Complications of dental implants identification frequency and associated risk factors
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Complications of Dental Implants: Identification, Frequency and Associated Risk Factors. NE McDermott, BS*, S-K Chuang, DMD, MD*, VA Vehemente, BS*, S Daher, DMD † , A Muftu, DDS, MS †† , TB Dodson, DMD, MPH *‡ Harvard School of Dental Medicine * Massachusetts General Hospital ‡

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Complications of Dental Implants: Identification, Frequency and Associated Risk Factors

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Complications of dental implants identification frequency and associated risk factors

Complications of Dental Implants: Identification, Frequency and Associated Risk Factors

NE McDermott, BS*, S-K Chuang, DMD, MD*,

VA Vehemente, BS*, S Daher, DMD†,

A Muftu, DDS, MS††, TB Dodson, DMD, MPH*‡

Harvard School of Dental Medicine *

Massachusetts General Hospital‡

Boston University Goldman School of Dental Medicine†

Tufts University School of Dental Medicine††


Complications of dental implants identification frequency and associated risk factors

  • Dental implants are a widely accepted treatment modality.

  • Questions exist regarding complications associated with dental implants.

  • Systematic reports of implant complications and associated risk factors are limited.

Background and Significance


Specific aims

Specific Aims

  • Specific Aim 1: To identify complications associated with dental implants.

  • Specific Aim 2: To estimate the frequency of implant complications.

  • Specific Aim 3: To identify risk factors associated with implant complications.


Hypothesis

Hypothesis

  • We hypothesize that we will identify risk factors associated with implant complications that maybe modified by the clinician to enhance patient outcome.


Complications of dental implants identification frequency and associated risk factors

  • Study Design: Retrospective cohort

  • Sample:Patients having > one Bicon® implant placed at the Implant Dentistry Centre (IDC), Faulkner Hospital (Boston, MA) between 1992 and 2000

  • Randomly selected one implant per patient for study inclusion

Materials and Methods


Study variables

Study Variables

• Predictor Variables (Risk Factors)

•Demographic

-gender

-age

•Medical

-ASA status

-tobacco use


Complications of dental implants identification frequency and associated risk factors

  • Anatomic

    • implant location (maxilla vs. mandible, anterior vs. posterior)

    • bone quality (1-4)

    • implant proximity to teeth or implants

  • Implant Specific

    • implant diameter and length

    • well size

    • implant coating

    • implant staging

    • abutment diameter and angulation


Complications of dental implants identification frequency and associated risk factors

  • Prosthetic

    • removable (overdenture) or fixed (crown/ bridge)

  • Reconstructive

    • use of procedures/materials to enhance recipient site

  • Other

    -perioperative antibiotic use


Study variables cont d

Study Variables (Cont’d)

• Outcome Variable

  • presence or absence of complications

    • Complications grouped into three categories

  • inflammatory

  • prosthetic

  • operative


Complications of dental implants identification frequency and associated risk factors

  • Inflammatory Complications

    -mobility

    -pain

    -infectious process

    -peri-implantitis

    -impaired wound healing

    -gingival recession


Complications of dental implants identification frequency and associated risk factors

  • Prosthetic Complications

    • abutment fracture/loosening

    • O-ring damage requiring replacement less than twelve months after insertion of overdenture

    • occlusal or prosthetic adjustment more than two weeks after delivery of permanent restoration

    • recementation of loose prosthesis within two weeks of delivery


Complications of dental implants identification frequency and associated risk factors

  • Operative complications

    • inadvertent placement of implant into sinus or submandibular space

    • paresthesia


Data analysis

Data Analysis

• Descriptive statistics and complication frequencies

• Analyses to identify candidate variables (risk factors) associated with complications (p<0.15)

-univariate Cox proportional hazards regression model

• Identification of specific variables associated with complications (p< 0.05)

-multivariate Cox proportional hazards regression model


Descriptive statistics

Descriptive Statistics

Sample Size 677

Demographic Variables

Age (yr) 53.9 ± 13.9

Gender (female) 339 (50.1)

Medically Related Variables

ASA Status ( >II)6 (0.9)

Medically Compromised (Yes)57 (8.5)

Tobacco User (Yes) 57 (10.3)


Complications of dental implants identification frequency and associated risk factors

Anatomic Variables

Jaw

• Maxilla425 (62.8)

Location

• Posterior471 (69.6)

Implant Proximity

• Between two natural teeth259 (38.7)

• Between one tooth/one implant182 (27.1)

• Other configurations 236 (34.2)


Complications of dental implants identification frequency and associated risk factors

Anatomic Variables (cont’d)

Bone Quality

•Type I45 (0.7)

•Type II126 (23.1)

•Type III137 (25.1)

•Type IV279 (51.1)


Complications of dental implants identification frequency and associated risk factors

Implant Related Variables

Implant Diameter

•3.0-3.5mm 195 (30.4)

•4.0-4.5mm 260 (40.6)

•5.0mm 168 (26.2)

•6.0mm18 (2.8)

Implant Length

•4-6mm 10 (1.6)

•8mm 156 (24.3)

•11mm 433 (67.5)

•14mm 42 (6.6)


Complications of dental implants identification frequency and associated risk factors

