Surgical complications during implant placement are not uncommon. According to a retrospective study by McDermott et al,1 677 patients (2379 implants) were investigated, and an overall frequency of complications was 13.9%. Operative complications made up a mere 1% of the overall, whereas inflammatory and prosthetic complications were 10.2% and 2.7%, respectively. Complications are expected and can lead to a number of poor treatment outcomes. The aim of this article was to address the etiology, and emphasize the potential problems as well as, basic treatments that occur during the surgical phases of implant treatment. Complications can be outlined in 4 categories (Fig. 1): treatment plan-related, anatomy-related, procedure-related, and other.
Treatment Plan-Related Complications
Well organized, thorough treatment plans lead to successful implant treatment and patient satisfaction, which are the ultimate long-term goals. Patient selection is one of the most important determinants of success or of failure. Implant treatment planning should begin with reviewing pertinent medical history information and identifying any possible contraindications to anticipate problems before they occur. Predictability of implant success can be jeopardized by absolute and relative risk factors. For example, an 11 year retrospective study done by Moy et al,2 showed relative risk ratios (RR): increasing age (60–79 y/o) had a strong association on risk with implant failure (RR = 2.24), as well as smoking (RR = 1.56), diabetes (RR = 2.75), head and neck radiation (RR = 2.73), and postmenopausal estrogen therapy (RR = 2.55).
Implant angulation is yet another determinant for implant success. Proper angulation should be determined according to the future prosthesis with the consideration of bucco-lingual, apico-coronal, and mesio-distal positions. To place implants based on available bone often results in poor esthetic outcomes as well as long-term biomechanical instability. Although, there are many “rescue techniques” for restoring cases placed outside of the occlusion (eg, having to be with custom and angled abutments), the surgery should be planned for suitable angulation at the onset. Surgical guides can help control the implant placement angle if they are made and used correctly. Choi et al3 investigated the effects of dimensional factors of the surgical guides on implant placement and found that the length of the guide channel was the primary factor in reducing angle deviations in the mesio-distal and bucco-lingual direction. It should be noted that computer-aided guides,4,5 made with no channel (eg, vacuum-formed matrix) and only a hole, do not merit angulation guidance.
Mandibular teeth in the natural dentition are lingually inclined in relation to both the mandibular base,6 specifically as 109 degrees,7 as well as the maxillary opposing arch dentition (eg, lingual cusp buccal inclination)and therefore implants should be placed at a similar inclination. Failure to do so may result in perforation of the lingual concavity, constriction of the lingual space or damage of the lingual artery. Restorations may be difficult to restore due to tongue impingement or incorrect opposing positions. In the posterior mandible, limited mouth opening prevents the drill and implant carrier from fitting correctly in the vertical direction. Teeth adjacent to implant sites and surgical guides with long drill channels, often require the use of drill extensions and maximum opening by the patient which may be strenuous. Short breaks to relieve muscle tension, using a bite block and having the patient shift their jaw to the opposite side can help ensure the correct angulation of the drill.
Yet another type of problem leading to incorrect implant angulation is the use of a finger rest while drilling (Fig. 2). Dentists have traditionally been taught to stabilize their hands by placing a finger on adjacent teeth or the chin while using instruments/handpieces during periodontal and operative work to stabilize the hand as well as to reduce the muscle fatigue, but implant dentistry is different. Due to the length of implant drills (∼10−20 mm), using a finger rest while drilling, results in an inclination of the drill towards the hand that is steadied. Hence, using finger rests is an ergonomic principle that should not be used for implant placement.
Surgical guides and proper treatment planning can alleviate angulation problems, but even so, angled abutments are hot selling items because clinicians are failing to abide by this important principle. The development of angled abutments has been a rescue technique for these wrongly placed implants and allows for a more successful esthetic outcome. In summary, use a surgical guide with a long channel that does not give leeway to veer and communicate with the restorative doctor.
