Complications of Dental Implants

Document Sample
Complications of Dental Implants Powered By Docstoc
					Complications of Dental Implants:
  Identification, Frequency and
    Associated Risk Factors
NE McDermott, BS*, S-K Chuang, DMD, MD*,
    VA Vehemente, BS*, S Daher, DMD†,
A Muftu, DDS, MS††, TB Dodson, DMD, MPH*‡
             Harvard School of Dental Medicine *
               Massachusetts General Hospital‡
     Boston University Goldman School of Dental Medicine†
         Tufts University School of Dental Medicine††
   Background and Significance
•Dental implants are a widely accepted
treatment modality.

•Questions exist regarding complications
associated with dental implants.

• Systematic reports of implant
complications and associated risk factors
are limited.
            Specific Aims
• Specific Aim 1: To identify
  complications associated with dental
  implants.

• Specific Aim 2: To estimate the
  frequency of implant complications.

• Specific Aim 3: To identify risk factors
  associated with implant complications.
           Hypothesis
• We hypothesize that we will identify
  risk factors associated with implant
  complications that may be modified
  by the clinician to enhance patient
  outcome.
      Materials and Methods
•Study Design: Retrospective cohort

•Sample: Patients having > one Bicon®
implant placed at the Implant Dentistry
Centre (IDC), Faulkner Hospital (Boston,
MA) between 1992 and 2000

•Randomly selected one implant per
patient for study inclusion
         Study Variables
• Predictor Variables (Risk Factors)
  •Demographic
   -gender
   -age
  •Medical
   -ASA status
    -tobacco use
• Anatomic
  – implant location (maxilla vs. mandible,
    anterior vs. posterior)
  – bone quality (1-4)
  – implant proximity to teeth or implants
• Implant Specific
  – implant diameter and length
  – well size
  – implant coating
  – implant staging
  – abutment diameter and angulation
• Prosthetic
  – removable (overdenture) or fixed (crown/
    bridge)
• Reconstructive
  – use of procedures/materials to enhance
    recipient site
• Other
  -perioperative antibiotic use
    Study Variables (Cont’d)
• Outcome Variable
  – presence or absence of complications
• Complications grouped into three
  categories
  – inflammatory
  – prosthetic
  – operative
• Inflammatory Complications
   -mobility

   -pain
   -infectious process
   -peri-implantitis
   -impaired wound healing
   -gingival recession
• Prosthetic Complications
 –abutment fracture/loosening
 –O-ring damage requiring replacement
  less than twelve months after insertion
  of overdenture
 –occlusal or prosthetic adjustment more
  than two weeks after delivery of
  permanent restoration
 –recementation of loose prosthesis
  within two weeks of delivery
• Operative complications
 –inadvertent placement of implant
  into sinus or submandibular space
 –paresthesia
            Data Analysis
• Descriptive statistics and complication
  frequencies
• Analyses to identify candidate variables
  (risk factors) associated with
  complications (p<0.15)
 -univariate Cox proportional hazards
    regression model
             of specific variables
• Identification
 associated with complications (p< 0.05)
  -multivariate Cox proportional hazards
    regression model
        Descriptive Statistics
Sample Size                      677


Demographic Variables
Age (yr)                         53.9 ± 13.9
Gender (female)                  339 (50.1)


Medically Related Variables
ASA Status ( >II)                6 (0.9)
Medically Compromised (Yes)      57 (8.5)
Tobacco User (Yes)               57 (10.3)
Anatomic Variables
Jaw
 • Maxilla                         425 (62.8)
Location
 • Posterior                       471 (69.6)
Implant Proximity
 • Between two natural teeth       259 (38.7)
 • Between one tooth/one implant   182 (27.1)
 • Other configurations            236 (34.2)
Anatomic Variables (cont’d)
Bone Quality
 •Type I                      45 (0.7)
 •Type II                     126 (23.1)
 •Type III                    137 (25.1)
 •Type IV                     279 (51.1)
Implant Related Variables
Implant Diameter
 •3.0-3.5mm             195 (30.4)
 •4.0-4.5mm             260 (40.6)
 •5.0mm                 168 (26.2)
 •6.0mm                 18 (2.8)
Implant Length
 •4-6mm                 10 (1.6)
 •8mm                   156 (24.3)
 •11mm                  433 (67.5)
 •14mm                  42 (6.6)
Implant Related Variables (cont’d)
Coating
 • Uncoated              115 (19.4)
 • TPS                   187 (31.5)
 • HA                    291 (49.1)
Well Size
 • 2.0mm                 599 (88.7)
 • 3.0mm                 76 (11.3)
Staging
  •Two-stage             568 (84.0)
Abutment Related Variables
Diameter
 • 3-4mm                     118 (25.3)
 • 5.0-5.5mm                 258 (55.2)
 • 6.0-6.5mm                 91 (19.5)