Implant Related Variables (cont’d)

Coating

•Uncoated115 (19.4)

• TPS 187 (31.5)

• HA 291 (49.1)

Well Size

•2.0mm 599 (88.7)

• 3.0mm 76 (11.3)

Staging

•Two-stage568 (84.0)


Complications of dental implants identification frequency and associated risk factors

Abutment Related Variables

Diameter

•3-4mm 118 (25.3)

• 5.0-5.5mm 258 (55.2)

• 6.0-6.5mm 91 (19.5)

Abutment Angulation

•0°435 (73.9)

•15°138 (23.4)

•25°16 (2.7)


Complications of dental implants identification frequency and associated risk factors

Prosthetic Related Variables

Fixed Prosthesis632 (93.4)

Other

Antibiotic Use 574 (84.8)

Reconstructive Procedures242 (35.8)


Complications of dental implants identification frequency and associated risk factors

Implant Complications: Identification and Frequency

Overall Complication Rate: 13.9% (94/677)


Complications of dental implants identification frequency and associated risk factors

Table 1: Factors Associated with Overall Implant Complications

Multivariate Cox Model

Exposure Hazard Ratio95% C Ip-value

Tobacco Use 2.31 1.29, 4.16 0.0051

(smoker vs. nonsmoker)

Reconstructive Procedure 1.18 1.03, 1.34 0.017

(present vs. absent)

Implant Staging2.56 1.45, 4.55 0.0013

(one vs. two-stage)

Age (older vs. younger) 1.0 0.98,1.0 0.89

Gender (female vs. male) 0.92 0.58,1.44 0.72

Prosthetic Type 1.97 0.92,4.21 0.083

(removable vs. fixed)


Complications of dental implants identification frequency and associated risk factors

Breakdown of Inflammatory Complications

10.2% (69/677) frequency

Impaired wound healing 0.7% (5/677)

Peri-implantitis 1.0% (7/677)

Gingival recession 0.4% (3/677)

Infectious process 2.4%(16/677)

Pain 1.6%(11/677)

Mobility 4.0%(27/677)


Complications of dental implants identification frequency and associated risk factors

Table 2: Factors Associated with Inflammatory Complications Multivariate Cox Model

ExposureHazard Ratio95% C Ip-value

Tobacco Use3.26 1.74, 6.10 0.0002

(smoker vs. nonsmoker)

Reconstructive Procedure 1.17 1.001, 1.36 0.049

(present vs. absent)

Implant Staging 3.03 1.64, 5.56 0.0004

(one- vs. two-stage)

Age (older vs. younger) 1.0 0.98,1.017 0.77

Gender (female vs. male) 0.94 0.56,1.57 0.82

Jaw (maxilla vs. mandible) 0.64 0.36,1.15 0.13 


Complications of dental implants identification frequency and associated risk factors

Table 3: Factors Associated with

Operative Complications

Multivariate Cox Model

ExposureHazard Ratio95% C I p-value

Jaw 5.22 1.01, 27.03 0.048

(maxilla vs. mandible)

Reconstructive Procedure1.84 1.26, 2.68 0.002

(present vs. absent)

Age (older vs. younger) 1.06 0.99,1.13 0.08

Gender (female vs. male) 0.40 0.069,1.96 0.24

Restorative Dentist 0.41 0.14,1.17 0.10


Table 4 factors associated with prosthetic complications multivariate cox model

Table 4: Factors Associated with Prosthetic Complications Multivariate Cox Model

  • No variables were found to be statistically related with prosthetic complications in the multivariate model (p<0.05).


Di scussion

DISCUSSION

Identification of implant complications

  • Inflammatory, Operative, and Prosthetic

  • Frequency of implant complications

    • Overall: 13.9% (94/677)

    • Inflammatory: 10.2% (69/677)

    • Prosthetic: 2.7% (18/677)

    • Operative: 1.0% (7/677)


  • Di scussion cont d

    DISCUSSION (cont’d)

    • Risk factors associated with implant complications

      • Overall: Smoking, one-stage implants, use of reconstructive procedures

      • Inflammatory: Smoking, one-stage implants, use of reconstructive procedures

      • Operative: Jaw (maxilla), use of reconstructive procedures

      • Prosthetic: None identified


    Conclusion

    Conclusion

    •We hypothesized that we would identify risk factors associated with implant complications that may be modified by the clinician to enhance patient outcome.

    • Tobacco use

    • Implant staging


    Future investigations

    Future Investigations

    •Tobacco Use

    -influence on implant complications

    •Reconstructive Procedures

    - influence on implant complications


    Complications of dental implants identification frequency and associated risk factors

    Acknowledgements

    Funding Sources: Department of Oral and Maxillofacial Surgery Research Fund (MGH)

    Oral and Maxillofacial Surgery Foundation (VAV)

    NIH/NIDCR Dentist Scientist Award - K16 DE000275 (SKC)

    NIH/NIDCR Mid-career Investigators Award – K24 DE000448 (TBD)

    We would like to acknowledge the clinicians and support staff of the Faulkner Hospital Dental Implant Center (Boston, MA) for their cooperation and unrestricted access to patient records.

    Inquiries: [email protected]


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