Improper Implant Location
Adjacent teeth should be at least 1.5 mm from the implant body8 and more than 3 to 4 mm between adjacent implants to prevent horizontal bone loss as well as to preserve esthetics.9 Preoperative measurements and planning are essential to achieve an ideal implant placement that facilitates future implant prosthesis. Placing an implant in the wrong location is a frustrating, embarrassing and avoidable complication (Fig. 3). Measurements (eg, interocclusal, interdental, ridge height, and ridge width) confirm whether implants are indicated in the first place. The spatial orientation should be in line with the occlusal plane and centered according to the opposing occlusion to prevent cross-bites or additional stresses on the prosthesis. Many times fixtures are ideally intended for one specific position to be in the proper occlusion (Fig. 4). If more than one implant is to be placed, a diagnostic wax-up should be used to determine the correct implant locations. At the very least, drawing and measuring on the stone casts will allow for calculations and treatment planning.
Hypothetically, a surgical complication could also occur, but not be realized by the surgeon at the actual time of surgery, especially when placing multiple implants. For example, Tarnow et al9 demonstrated in a retrospective study assessing 36 patients, that an implant placed <3 mm away from an adjacent implant can have adequate stability and function but may later result in lateral bone loss. Yet another issue to keep in mind when placing the implant is to measure the vertical distance between the base of the prosthetic contact point and the crestal bone. Tarnow et al10 found that if the distance was 5 mm or less, 98% of the time the embrasure space filled in, but as the distance increases to 6 and 7 mm, the presence of a papilla reduces to 56% and 27%, respectively. de Oliveira et al11 found that as long as 5 mm distance is maintained between contact point and alveolar bone crest, it does not make a difference in papilla formation or bone loss, whether the adjacent implants are 1, 2, or 3 mm apart from each other.12
Lack of Communication
An informed consent form is an excellent way of communicating potential surgical risks and complications to a patient. Common problems to address include but are not limited to postoperative infection, bleeding, swelling, facial discoloration, transient pain, paresthesia, neuralgia, fracture, joint pain, muscle spasm, tooth looseness and sensitivity, recession, speech change, trismus, and swallowing of foreign objects. Should a complication occur during the post operative healing time, it is recommended to give emergency contact information as well.
In the United States, 12.1% of medical malpractice payment reports were against dentists in 2002.13 In dentistry, the main causes for lawsuits are actual body injury (eg, loss of sensation, oroantral fistula, life-threatening bleeding) and major disappointment.14 This could be avoided if a patient understands the fundamentals of the surgical procedure and what is to be anticipated. A valuable tool used to communicate between surgeons’ and restorative doctors is a surgical guide. The sole purpose of fabricating the guide is to identify the correct location and angulation for implant placement which will undoubtedly reduce/eliminate unnecessary surgery/prosthetic complications. Surgical guide designs include the labial outline surgical guide fabricated from a wax arrangement of the intended definitive restoration,15 a clear vacuum-formed matrix,16 a duplicate of the existing restoration,17 a light-polymerized composite material and drill blanks with a diagnostic cast,18 as well as many other methods.
When placing implants in the mandible, proper radiographs and pretreatment planning must be done to ensure complete aversion of the inferior alveolar, mental, incisive or lingual nerves. If the mandibular canal cannot be seen on a panoramic radiograph, a computer tomography (CT) scan should be taken to verify the location. The potential risks and complications of injury or damage to these vital structures should be included on the informed consent to avoid liability in cases of lawsuits.
Possible causes of nerve injury include poor flap design, traumatic flap reflection, accidental intraneural injection, traction on the mental nerve in an elevated flap, penetration of the osteotomy preparation and compression of the implant body into the canal.
To circumvent trauma to the inferior alveolar nerve (IAN), some clinicians suggest local infiltrating instead of a mandibular nerve block. This idea is a safety precaution to avoid having the drill approach too close to the canal.19 Overpenetration occurs when the cortical portion of the alveolar crest puts resistance on the drill, but as it enters the marrow spaces, it drops into the neurovascular bundle. Worthington20 investigated penetration into the IAN canal in human cadavers and recommended reviewing radiographs before surgery using the correct magnification as well as, allowing a 1 to 2 mm safety zone. This distance is to accommodate the Y dimension of the drill (apical extent of the tip which gets longer as the implant diameter gets wider), where it ranges from 1 mm (3.4 mm drill) to 1.45 mm (4.85 mm drill) as well as 1 mm thickness of cortical plate above the mandibular canal (unpublished data).