Abutment Angulation
 •0°                         435 (73.9)
 •15°                        138 (23.4)
 •25°                        16 (2.7)
Prosthetic Related Variables
Fixed Prosthesis            632 (93.4)


Other
Antibiotic Use              574 (84.8)


Reconstructive Procedures   242 (35.8)
   Implant Complications:
Identification and Frequency
           Overall Complication Rate: 13.9% (94/677)

                    Prosthetic
                                         Operative
                   2.7% (18/677)
                                        1.0% (7/677)
  Inflammatory
  10.2% (69/677)                                            No
                                                       complications
                                                           86.1%
                                                         (583/677)
         Table 1: Factors Associated with
          Overall Implant Complications
              Multivariate Cox Model
Exposure                 Hazard Ratio    95% C I     p-value

Tobacco Use                   2.31      1.29, 4.16   0.0051
(smoker vs. nonsmoker)

Reconstructive Procedure 1.18           1.03, 1.34   0.017
(present vs. absent)

Implant Staging               2.56      1.45, 4.55   0.0013
(one vs. two-stage)

Age (older vs. younger)       1.0        0.98,1.0      0.89
Gender (female vs. male)      0.92       0.58,1.44     0.72
Prosthetic Type               1.97       0.92,4.21     0.083
(removable vs. fixed)
             Breakdown of Inflammatory
                   Complications
                            10.2% (69/677) frequency

                         Impaired wound healing 0.7% (5/677)

Peri-implantitis 1.0% (7/677)                             Gingival recession 0.4% (3/677)


Infectious process 2.4% (16/677)



Pain 1.6% (11/677)



Mobility 4.0% (27/677)
           Table 2: Factors Associated with
             Inflammatory Complications
                Multivariate Cox Model

 Exposure                    Hazard Ratio    95% C I      p-value

Tobacco Use                    3.26         1.74, 6.10    0.0002
(smoker vs. nonsmoker)

Reconstructive Procedure 1.17               1.001, 1.36   0.049
(present vs. absent)

Implant Staging                 3.03        1.64, 5.56    0.0004
(one- vs. two-stage)

Age (older vs. younger)         1.0         0.98,1.017     0.77
Gender (female vs. male)        0.94        0.56,1.57      0.82
Jaw (maxilla vs. mandible)      0.64        0.36,1.15      0.13
          Table 3: Factors Associated with
             Operative Complications
             Multivariate Cox Model

Exposure                   Hazard Ratio    95% C I      p-value
Jaw                           5.22        1.01, 27.03    0.048
(maxilla vs. mandible)
Reconstructive Procedure      1.84        1.26, 2.68     0.002
(present vs. absent)

Age (older vs. younger)       1.06        0.99,1.13      0.08
Gender (female vs. male)      0.40        0.069,1.96     0.24
Restorative Dentist           0.41        0.14,1.17      0.10
 Table 4: Factors Associated
with Prosthetic Complications
    Multivariate Cox Model
• No variables were found to be
  statistically related with prosthetic
  complications in the multivariate model
  (p< 0.05).
             DISCUSSION
Identification of implant complications
  – Inflammatory, Operative, and Prosthetic

• Frequency of implant complications
  – Overall: 13.9% (94/677)
  – Inflammatory: 10.2% (69/677)
  – Prosthetic: 2.7% (18/677)
  – Operative: 1.0% (7/677)
         DISCUSSION (cont’d)

• Risk factors associated with implant
  complications
  – Overall: Smoking, one-stage implants, use of
    reconstructive procedures
  – Inflammatory: Smoking, one-stage implants, use
    of reconstructive procedures
  – Operative: Jaw (maxilla), use of
      reconstructive procedures
  – Prosthetic: None identified
           Conclusion
• We hypothesized that we would
  identify risk factors associated with
  implant complications that may be
  modified by the clinician to enhance
  patient outcome.
 – Tobacco use
 – Implant staging
    Future Investigations

•Tobacco Use
 -influence on implant complications


•Reconstructive Procedures
- influence on implant complications
           Acknowledgements
Funding Sources: Department of Oral and Maxillofacial
  Surgery Research Fund (MGH)
Oral and Maxillofacial Surgery Foundation (VAV)
NIH/NIDCR Dentist Scientist Award - K16 DE000275 (SKC)
NIH/NIDCR Mid-career Investigators Award – K24 DE000448
  (TBD)

We would like to acknowledge the clinicians and support staff
 of the Faulkner Hospital Dental Implant Center (Boston, MA)
 for their cooperation and unrestricted access to patient
 records.

Inquiries: nancy_mcdermott@student.hms.harvard.edu

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:7
posted:5/16/2012
language:English
pages:31
fanzhongqing fanzhongqing http://
About