to fail in the maxilla, or the upper jaw, than mandible, or lower jaw, though researchers are unsure of the exact reason why.

The reason the first two or three months is a vital and fragile time is because the implant itself is “biologically integrating,” or binding, with the jaw bone. “It’s very important that there is enough bone to support the implant to begin with so the implant has enough structural support, and that the implant is protected while it binds to the bone in that early time period,” said Dr. David Cochran, D.D.S., M.S., Ph.D., professor and chairman of the department of periodontics at the University of Texas Health Science Center at San Antonio dental school. “This healing period is crucial to implant success.”

Poorly Controlled Blood Sugar

One study found that the risk of dental implants failing was more than 2.5 times greater for patients with diabetes compared to those without. One bad habit in diabetes patients is being lax about checking blood sugar. Poorly-controlled blood sugar can lead to poor dental health, periodontal disease, poor circulation and dry mouth, and problems with healing, all of which may contribute to implant failure. Taking care of one’s implants should also include routine dental care and daily brushing and flossing, whether you have diabetes or not.

Smoking and Chewing Tobacco

More than 24.8 million men and 21.1 million women smoke in the United States. Because smoking is still so pervasive, it is one of the most-studied risk factors for dental implant failure.

“Smokers certainly seem to be more susceptible to dental implant failure compared to non-smokers, with double the failure rate,” said Dr. Scott Tomar, D.M.D., Dr. P.H., department chairman and professor of community dentistry and behavioral science at the University of Florida’s College of Dentistry. Dr. Tomar says that chemicals in the cigarette smoke, including nicotine, may interrupt collagen formation and wound healing, not to mention disrupting circulation. “We know the chemicals in tobacco smoke have immunosuppressive affects that increase the risk of infection and conditions like periodontitis, so it’s not the temperature of the smoke per se.”

Will an oral surgeon refuse to place implants in a smoker because they want to increase their overall success rate? Probably not, says Dr. Schoor. “Smoking…we don’t condone it but we don’t go out of our way to not treat patients if they are smokers.” Dr. Schoor says heavy smokers – who smoke more than 10 cigarettes a day – are more at risk for implant failure. “We tell patients that smoking is bad. Don’t smoke. It will not only hinder your chances for implant success, but it will hinder your health in so many other areas.”

Although there are obvious health benefits to stopping smoking, including a better prognosis for dental implant success, dentists and oral and maxillofacial surgeons understand it is actually difficult to achieve.

Dr. Thomas Dodson, D.M.D., M.P.H., an associate professor of oral and maxillofacial surgery at Harvard University and Massachusetts General Hospital, incentivizes his patients. “If I have a patient who smokes, I detail all the risks of smoking,” he said. “I can get you to stop if I get you thinking seriously about the risks of dental implant failure, not to mention all the other damage smoking causes in the mouth. And then I tell them ‘If you stop smoking and the implant fails within six months, I buy the new one. If you don’t stop smoking and the implant fails, the cost is on you.’”

The risk of chewing tobacco, however, is not as well known as with smoking, but the same principles of harm may still apply. “We know that tobacco use in general, smoking it or chewing it, has been clearly related to the microvasculature of the mouth,” said Dr. Dodson.

But why hasn’t the effects of smokeless chewing tobacco on dental implants been studied as much as smoking cigarettes?

“Maybe one reason is because smokeless tobacco is typically used more by younger people, who are also less likely to need implants. Also, the prevalence of people who chew tobacco is a much less population proportionally compared to smokers, said Dr. Dodson. “Because of that, it’s also been difficult to demonstrate definitively that chewing tobacco causes cancer. But that should never condone its use.”

Alcohol Use

Although alcohol use is thought to somehow affect the risk of dental implant failure, researchers say we don’t know nearly enough about it compared to smoking. “Aside from tobacco smoking, we definitely have not collected enough data on substance or recreational drug abuse,” said Dr. Dodson. “But the thing about alcohol or substance abuse, including recreational drugs, is if the problem gets bad enough, it’s not a stretch to say that it probably affects dental care, including implants.”

But what little research we do have suggests that alcohol does indeed have a negative effect on dental implant survival. For instance, one 2004 study found that alcohol consumption can actually delay bone repair and healing in rats. One year later, this same result was confirmed in humans. Researchers also found that daily alcohol use in excess of 10 grams was linked to not just stunted bone repair around implants, but loss of bone, too.