Bartling et al21 observed 405 mandibular endosseous implants placed in 94 patients to determine the incidence of altered sensation using standard neurologic tests over a 6-month period. An incidence of 8.5% was found at the first postoperative appointment. Only 1 patient experienced complete anesthesia for 2 months. This was later resolved by 4 months. Unique to this study was that no permanent altered sensation was found for any of the subjects over the 6 months. Van Steenberghe et al,22 also reported a similar incidence rate of 6.5% for altered sensation at 1 year after mandibular implant placement. In contrast, other studies have reported higher rates. Ellies and Hawker23 found an altered sensation incidence of 36%, of which 10% to 15% of those patients never regained sensation.
Radiographs should be taken if the surgeon has any doubt about where the drill is or if the drill or implant is in close proximity to or invading, neural anatomical structures. If the situation is the latter, the implant needs to be removed, or a shorter body implant should be placed instead. Within days or months, minor trauma injuries usually heal but permanent damage from neuritis can occur. Treatment options include neuronal anti-inflammatory drugs such as clonazepam, carbamazepine or vitamin B-complex,24 although marginal effects have been shown. Referral and treatment for IAN injuries should be done immediately before distal nerve degeneration develops.25 According to Hegedus and Diecidue,26 follow-up appointments should take place at 4, 8, and 12 weeks after placement and each visit should include documentation of subjective symptoms, oral/facial function and atrophic/cutaneous changes. The patient should then be referred for microsurgery if total anesthesia persists, or if after 16 weeks, if dysesthesia is on-going.24,27 Timely referral for microneurosurgery is necessary to re-establish nerve continuity, improve sensation and motor skills and to possibly relieve pain.26
Life-threatening events associated with dental implants are rare but major complications such as severe hemorrhage are more common and Goodacre et al,28 found hemorrhage-related implant complications had an incidence of 24%. Potential causes include incision of arteries in soft tissue, osteotomy preparation, and lateral wall sinus lift procedures.
Kalpidis and Konstantinidis29 reported a case involving a perforation of the lingual cortical plate during an implant osteotomy preparation of the first mandibular premolar position. A critical hemorrhage and multiple hematomas immediately occurred after perforation which was verified by a CT scan.
Risk sites30 as described above in the posterior mandible include the sublingual fossa and lingual cortex. A ruptured artery in the area within 30 minutes, can cause a blood loss rate of 14 mL/min31 and if >500 mL of blood loss occurs, hypotension can result.32 Life-threatening airway obstruction is a serious threat and early treatment is essential. Treatment involves having the patient stick out their tongue to compress the blood vessels against the body of the mandible. Placing pressure with gauze in the sublingual area does not work as one would intuitively think. Extraoral pressure to the submental or submandibular arteries for 20 minutes against the body of the mandible helps.33
The posterior superior alveolar and infraorbital arteries are located approximately 19 mm above the maxillary alveolar ridge,34 and the anastomoses of these arteries can pose a risk during sinus lift procedures by lateral window preparation. Bone wax, pressure, crushing, and electrocautery can alleviate hemorrhage. In summary, hemorrhage treatments at implant osteotomy sites include compression, finger pressure, vasoconstriction, cautery, bone graft, bone cement, and ligation of arteries.33
Cortical Plate Perforation
The buccal cortical plate varies in thickness throughout the mouth and traumatic dental extractions can cause markedly thin plates or concavities, as well as overall ridge width deficiency.35 When preparing osteotomy sites or placing implant fixtures in areas with minimal labial plate thickness, or if the implant is placed too buccally, a fenestration or dehiscence implant defect is a common finding. A fenestration leaves intact bone coronally with the exposed threads at the apical portion of the crest, whereas a dehiscence defect has the coronal portion of the implant exposed. Tinti et al,36 further classified these defects as Class I if the implant was within the envelope of bone and Class II if it was left staying outside the envelope. Immediate correction with particulate bone grafting with or without a membrane during the time of implant placement, can be done as long as primary stability has been achieved. “Flapless” implant surgeries should be avoided in areas of potential perforation of the buccal or lingual bone.
