Complex Dental Implant Complications

Foreword
Preface
Contents
Preoperative Implant Evaluation and Complications of Treatment Planning
	1 Introduction
	2 Initial Consultation
	3 Medical History
	4 Soft Tissue Evaluation
	5 Hard Tissue Evaluation
	6 Clinical Alveolar Ridge Assessment
	7 Dental Arch Assessment
	8 Ideal Implant Positioning
	9 Virtual Surgical Planning
	10 Complications and Root-Cause Analysis
	References
Medical Complications in Dental Implantology
	1 Cardiovascular Disease
	2 Liver Disease
	3 Renal Disease
	4 Hematological Disease
	5 Head and Neck Cancer
	6 Bone Modifying Agents: Anti-resorptives
	7 The Smoker
	8 Alcohol Consumption
	9 Inflammatory Diseases
	10 Immune System Dysfunction
	11 Diabetes
	12 Advanced Age
	13 Neurologic and Musculoskeletal Deficits Patients
	14 Psychiatric Disorders
	15 Conclusion
	References
Intraoperative Dental Implant Complications
	1 Introduction
	2 Aspiration or Ingestion of Implants and Their Associated Components
	3 Inadequate Stability and Displacement
		3.1 Malpositioned Implants
	4 Damage to Adjacent Teeth
	5 Mandible Fracture
	6 Insufficient Inter-implant Distance
	7 Nerve Injury
	8 Hemorrhage: Bleeding
	References
Anatomic Basis of Dental Implant Complications
	1 Introduction
	2 Vascular Injuries
		2.1 General Blood Supply to the Head and Neck
		2.2 The Venous System
		2.3 Blood Supply to the Mandible
		2.4 Blood Supply to the Maxilla
	3 Neurologic Injuries
		3.1 Overview of the Trigeminal Nerve
		3.2 The Lingual Nerve
		3.3 Parasympathetic Innervation
		3.4 The Inferior Alveolar Nerve
		3.5 The Nasopalatine Nerve
	4 Osseous and Dental Injuries
		4.1 The Maxillary Sinus
		4.2 Mandible Fractures
	5 Case: “Infected Implants”
		5.1 Dental Injuries
		5.2 Soft tissue Injuries
	6 Involvement of Fascial Spaces
		6.1 Displaced (Lost) Material
	7 Case: Displaced Implant During Stage I Surgery
		7.1 Possible Areas of Displacement
		7.2 Approach
	8 Conclusions
	References
Aesthetic Dental Implant Complications
	1	 Background
	2	 Hard Tissue at Site of Implant
	3	 Soft Tissue at Site of Implant
		3.1	 Importance of Quantity (Biotype)
		3.2	 Importance of Quality (Keratinized Tissue)
	4	 3D Implant Positioning
		4.1	 Apico-coronal Placement
		4.2	 Mesiodistal Placement
		4.3	 Facio-lingual Placement
	5	 Single vs. Multiple Implants
	6	 Impact of Implant Diameter
	7	 Level of Bony Attachment on Adjacent Teeth
	8	 Timing: Immediate, Early, Late
		8.1	 Indications for Immediate Implant Placement
		8.2	 Indications for Early Implant Placement with Soft Tissue Healing in 4–8 Weeks
		8.3	 Indications for Early Implant Placement with Partial Bone Healing in 12–16 Weeks
	9	 Immediate Implant Placement, Immediate Provisionalization
	10	 Patient Selection and Smile Line
	11	 Clinical Skill and Experience
	12	 Surgical Intervention for Correction of Aesthetic Failures
	13	 Clinical Cases
		13.1	 Case 1
		13.2	 Case 2
		13.3	 Case 3
		13.4	 Case 4
		13.5	 Case 5
		13.6	 Case 6
	14	 Conclusion
	References
Infectious Dental Implant Complications
	1 Introduction
	2 Description
	3 Etiology
		3.1 Physical and Thermal Effects
			3.1.1 Intraoperative
			3.1.2 Immediate Implant Placement to Fresh Extraction Site and/or Immediate Loading
			3.1.3 Long-Term Postoperative
				Prosthesis Related Problems
				Overloading or Lateral Forces
				Prosthesis-Related Problems
		3.2 Medications
