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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

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††


Background and Significance


Specific aims
Specific Aims and Associated Risk Factors

  • 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 and Associated Risk Factors

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


  • Study Design: and Associated Risk FactorsRetrospective 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 and Associated Risk Factors

• Predictor Variables (Risk Factors)

•Demographic

-gender

-age

•Medical

-ASA status

-tobacco use


  • Anatomic and Associated Risk Factors

    • 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


  • Prosthetic and Associated Risk Factors

    • 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) and Associated Risk Factors

• Outcome Variable

  • presence or absence of complications

    • Complications grouped into three categories

  • inflammatory

  • prosthetic

  • operative


  • Inflammatory Complications and Associated Risk Factors

    -mobility

    -pain

    -infectious process

    -peri-implantitis

    -impaired wound healing

    -gingival recession


  • Prosthetic Complications and Associated Risk Factors

    • 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


  • Operative complications and Associated Risk Factors

    • inadvertent placement of implant into sinus or submandibular space

    • paresthesia


Data analysis
Data Analysis and Associated Risk Factors

• 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 and Associated Risk Factors

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)


Anatomic Variables and Associated Risk Factors

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)


Anatomic Variables (cont’d) and Associated Risk Factors

Bone Quality

•Type I45 (0.7)

•Type II126 (23.1)

•Type III137 (25.1)

•Type IV279 (51.1)


Implant Related Variables and Associated Risk Factors

Implant Diameter

•3.0-3.5mm 195 (30.4)

•4.0-4.5mm 260 (40.6)

•5.0mm 168 (26.2)

•6.0mm 18 (2.8)

Implant Length

•4-6mm 10 (1.6)

•8mm 156 (24.3)

•11mm 433 (67.5)

•14mm 42 (6.6)


Implant Related Variables (cont’d) and Associated Risk Factors

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)


Abutment Related Variables and Associated Risk Factors

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)


Prosthetic Related Variables and Associated Risk Factors

Fixed Prosthesis 632 (93.4)

Other

Antibiotic Use 574 (84.8)

Reconstructive Procedures 242 (35.8)


Implant Complications: Identification and Frequency and Associated Risk Factors

Overall Complication Rate: 13.9% (94/677)


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)


Breakdown of Inflammatory Complications 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)


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 


Table 3: Factors Associated with Inflammatory Complications Multivariate Cox Model

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 Inflammatory Complications Multivariate Cox ModelMultivariate Cox Model

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


Di scussion
DI Inflammatory Complications Multivariate Cox ModelSCUSSION

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
    DI Inflammatory Complications Multivariate Cox ModelSCUSSION (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 Inflammatory Complications Multivariate Cox Model

    • 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 Inflammatory Complications Multivariate Cox Model

    •Tobacco Use

    -influence on implant complications

    •Reconstructive Procedures

    - influence on implant complications


    Acknowledgements Inflammatory Complications Multivariate Cox Model

    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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