Sinus Membrane Complications
In the maxillary posterior, the proximity of the sinuses37,38 can create a problem for dental implants if there is minimal residual crestal bone (<5 mm) for stability. The maxillary sinus lift technique is an accepted procedure, demonstrated by Tatum,39 to augment vertical height in the severely resorbed posterior maxilla area to facilitate proper implant placement. Sinus complications often occurred when the membrane is perforated at time of surgery. Ardekian et al40 found maxillary sinus membrane perforations were more common in areas with minimal amount (<5 mm) of residual alveolar bone but this did not affect the overall implant success rate. No statistical differences were found between the perforation group compared with the intact membrane group. In contrast, Proussaefs et al41 found implant survival at second-stage surgery was superior for the nonperforated sites (100%) compared with perforated sites (69.6%). Bone density after grafting should be assessed, regardless whether or not a perforation occurs, because poor bone quality often lead to a higher implant failure rate.34
What happens if an implant protrudes into the maxillary sinus cavity (Fig. 5)? Jung et al42 reported the risk of maxillary sinus complications in implants which penetrated the bone and mucous membrane of the sinus floor at 2, 4, and 8 mm extensions. After 6 months, radiographic and histologic examinations did not show any signs of pathologic findings in the maxillary sinus of the 8 dogs. Despite the convincing results, the question remains whether 6 months is a long enough follow-up period. Hence, it has been suggested that simultaneous implant placement during sinus lift procedures is not considered a contraindication or less predictable procedure. Nonetheless, careful planning and precise surgery execution are essential to avoid any potential sinus complications.
Lastly, losing an implant into the maxillary sinus is a relatively uncommon surgical complication. However, in cases with less than 5 mm of bone, mastication can cause the implants to move during the graft maturation timeframe.43 Transantral endoscopic surgery is a reliable, minimally invasive method for retrieving displaced objects from the maxillary antrum with minimal complications,44,45 but it does require having an endoscope or a referral to an ENT or oral surgeon.
Devitalization of Adjacent Teeth
Adjacent teeth at implant recipient sites should be evaluated before implant placement. Pulpal and periradicular conditions such as small periapical radiolucencies, root resorption and large restorations in/near the vital pulp are often misdiagnosed. Numerous case reports33,46,47 describe implant pathosis caused by dormant endodontic problems of adjacent teeth that flare up after implant surgery.48 Therefore, it is worth the time of pulp testing suspicious teeth and completing a thorough radiographic examination. If endodontic pathosis is identified, root canal treatment or extraction should be initiated before implant placement to prevent microbial contamination of the implant49 during healing and possible failure.
Dilacerated roots and excessive tilting in the mesiodistal direction that invade the implant space often prevent ideal placement. If a drill and/or implant fixture invades the PDL, hard tooth structure and/or vital pulp, this will lead to endodontic lesions.50 Devitalization of an adjacent tooth next to an implant delays treatment and adds additional financial burden for both the patient and surgeon. A proper surgical guide and a careful radiograph analysis are necessary to avoid improper angulation and hidden dilacerated roots.
Situations deeming an implant as “hopeless” are usually associated with surgical trauma during osteotomy preparation with the drill. Ericsson and Albrektsson51 showed bone resorption occurred at 47°C when drilling was applied for more than 1 minute in rabbits. The result obtained from this study leads to the conclusion that if temperature or duration increases while drilling in bone, necrosis can occur causing detrimental effects for osseointegration. Nonetheless, Ercoli et al52 later reported that the harmful temperature only occurred when drilling was continuous or when the drill reached beyond 15 mm during 5 osteotomies.
