Unfortunately, dental implant failure is a common occurrence. A sizeable proportion of Dr. Chal's practice is dedicated to treating failed cases from other dentists. Dental implant failure, by itself, is not an indication of malpractice. However, coupled with deviations from the implant dentistry standard of care, it could be.
Four Basic Categories of Dental Implant Failure:
- Perforation of body cavities - We have seen cases where dental implants have perforated the mandibular lingual space, nasal sinuses, and even the nose. This will cause discomfort and can lead to infection and other problems. It's usually a result of inadequate diagnostic procedures.
- Loose implants - With non-FDA-approved root forms, or if the implants are placed under load prematurely, or if they are placed in bone that is inadequate in either volume or quality, they can become loose. This can be caused by factors outside the dentist's control, or by short-cutting diagnostic procedures.
- Infection - Either of the above problems can lead to persistent or recurring infection.
- Nerve Impairment - Persistent numbness, tingling, or pain could be caused from a dental implant impinging on a nerve. In most cases, nerve impingement would be considered a violation of the standard of care, because it would arise from a lack of diligence and care in the placement of the implant.
This is a loose screw that Dr. Chal removed from a patient. She had a substandard fixture, and the screw had become loose, and this allowed an opening for infection.
Causes of Dental Implant Failure
Failure isn't necessarily an indication of negligence, but all too often it is. Since implant dentistry is relatively expensive compared to other dental care, these patients tend to be price sensitive. This puts pressure on the dentist to keep fees low, and they may do this by looking for shortcuts and cheaper alternatives. Here are some of the issues involved:
- Shortcutting the diagnostic phase - Three-dimensional CT scans are expensive, so the dentist may try to place the implants with only a two-dimensional panographic x-ray. While this x-ray is adequate for much dental treatment, it doesn't reveal the amount and quality of the bone available to support the implants or the exact positions of nerves and blood vessels. The result could be perforations of body cavities or nerve impairment.
- Non-FDA-approved dental implant fixtures - Many companies are currently manufacturing dental implant components. To be approved by the FDA requires published juried research with test results documenting the quality of those fixtures. Research is expensive, and the pressure to cut costs leads some dentists to purchase sub-standard fixtures.
- An inadequate medical history - This could arise again out of the pressure for shortcuts, or it could be a manifestation of the lack of training of the dentist. There are several medical conditions that could adversely affect the success of dental implant treatment.
- A lack of communication between the restorative dentist and the surgeon - If the surgeon places the dental implants without a guide from the restorative dentist that indicates exactly where they should be placed, it can cause the fixture to be subjected to excessive stresses in function which could lead to failure. Sometimes oral surgeons will even place the fixtures before the patient has seen a restorative dentist or had any kind of restorative treatment plan.
For more information on implant dentistry and dental implant failure, please see the dental implants section of Dr. Chal's main dental practice website.