As with every surgical procedure, complications may arise with any step of the entire implant reconstruction sequence.  This can range from immediately postoperative complications to ones that surface many years after the implants have already been in function.  Either way, often we can resolve some of these problems if we diagnose them early and initiate appropriate corrective measures.  In order to avoid complications once the implant is in function (with a prosthesis on top) proper maintenance and care on the patient’s side is a must.

Complications:

Complications can usually be divided into three different categories:

• Post Surgical Complications

• Integration Time Complications

• Post Prosthetic Complications

Post Surgery Complications are complications that occur within the first few days after the placement of implants or a grafting procedure.  These usually include swelling, pain, nausea, bleeding, possible infection, or partial numbness in certain areas.  Swelling, pain, nausea and some minor bleeding are, to a certain extent, fairly normal responses to general surgical invasion of tissues.

Pain can usually be reduced with proper medication. 

Swelling will usually dissipate after a few days, although one can use ice packs immediately post-surgery to reduce the swelling somewhat.

Nausea is usually a side effect of medications (usually narcotic in nature) given I.V. during surgery or taken post-operatively. 

Bleeding (minor bleeding) can be controlled with moderate pressure to the area utilizing gauze pads (one can also wrap a moist tea bag into the gauze pads – the tannic acid in the tea will help constrict some of the blood vessels). 

Infections are usually not a big occurrence, because most patients are on an antibiotic regimen for some time after surgery.  If an infection persists nevertheless, your doctor will usually pursue more aggressive methods of infection control. 

Partial Numbness can sometimes occur after surgery in the lower jaw.  This usually involves the lower part of the lip and chin area or one side of the tongue.  This can be very short lived or extend over long periods of time (may even be permanent, depending on the procedure).  This is usually due to either temporary ‘fluid pressure’ on the nerve or some form of mechanical manipulation of the nerve.

Integration Time Complications are usually not very extensive and for our purposes we will only mention two: Exposure of surgical site (implants, grafts, membranes, etc.) and Rejection of the implant.

Exposure of the surgical site needs to be distinguished between the gradual showing of the ‘top’ of the implant through the gums or the exposure of a grafted site.  If you see the top of the implant coming through your gums after a while, it is usually not a problem at all (although you should have your doctor check it to make sure), since many times implants are actually placed and left exposed through the gums immediately post surgery.  This usually eliminates the Uncovery procedure.  If, on the other hand a graft site becomes exposed this may pose a more dangerous problem and you should contact your doctor immediately.

Rejection of the implant statistically happens approximately one out of twenty times.  The true reason for this is sometimes not known, however, there are several etiologic factors that we know may be responsible for that.  The most prevalent is disturbance of the implant during the healing time.  Try to ‘baby’ the implant as much as possible during the first four weeks.  If your doctor advises you to not wear certain removable appliances (dentures, partials, etc.) during that time, you must follow his advice, or you may risk loosing the implant.  Also, smoking increases the chance of rejecting the implant.  The reason for this is still unclear, but it is hypothesized that the nicotine, being a fairly strong Vasoconstrictor, limits blood supply to the surgical site and thus compromising the healing and osseointegration process.  Lastly poor surgical technique (Sa. overheating the bone during preparation) may sometimes be the cause.

Post-Prosthetic Complications encompasses everything that happens to either the implant or the prosthesis after the implant is in function.  However, before I elaborate on that it should be mentioned that sometimes everything can ‘go well’ with the surgery and healing and, as you can see below, the making of a final prosthesis can be the beginning of a long-lasting nightmare.

This can usually be avoided by doing your research about the doctor(s) placing and/or restoring your implants (See the Related Links section for more details on Implant Organizations).  Assuming, that the implant(s) is (are) successfully connected to a prosthesis, things might still go wrong in the future.  The implant(s) may experience extensive bone loss over a certain period of time.  This can be due to excessive load on the implant.  Chewing or grinding too heavily on the implant crown(s) spells disaster for the future survival of the implant.  Beyond the potential bone loss around the implant(s) this can also fracture some of the components, if not the implant itself.  If this is the case, the crown(s) need to be adjusted and/or a night guard should be worn.  Compromised oral hygiene may also be a factor, although this seems to be less and less an etiologic factor, according to latest research (which does not mean one can neglect oral hygiene around implants all together – on the contrary).

All other problems are usually linked to the prosthesis on top of the implant(s).  This may include screw loosening, fracture of porcelain or acrylic, etc.  These problems can usually be corrected, since most implant systems are based on a screw-retained platform, which makes the prosthesis usually retrievable (but not necessarily repairable).  This however does not endanger the implant fixtures.  On a good note, decay or cavities will never be a problem.

Maintenance and Care:

As already mentioned above, care of your implants is an important factor.  Oral hygiene should be performed on a daily basis, as explained to you by your dental professional.  Usually it does not involve any more care than your natural teeth need.  Forceful water picks and harsh tooth brushing should be avoided.