Dense cortical bone (eg, type I bone quality), when compared with type III or IV soft cancellous bone, can be overheated when preparing osteotomies because more pressure is needed to advance the drill apically in comparison to soft bone. To reduce frictional heat, high speed handpieces, an up-down motion technique of the bone preparation, and copious irrigation can be used. Misch53 recommends using external and/or internal irrigation, as well as cool saline irrigation, intermittent pressure on the drills, pausing every 3 to 5 seconds, using new drills, and an incremental drill sequence. Generating less heat by preparing implant sites at 2500 rpm may decrease osseous damage.54
Tapping dense cortical bone is suggested. The benefits of tapping include limiting full osteotomy depth, allowing passive implant fit, preventing internal implant-body/implant-bone interface microfracture, and compression necrosis, and removing drill remnants.53
According to Quirynen et al,55 overpreparation or overheating osteotomies can result in inactive and active retrograde peri-implantitis lesions that can be detected on radiographs as periapical radiolucencies up to a month after insertion.47 A good example of an inactive lesion is placing a shorter implant into a larger prepared osteotomy site. Clinically, these lesions are asymptomatic and radiographically, they present as periapical radiolucencies. As long as the radiolucency stays stable in size and the implant is integrated, no treatment is necessary. In contrast, problems with microbial invasion during surgery, such as implant contamination during insertion or placing the implant into an area with previous inflammation (eg, endodontic lesion) can lead to active lesions. A risk of successful treatment can be considered in extraction sites with a history of failed endodontic treatment or adjacent teeth with endodontic pathology.55
Esposito et al,56 during a review of literature to find diagnostic criteria for monitoring implant conditions, found that surgical trauma and anatomical conditions both were the most significant etiologic factors for early implant failures in Branemark implants (3.63%). Interestingly, the ITI implants had higher losses due to peri-implantitis and the authors attributed design and surface type as the problem. Early implant failures are due to excessive surgical trauma along with impaired wound healing, premature loading and infection.56
Lack of Primary Stability
Lack of primary stability is a surgical complication that should be dealt with at the time of implant surgery. An unstable implant (eg, a “spinner”) should be removed or an attempt to place a larger diameter should be completed. To leave an unstable implant without action can often lead to fibrous encapsulation that causes implant failure.57 Nonetheless, bone fill will occur in immediate implants placed into extraction sockets with a marginal defect lateral to the implant wider than 1 mm58 but primary stability is still a requirement.
The mandible is the most frequently fractured facial bone,59 many factors have been proposed to contribute to the fractures. These include but are not limited to site, direction and severity of the force as well as impact.60 Attempts to place implants in patients with severely atrophic mandibles increases the risk of fracture, especially when monocortical grafts and ridge-splitting surgeries are completed. In patients who present with osteomalacia or osteoporosis, implant placement may subject the brittle bone to splintering because of the loading or frictional forces.61 Other reasons for mandibular fracture may include using the wrong implant (eg, 10 mm site preparation with intent of placing a 12 or 14 mm implant). Checking the implant size/diameter before opening the package is important.
A fracture of the mandible should be restored to maintain form and function. Management should include stabilization with an attempt to also simultaneously eliminate atrophy if indicated. A retrospective study by Eyrich et al62 found that treatment for mandibular fractures should be based on the type and location of the fracture, as well as the severity of the atrophy. Treatment options included using the wiring of a modified prosthesis, lag screws, wires and plates. The most relevant option of our field includes combined bone augmentation, fixation and simultaneous implant placement. Increasing mandibular height after augmentation may be unpredictable but using implants concurrently may reduce bone resorption. If an implant lies in the line of fracture, osseointegration will still occur as long as there is no mobility or infection.63
Another recommended approach for mandibular fracture is using reduction and immobilization with monocortical miniplates to avoid any nonunion and malunion healing.33 Two miniplates or a combination with microplates can obtain stable fixation in severely atrophic fractured mandibles and is a less invasive treatment option.64
Ingestion and Aspiration
For the sake of completeness, it should be mentioned that extreme caution should be emphasized when handling small implant components in the oral cavity. Most instruments have a special tip to help ensure screws and abutments transfer directly from the surgical tray into the patient's mouth, but nevertheless, accidents happen. Unfortunately, components winding up on the floor or down a patient's throat can be embarrassing and expensive mishaps, not to mention serious implications could occur if aspiration takes place. For these reasons, preventative measures such as gauze throat screens and floss ligatures on implant pieces are encouraged.