		3.3 Infection
			3.3.1 Intraoperative Contamination
			3.3.2 Increased Surgery Time
			3.3.3 Lack or Loss of Keratinized Gingiva
			3.3.4 Experience of Surgeon
			3.3.5 Previous Infections: Immediate Placement at an Infected Tooth Socket
			3.3.6 Retrograde (Periapical) Peri-implantitis (Periapical Implant Lesion)
		3.4 Implant and Sinus Interactions
			3.4.1 Periodontitis and Peri-Implantitis Relation
			3.4.2 Spread of Adjacent Infection to Implant
			3.4.3 Bur Cleaning
			3.4.4 Perioperative Antimicrobial Agent Use
			3.4.5 Lack of Postoperative Follow-Up
			3.4.6 Micro Gap Between Implant and Abutment as a Bacteria Resource
			3.4.7 Peri-implant Graft Related Risk
			3.4.8 Structure of Implant
			3.4.9 Genetic Tendency
			3.4.10 Systemic Condition of the Patient
	4 Diagnosis and Treatment Planning
		4.1 Clinical Findings
		4.2 Imaging
		4.3 History
	5 Treatment of Peri-implant Infections
	6 Non-surgical Techniques: Surface Decontamination
		6.1 Mechanical Debridement
			6.1.1 Hand Scalers
				Ultrasonic Scalers
			6.1.2 Air Pressured Abrasive Powder
			6.1.3 Rotating Brush
	7 Chemical
		7.1 Irradiation
			7.1.1 Laser
		7.2 Implantoplasty
	8 Regenerative Surgery: Surgical Techniques
	9 Bone Reconstruction Techniques
		9.1 Vertical Defects Less Than 3 mm
		9.2 Vertical Defects More and Equal to 3 mm
		9.3 Horizontal Defects Smaller Than Half of Implant Diameter
		9.4 Horizontal Defects Larger Than Half of Implant Diameter
	10 Implant Removal: Explantation
	11 Complications of Peri-implantitis
	12 Pathologic Lesions Around Dental Implant
	13 Corrosion and Implantoplasty Co-products
	14 Summary
	References
Preventing and Treating Dental Implant Complications from Drugs Known to Cause Osteonecrosis of the Jaws
	1	 Section I: The Patient with Osteoporosis
		1.1	 Drugs Known to Cause DIONJ in the Treatment of Osteoporosis
			1.1.1	 Oral Drugs Known to Cause DIONJ
		1.2	 Drug and Potency
		1.3	 Frequency
		1.4	 Length of Use
		1.5	 Last Dose Taken
			1.5.1	 Safety of Dental Implantology in Patient Taking Oral Bisphosphonates Using an Appropriate Drug Holiday
		1.6	 The Value and Limitations of the CTX Test
			1.6.1	 Representative Case Examples
	2	 Resolving DIONJ to Prepare a Patient for Dental Implants in Osteoporotic Patient
		2.1	 Infection Control in DIONJ
		2.2	 Staging DIONJ in the Osteoporosis Patient
		2.3	 Principles of Resolving DIONJ in the Osteoporotic Patient
		2.4	 Extensive DIONJ Cases in the Osteoporotic Patient
		2.5	 Safety of Dental Implants in Patients Taking Subcutaneous Denosumab for Osteoporosis
	3	 Section II: The Cancer Patient with Bony Metastasis and/or Hypercalcemia of Malignancy
		3.1	 Drugs Known to Cause DIONJ in the Metastatic Cancer Patient
	4	 Prevention of DIONJ in Metastatic Cancer Patients Taking Drugs Known to Cause DIONJ and Requiring Implants
		4.1	 Prevention Before Beginning Treatment
		4.2	 Avoiding Dental Implant Complications During Treatment with Drugs Known to Cause DIONJ in Metastatic Cancer Patients
		4.3	 Treating Complications of Dental Implants Placed in Metastatic Cancer Patients Who Have Received Drugs Known to Cause DIONJ
	References
Complications in the Atrophic Mandible
	1	 Introduction
	2	 Soft Tissue Complications
		2.1	 Incorrect Soft Tissue Manipulation and Dehiscence
		2.2	 Hemorrhage and Hematoma
		2.3	 Nerve Damage
		2.4	 Infections