If that’s not enough, heavy drinkers, or alcoholics, could add even more risk for dental implant failure because of their habit. “The liver is such an amazing, vital organ that has a number of crucial body functions,” said Dr. Schoor. “When that organ is compromised by being forced to metabolize excess alcohol, it impairs clotting factors, the immune response, and may significantly affect healing.”

Teeth Grinding (Bruxism)

Teeth grinding is a stress-related disorder that manifests itself during sleep or wakefulness in people of all ages. While children are known to sometimes grind their teeth (also known as bruxism), many adults tend to clench or grind their teeth during the day, which could potentially be a big problem with dental implants.

“Crunching and grinding is certainly an issue with dental implants because it loosens implants and crowns,” said Dr. Schoor. “They take their aggression out on their teeth. It’s a habit, and it’s usually very hard to break.”

One study released this year found that zirconia implants had a 10 percent failure rate from “mechanical overloading.”

“Anything that would ‘load’ the implant inadvertently during the integration period of the first two or three months could possibly increase its risk for failure,” said Dr. Cochran.

To help save teeth and implants, an acrylic mouthguard can be worn to help distribute the loading forces in clenchers and grinders.

Sources:

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Bombonato-Prado KF, Brentegani LG, Thomazini JA, Lachat JJ, and Carvalho TL. 2004. Alcohol intake and osseointegration around implants: a histometric and scanning electron microscopy study. Implant. Dent. 13 (3): 238-244.

Courtney MW, Jr., Snider TN, and Cottrell DA. 2010. Dental implant placement in type II diabetics: a review of the literature. J. Mass Dent. Soc. 59 (1): 12-14.

Gahlert M, Burtscher D, Grunert I, Kniha H, and Steinhauser E. 2011. Failure analysis of fractured dental zirconia implants. Clin. Oral Implants. Res.

Galindo-Moreno P, Fauri M, Avila-Ortiz G, Fernandez-Barbero JE, Cabrera-Leon A, and Sanchez-Fernandez E. 2005. Influence of alcohol and tobacco habits on peri-implant marginal bone loss: a prospective study. Clin. Oral. Implants. Res. 16 (5): 579-586.

Johansson A, Omar R, and Carlsson GE. 2011. Bruxism and prosthetic treatment: A critical review. J. Prosthodont. Res. 55 (3): 127-136.

Palma-Carrio C, Maestre-Ferrin L, Penarrocha-Oltra D, Penarrocha-Diago MA, and Penarrocha-Diago M. 2011. Risk factors associated with early failure of dental implants. A literature review. Med. Oral Patol. Oral Cir. Bucal. 16 (4): e514-e517.

Snider TN, Cottrell D, and Batal H. 2011. Summary of current consensus on the effect of smoking on implant therapy. J. Mass. Dent. Soc. 59 (4): 20-22.

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According to the American Academy of Cosmetic Dentistry, approximately 30 percent of aesthetic dental procedures are performed on baby boomers “wanting to look better.”   It’s no wonder, then, why recent a report from Millennium Research Group, a reputed global authority in medical technology trends, forecasted a 9 percent growth in demand for dental implants over the next five years. While almost 13 percent of the current U.S. population is age 65 and older, that statistic is increasing exponentially as baby boomers grow in number within this demographic over the next two decades, according to information provided by the Administration on Aging.

Although dental implants have a long, established history worldwide, the technology to safely and effectively conduct the procedure for the masses has only come to be in recent years.  This directly correlates with improvements in implant materials over the past 50 years and decreasing costs and effectiveness of pre and post-implant diagnostics.  Within the past five years, traditional film x-rays in dental offices have frequently been replaced with higher reliability technological solutions, such as the CAT Scan and 3D CAT scan machines.  Having access to this detailed information is more expedient to both dentist and patient because the condition of the jaw is a known factor, before attempting implantation.  This means that present day implant procedures are much more expedient, accurate and less invasive physically than in years past.

In generations past, turning 65 used to mean automatic dentures and a soft-food diet, but technology’s ability to discern what’s on the outside and the inside allows us all the opportunity to grow older gracefully.