Tiwana et al,65 found over a 10 year retrospective institutional study, only 36 cases of ingestion were reported and amazingly only one case of aspiration. Fixed prosthodontic therapy reported having the most incidences of ingestion. In particular, cemented single-tooth cast or prefabricated restorations had a higher likelihood of aspiration.
If a patient swallows or aspirates an implant component, they should be referred to the hospital because acute obstruction can be life threatening and prolonging the removal of foreign objects may make a bronchoscopy technically more difficult.66 If the foreign object is aspirated it should be removed within 24 hours. Chest radiographs are a diagnostic tool available to rule out ingestion or aspiration.
A study done by the Dental Implant Clinical Research Group67 found that inexperienced surgeons (<50 implants) were twice as likely to have implant failures compared with more experienced surgeons. Such a statistic is a good reminder in realizing that some of our literature is based on the work of graduate students who start out as amateur implant surgeons hence the data cannot be generalized. The realization also exists that many general dentists starting to place implants may have more failures and complications compared with experienced specialists.
Surgical implant complications are not uncommon and should be addressed immediately. Causality may be iatrogenic, due to poor treatment techniques, or lack of communication between dental disciplines. Time should be spent in the implant “planning” stages, such as tracing preoperative radiographs, measuring models, taking CT scans and making proper surgical guides. Basic anatomy must not be forgotten and should be reviewed by the surgeon in every case. As more surgically inexperienced dental professionals start placing implants an increase in surgical complications will likely occur. In summary, a competent surgeon should be able to treatment plan a predictable surgery, (Fig. 6) and recognize how to remedy a problematic dental-implant situation.
The authors do not have any financial interests, either directly or indirectly, in the products listed in the study.
This article was partially supported by the University of Michigan Periodontal Graduate Student Research Fund.
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67. Truhlar RS, Morris HF, Ochi S, et al. Second stage failures related to bone quality in patients receiving endosseous dental implants DICRG, Interim report #7. Implant Dent
GERMAN / DEUTSCH
AUTOR(EN): Kelly Misch, DDS, Hom-Lay Wang, DDS, MSD, PhD. Korrespondenz an: Hom-Lay Wang., DDS., MSD, PhD, Abteilung für Parodontie und Oralmedizin (Dept. of Periodontics and Oral Medicine), Universität von Michigan (University of Michigan), zahnmedizinische Fakultät (School of Dentistry), 1101 N. University, Ann Arbor, MI 48109-1078. Telefon: 734-763-3383, Fax: 734-936-0374, eMail:[email protected]
Komplikationen bei Implantationsoperationen: Átiologie & Behandlung
ZUSAMMENFASSUNG: In der Zahnheilkundlichen Praxis treten häufig Komplikationen bei Implantierungsoperationen auf. Es ist von maßgeblicher Bedeutung, hier über eine möglichst erfolgreiche Problembewältigung Bescheid zu wissen. Die vorliegende Studie zielt darauf ab, die Herausforderungen hinsichtlich der Behandlung von Komplikationen in Verbindung mit dem Behandlungsplan, der spezifischen Patientenanatomie und dem Behandlungsvorgehen herauszustellen sowie die Átiologie und die Optionen für Problembewältigung und Behandlung mit dem Ziel eines zufrieden stellenden Behandlungsergebnisses zu diskutieren.
SCHLÜSSELWÖRTER: Zahnimplantate; Implantierungskomplikationen; Versagen von Zahnimplantaten.
SPANISH / ESPAÑOL
AUTOR(ES): Kelly Misch, DDS, Hom-Lay Wang, DDS, MSD, PhD. Correspondencia a: Hom-Lay Wang., DDS., MSD, PhD, Dept. of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, 1101 N. University, Ann Arbor, MI 48109-1078. Teléfono: 734-763-3383, Fax: 734-936-0374, Correo electrónico:[email protected]
Complicaciones de la cirugía de implante: Etiología y tratamiento
ABSTRACTO: Las complicaciones de la cirugía de implante son ocurrencias frecuentes en la práctica odontológica y el conocimiento de la atención de estos casos es esencial. El objetivo de este trabajo es destacar los desafíos en el tratamiento de complicaciones quirúrgicas relacionadas con el plan, con la anatomía y los procedimientos así como explicar la etiología, atención y opciones de tratamiento para lograr un resultado satisfactorio.
