Clinically unhealthy implants are classified as “ailing” or “failing”. It is necessary to distinguish between an ailing versus a failing implant to determine the treatment steps necessary to salvage the unhealthy implant. Implants exhibiting soft tissue problems exclusively are classified as ailing and have a more favourable prognosis—Peri-implant mucositis involves inflammatory changes confined to the soft tissue surrounding an implant. In some instances, the ailing implant may have exhibited early bone loss along with soft tissue pocketing. However, this bone loss tends to become static at the 3 to 4 month maintenance checks. A lamina dura indicating a state of chronicity also may be present at the borders of the osseous defect.
In contrast, the failing implant may show evidence of pocketing, bleeding upon probing, purulence, and indicates the bone loss patterns are progressing despite previous therapy. Therefore, an implant that is progressively losing its bone anchorage, but is still clinically stable, can be defined as failing.Failing implants have a poorer prognosis but however, if properly recognized and treated, a failing implant may be saved. Microflora associated with failing dental implants are identical to those found in chronic adult periodontitis. This microflora triggers inflammation and bone loss and is termed peri-implantitis. Peri-implantitis occurs when there is progressive peri-implant bone loss in conjunction with a soft tissue inflammatory lesion.
Historically, other signs and symptom markers have been used to classify the ailing and failing implant. Tissue tone, pocket depth, attachment levels, bleeding on probing,suppuration, cervical fluid flow, plaque index, gingival index, mobility, oxygen tension levels, tissue collagenase activity, radiographic evaluation, and microbiological characterization of subgingival flora have all been utilized in implant classification.
Clinical warning signs of implant failure
The clinical signs of implant failure are:
1) Connecting Screw loosening.
2) Connecting Screw failure.
3) Gingival bleeding and enlargement.
4) Purulent exudates from large pockets.
5) Pain.
6) Fracture of prosthetic component.
7) Angular bone loss noted radiographically.
8) Long standing infection and soft tissue sloughing seen during healing after stage one surgery.
Mobility of the implant with or without purulent exudates is the final clinical evidence of a failed implant.There is a classification by Carl Misch which delineates the failures as per the stage as seen and it helps to streamline the cause.
In contrast, the failing implant may show evidence of pocketing, bleeding upon probing, purulence, and indicates the bone loss patterns are progressing despite previous therapy. Therefore, an implant that is progressively losing its bone anchorage, but is still clinically stable, can be defined as failing.Failing implants have a poorer prognosis but however, if properly recognized and treated, a failing implant may be saved. Microflora associated with failing dental implants are identical to those found in chronic adult periodontitis. This microflora triggers inflammation and bone loss and is termed peri-implantitis. Peri-implantitis occurs when there is progressive peri-implant bone loss in conjunction with a soft tissue inflammatory lesion.
Historically, other signs and symptom markers have been used to classify the ailing and failing implant. Tissue tone, pocket depth, attachment levels, bleeding on probing,suppuration, cervical fluid flow, plaque index, gingival index, mobility, oxygen tension levels, tissue collagenase activity, radiographic evaluation, and microbiological characterization of subgingival flora have all been utilized in implant classification.
Clinical warning signs of implant failure
The clinical signs of implant failure are:
1) Connecting Screw loosening.
2) Connecting Screw failure.
3) Gingival bleeding and enlargement.
4) Purulent exudates from large pockets.
5) Pain.
6) Fracture of prosthetic component.
7) Angular bone loss noted radiographically.
8) Long standing infection and soft tissue sloughing seen during healing after stage one surgery.
Mobility of the implant with or without purulent exudates is the final clinical evidence of a failed implant.There is a classification by Carl Misch which delineates the failures as per the stage as seen and it helps to streamline the cause.
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| The figures show natural tooth on the left(L) side and implant(R) in the right half (i) - Normal Tooth(L) & Implant(R), (ii)- Ginvitis(L) &Perimucositis (R), (iii)- Periodontitis (L) & Perimplantitis (R) |
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