about Dental implant complications & technological advancements.

Dr. Anthony G. Sclar repied to the questions about Dental implant complications & technological advancements.

Improvements in implant surface technologies, surgical instrumentation, and prosthetic connections and restorative materials have greatly reduced hardware associated complications. In addition, implant designs which incorporate a “superior shift” of the implant abutment junction such as the Straumann ITI implant or more recently a “central shift” of the implant abutment junction such as the Prevail ™implant from BioMet 3i, the Ankylose® implant from Dentsply Tulsa Dental, and the OsseoSpeed™ implant from Astra Tech Dental, provide the opportunity for improved management of biologic width thus enhancing “soft tissue integration” and stability of underlying crestal bone levels. The potential benefits include improved esthetics and reduced incidence of peri-implant mucositis or peri-implantitis.

Nevertheless, I believe that Cone Beam CT technology and treatment planning software have the greatest potential for helping doctors avoid or reducing the numbers of implant complications. Our in office I-Cat cone beam CT (Imaging Sciences International) scanner allows us to evaluate the patient’s anatomy in 3 D and accurately identify the location and course of vital structures such as the inferior alveolar nerve. In addition, dental pathology not seen on plain films occasionally becomes readily apparent with this technology. When combined with a scan guide derived from a diagnostic wax up that duplicates the proposed final restoration, we are able to perform 3D treatment planning as we evaluate all of the restorative and surgical information on the screen. We can then convert the scan guide into a conventional surgical guide to prepare our sites for implant placement or to guide our 3D hard tissue site development procedures. The 3D diagnostics provides greater information allowing us to make better treatment planning and intra-operative decisions. Taking it a step further, we can order a computer generated surgical guide that incorporates a master cylinder and drill sleeves to allow precise 3D osteotomy preparation or even guided implant placement.

As with any technology, there is a learning curve and nuances which must be understood in order to avoid complications related to the technology itself. Some examples include misinterpretation of CT data or misfit or movement of a guide during surgery which can lead to irreversible complications. The bottom line for doctors is to make a commitment to learn all that they can about the technology and apply it at an entry level before proceeding into advanced applications such as guided surgery.