PALABRAS CLAVES: Implantes dentales; complicaciones del implante; falla del implante.
PORTUGUESE / PORTUGUÊS
AUTOR(ES): Kelly Misch Cirurgião-Dentista, Hom-Lay Wang Cirurgião-Dentista, Mestre em Odontologia, PhD. Correspondência para: Hom-Lay Wang., DDS., MSD, PhD, Dept. of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, 1101 N. University, Ann Arbor, MI 48109-1078. Telefone: 734-763-3383, Fax: 734-936-0374, e-mail:[email protected]
Complicações de Cirurgia de Implante: Etiologia & Tratamento
RESUMO: Complicações de cirurgia de implante são ocorrências freqüentes na prática dentária e o conhecimento da gestão desses casos é essencial. O objetivo desta revisão é realçar os desafios de complicações cirúrgicas relacionadas a planos de tratamento e a anatomia, bem como discutir as opções de etiologia, gestão e tratamento para alcançar um resultado de tratamento satisfatório.
PALAVRAS-CHAVE: Implantes dentários; complicações de implantes; falhas de implantes.
АВТОРЫ: Kelly Misch, доктор стоматологии, Hom-Lay Wang, доктор стоматологии, магистр ||R=ирургичeской стоматологии,, доктор философии. Адрeс для коррeспондeнции: Hom-Lay Wang., DDS., MSD, PhD, Dept. of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, 1101 N. University, Ann Arbor, MI 48109-1078. Тeлeфон: 734-763-3383., Факс: 734-936-0374, Адрeс элeктронной почты:[email protected]
Осложнeния, встрeчающиeся при ||R=ирургичeской имплантации: этиология и лeчeниe
РEЗЮМE. Осложнeния при ||R=ирургичeской имплантации являются частым явлeниeм в стоматологичeской практикe, поэтому очeнь важно знать мeтоды борьбы с такими случаями. Цeль этого обзора — показать трудности лeчeния ||R=ирургичeски||R= осложнeний, связанны||R= с планом лeчeния, анатомиeй и процeдурой, а такжe обсудить этиологию, мeтоды борьбы и варианты лeчeния для достижeния удовлeтворитeльного рeзультата.
КЛЮХEВЫE СЛОВА: зубныe имплантаты; осложнeния при имплантации; нeудачная имплантация.
TURKISH / TÜRKÇE
YAZARLAR: Diçs Hekimi Kelly Misch, Diçs Hekimi Hom-Lay Wang. Yazışma için: Hom-Lay Wang., DDS., MSD, PhD, Dept. of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, 1101 N. University, Ann Arbor, MI 48109-1078 ABD. Telefon: 734-763-3383, Faks: 734-936-0374, eposta:[email protected]
Oral ||DImplantolojide Profilaksi Amacıyla Antibiyotik Rejimi: Nedenler ve Protokol
ÖZET: Oral implantolojide antimikrobiyal ilaç kullanımı, cerrahi yaradaki enfeksiyonları azaltır. Antimikrobiyal profilaksi, tüm Sınıf 2 (temiz-kontamine) cerrahi prosedürleri için endike olup, bunlara dental implantın bakteriyel kontaminasyonu sırasında yeterli düzeyde kan bulunan cerrahi prosedürler ile kemik greft prosedürleri de dahildir. Antibiyotiklerin etkinli||uUi açısından zamanlama ve doz, kritik önem taçır. Antibiyotik genelde prosedür nedeniyle enfeksiyona sebep vermesi en olası olan bakteriye göre seçilir. Yazarlar, diç hekiminin uygun çekilde ilaç reçetelemesine yardımcı olmak üzere prosedüre, yerel konakçıya ve sistemik faktörlere dayanan bir sınıflama ve protokol sistemi geliçtirmiçlerdir.
ANAHTAR KEL||DIMELER: dental implantlar, antibiyotik profilaksi, cerrahi yara enfeksiyonu, farmakolojik protokol, risk faktörleri.