Implant Quality Scale

A scale for assessing the quality of health of implants was introduced by James and was modified by Misch. It is help in classifying the case depending on the condition and treat the implant accordingly.

Group I – Success which signifies Optimum Health
The features or clinical conditions which are representative of this group are:

i) No pain or tenderness in the implant upon function.

ii) No mobility in horizontal or vertical direction with loads upto 500 gm

iii) Less than 2mm bone loss from the initial surgery as detected by sequential radiographs.

iv) Probing depth less than 5mm

v) No history of exudates.

Management of Group I – Normal Maintenance
Group II – Satisfactory health
The implants shows history of or potential for problems though they exhibit health.The features or clinical conditions which are representative of this group are:

i) No pain or tenderness in the implant upon function, percussion, or palpation.

ii) No mobility

iii) 2-4 mm bone loss

iv) Probing depth between 5-7 mm

v) No history of exudates

Management of Group II
i)There is need to reduce the stresses on the implant –

ii) Frequent recall for maintenance or hygiene appointments.

iii) Gingivoplasty to reduce the pocket depth to get the probing depths to under 5mm so that the patient can maintain hygiene.

iv) Yearly radiographs to monitor bone levels.

Group III– Compromised health or ‘surviving’ implants

The features or clinical conditions which are representative of this group are:

i)No pain in the implant site upon function

ii) No mobility to IM 2 on the implant mobility scale.

iii) Radiographic bone loss is greater than 4mm

iv) The probing depth is greater than 7mm

v) The patient exhibits bleeding on probing and suppuration or its history.

Management of Group III cases:

i)Reduction of stress on the implant

– Removal of prosthesis when it is in the non aesthetic areas

– Occlusal adjustment

– Reducing Cantilever length

– Occlusal splint

ii) Drug theraphy comprising use of antibiotics and chlorhexidine gluconate mouth rinse.

iii) Surgical re-entry and revision as described in the next unit.

iv) Change in the prosthesis by change from a fixed configuration to an implant and tissue support if possible or even placing more implants if possible to share the load.

Group IV– Failure
The implant is considered a failed implant if it presents with even any one of the following features:

i)Pain on function (Rule out pain due to soft tissue entangled between components like at the implant – abutment interface)

ii) Mobility in the implant (Implant mobility scale 3,4)

iii) Radiographic bone loss greater than half the length of the implant.

iv) Uncontrolled exudates.

v) Sleepers – the implants which are placed in a way or location that does not allow prosthetic restoration

vi) Implant surgically removed or exfoliated

The management is only removal of implant.