	3	 Bone-Related Complications
		3.1	 Osseointegration Failure
		3.2	 Graft Resorption and Loss
		3.3	 Fractures of the Mandible
		3.4	 Drug-Induced Osteonecrosis
	References
Trigeminal Nerve Injuries
	1 Etiology and Prevention
		1.1 Errors in Diagnosis and Treatment Planning
		1.2 Local Anesthesia
		1.3 Surgical Flap
		1.4 Nerve-Repositioning
		1.5 Implant Osteotomy
		1.6 Implant Placement
		1.7 Medications
		1.8 Bone Graft
	2 Evaluation
	3 Treatment
	4 Surgical Case Examples
	5 Nonsurgical Treatment and Sensory Rehabilitation
	6 Summary and Conclusions
	References
Complications of Sinus Grafting and the Atrophic Maxilla
	1	 Background
	2	 Sinus Grafting
		2.1	 Lateral Window Technique
			2.1.1	 Preoperative Work-up
			2.1.2	 Intraoperative Complications
				Schneiderian Membrane Perforation
		2.2	 Prevention
		2.3	 Management of Sinus Membrane Perforation
			2.3.1	 Small Perforations (Less than 2 mm Diameter)
			2.3.2	 Perforations (2–10 mm Diameter) with Surrounding Intact Membrane
			2.3.3	 Perforations with 2–5 mm Diameter Close to Lateral Sinus Walls
			2.3.4	 Perforations with 5–10 mm Diameter Close to Lateral Sinus Walls
			2.3.5	 Perforations with a Diameter Larger than 10 mm
		2.4	 Postoperative Care
			2.4.1	 Intraoperative Bleeding
		2.5	 Prevention
		2.6	 Management
			2.6.1	 Cysts of the Maxillary Sinus
		2.7	 Postoperative Infection
		2.8	 Subcutaneous Emphysema After Sinus Lifting Surgery
			2.8.1	 Infection of the Graft Material
		2.9	 Management of Postoperative Graft Infection
			2.9.1	 Postoperative Sinusitis
		2.10	 Etiology and Prevention
		2.11	 Management
			2.11.1	 Transcrestal Technique
				Membrane Perforation
		2.12	 Prevention
		2.13	 Management
			2.13.1	 Benign Paroxysmal Positional Vertigo
		2.14	 Prevention
		2.15	 Management
			2.15.1	 Displacement of Implant in the Maxillary Sinus
		2.16	 Prevention
		2.17	 Management
	3	 Graft-Free Procedures to Rehabilitate the Atrophic Maxilla
		3.1	 Zygomatic Implants
			3.1.1	 Invasion to Vital Surrounding Structure
			3.1.2	 Postoperative Sinusitis
			3.1.3	 Oro-antral Communication
			3.1.4	 Soft Tissue Dehiscence
			3.1.5	 Bulky Palatal Extension of the Prosthesis
		3.2	 Pterygoid Implants
		3.3	 Tilted Trans-Sinus Implants
		3.4	 Ultrashort Implants
	4	 Augmentation with Onlay and Inlay Autogenous Graft
	5	 Conclusion
	References
Miscellaneous Complications in Oral Implant Surgery
	1 Introduction
	2 Inadequate Evaluation
		2.1 Implant in Existing Tooth Remnants and/or Pathologic Lesions
	3 Nonrestorable Implants
	4 Improper Treatment Planning
		4.1 Complications Due to Inappropriate Implant Size and Number of Dental Implants
	5 Size of Dental Implants
	6 Numbers of Dental Implants
	7 Implant–Tooth Connection: An Evidence-Based Approach
	8 Technical Complications
	9 Tooth Intrusion
	10 Biological Complications
	11 Toxicity of Titanium Dental Implants
	12 Metallic Attrition
		12.1	 Metal Release During Drilling and Osteotomy
		12.2 Metal Attrition During Implant Placement
		12.3 Metal Release in Abutment Fixture Connections
		12.4 Metal Release in the Maintenance Phase
		12.5 Proposed Local Adverse Effects of Titanium Implants
	13 Proposed Rare Systemic Adverse Effects of Titanium
	14 Allergy to Dental Implants
		14.1 Diagnosis of Titanium Allergy
			14.1.1	 Management of Patients with Allergy to Titanium
	Further Reading