Implantation – Complications and Risks

There may be complications occurring during implantations. In order to minimize complications during the implantation and make your treatment a success story, you will need to have the operation carried out by a highly-trained and widely-experienced implantologist.

Just like any surgical operation, the placing of implants is associated with some risks for the patient. However, the work of an implantologist, that is, the placing of implants, may be comparable to that of an engineer, rather than to the work a doctor would do. A good, reputable implantologist will always ask the patient to discuss the risks and benefits of the treatment and the costs incurred by the placing of implants and its succeeding prosthodontics. In any case, the implantologist should also point to alternatives to the implant and talk about its benefits.

About the complications occurring during the surgical procedure of placing implants

Improper Positioning of Implants:

During implant healing, the patient will most likely not be able to recognize an improper position of the implants. Crooked implants will adhere to the jaw bone through osseointegration as firm as properly placed implants. However, poorly placed implants will certainly cause problems at a later stage and pave the way for serious health problems. One may conclude that an improper positioning of implants into the jaw bone has principally been caused by the dentist. This is mostly due to poor planning, lack of knowledge of, and/ or experience in, prosthetic and surgical basics on the side of the implantologist, dentist, or oral surgeon.

In cases where the patients’ goals concerning new artificial teeth appear to be unrealistic or not in correspondence with the preconditions, it is up to the surgeon to reject their wishes and refuse implantation. The clarification of facts and a comprehensive and open discussion between patient and implantologist should enjoy the highest priority. Before the dentist commences an implantation, he or she should have given much thought and talk to these issues.

Incidences of Bleeding during Operation:

Any surgical intervention affecting the body inevitably causes bleedings. Implantations, which are, in effect, interventions into the body, show similar signs. To this end, the gum has been laid open and turned to one side. A hole or slot is drilled into the jaw bone for anchoring the dental implant. Mostly, bleedings are occurring to some extent. Implantations may also entail damages to arterial vessels. This complication will normally pose no risk to the patient as an experienced implantologist should be capable of dealing with it and stop the bleeding. Bleedings occurring during the surgical proceeding and posing a threat to the patient are extremely rare. However, the implantologist is advised to inform the patient in a clear and comprehensive manner about any bleedings that have occurred.

If patients take medications for blood thinning, or suffer from disturbances of blood clotting, a test should be taken prior to the implantation to check the clotting. Depending on the results of the examination, the doses of the medications meant to thin the blood should no longer be administered or if they have to, in small doses only. The dentist has to make sure that the patient will not be exposed to any risks through this.

Damages of the Nerves or Nerve Irritation:

In some rare cases, implantations may cause damages to the nerves, also called nerve irritation. There are merely two nerves running through the jaw that may be damaged when placing dental implants.

• 1. Damages to the Lingual Nerve:
  Most unlikely, but potentially possible, the lingual nerve could be hurt during implantations. It runs in the back end of the jaw on the right and left side on the tongue. The lingual nerve accounts for the sensation of the tongue and controls the gustatory nerves. If the lingual nerve has been damaged, both sensation and taste may be temporarily lost. It is unlikely but possible that the damage becomes irreparable.
  
  
• 2. Damages to the Mandibular Nerve:
  A rather afferent nerve runs through the lateral, back end of the lower jaw bone: This nerve accounts for the redirection of the sensation of the lips to the corresponding area in the brain. If an implant is placed close to this extremely afferent nerve, irritations of the nerve may occur, which however is only a temporary phenomenon. An irritation of the lips’ nerves is expressed through a numb feeling of the lip region concerned and/or a slight tingling, so as if the numbness would just be fading away. This hypersensitivity continues if the nerve has been seriously damaged during the placing of the implant, or cut through. If this has been done by an inexperienced implantologist, patients are well advised to remove the implant. Oral surgeons refer to this as a so-called explantation.

Damages to the Surrounding Teeth:

During the drilling, beating, or grinding of the holes for the implant into the lower or upper jaw bone, damages to the surrounding teeth may be caused by exceptional anatomic characteristics, poor planning by the dentist, or lack of training and experience in dental implantology. It may also occur that the roots of adjacent teeth become hurt or get even killed during the drilling of the cavity for the implant. Dentists refer to this as a devitalization of the tooth, which in most cases results in a filling of the root.

If the teeth’s roots are located very close to one another in the patient’s jaw, risks to damage of adjacent teeth through the drilling or insertion of the implant can be considered to be relatively high. The dentist should therefore carefully check the exact position of the implant, monitor the operational procedure through X-raying, and organize the treatment into separate steps. As a principle, any damages to the neighboring teeth can only happen because of the dentist’s mishap, and he or she assumes full responsibility for it.

The Opening of the Maxillary Sinus:

Similar to the removal of teeth from the upper jaw, implantations may result in the opening of the maxillary sinus. In cases of existing infections of the mouth, germs and bacteria may spread to the opening and cause infections there. In order to avoid these adverse effects, the oral surgeon has to check the exact composition and condition of the remaining osseous structure in the lateral parts of the upper jaw. Having done this enables the dentist to determine the precise length of the implant. If there is not a sufficient amount of osseous substance left, the dentist will discuss and offer measures to increase this substance. Most of dentists’ experience would suggest to have the implant planted not more than 2 millimeter into the maxillary sinus.

Perforation of the Jaw Bone:

Due to a wrong drilling-ankle during the drilling of the cavity for the implant as well as an insufficient amount of remaining osseous substance may lead to the perforation of the jaw bone. This suggests that the damage is a direct result of the lack of both adequate preparation and knowledge about the subject on the dentists’ side, thus falling within their responsibility. A perforation of the jaw bone, no matter from what direction it happened, will always pose the risk of damaging arterial or other veneers, nerve structures, and the entire mouth. As a basic rule, implants need to be completely surrounded by osseous substance. X-raying after implantation provides both patient and dentist with the certitude to have a fitting implant with a long durability (up to 15 years).