Dental implants outcomes in General Dental practices

Happy new year every one!

You may asked, is this IV fluids for treatment of dehydration after a little too much NYE celebration?  Or is this a sedated patient undergoing surgery?  Read on…

In a recent retrospective study published in the Journal of the American Dental Association (JADA) (2014;145(7):704-713) results suggest that dental implant survival and success rates in general dental practices may be lower that those placed by a specialist or academic practices.  This study was conducted by the PEARL network – a group of practitioners engaged in Applied Research and Learning.  Close to 920 implants and patients from 87 practices were followed for close to 4 years.  Of the 920 implants only 7% failed.  Below is a chart of the analysis of the risk factors:

 

The failures were mostly attributed to: 1. preexisting inflammation (at the site of the implant placement due to previously infected tooth), and 2. low quality type IV bone (due to a lack of bone grafting at the time of the extraction of the tooth).   How does this apply to our practice?

1. Pre-existing inflammation – This is the reason why prior to placement of dental implants, we provide PRE-OP IV antibiotics – through the same IV access that we provide the sedation.  Most patients assume that IV sedation is only provided for patient comfort, but they don’t realize that more importantly we provide other medications to reduce the risk of complications after surgery; i.e. antibiotics, anti-nausea, anti-swelling and even long-term pain medication.  Its the combination of all these IV medications prior to surgery that allow for a speedy post-operative recovery, with the least amount of complication – such as implant failures.

2. Low quality bone at the time of placement – This is why the research supports bone grafting any extraction site, especially if the ultimate goal is to replace the extracted tooth with an implant later.  Recently, a patient presented to my office in for an implant consult, 2 weeks after undergoing an extraction without bone grafting.  She was falsely under the impression that she could now magically have the dental implant placed in the same extraction site.  Unfortunately, because she was not bone grafted, she lacked quality bone.  Hence we could not place the dental implant.  We are now waiting at least another 4-6 months for the extraction site to naturally heal and to undergo osteogenesis before we can attempt the implant.  Initially if she had undergone the bone grafting at the same time as the extraction, then that time would be possibly cut in half.  Furthermore, she could have even been a candidate for an “immediate dental implant placement” – where the implant is placed on the same day as the extraction.

This is an example of evidence-based practice.  Only performing surgeries based on sound, proven science.

Take home message: Bone graft any extraction site when considering dental implants AND provide preoperative IV antibiotics for dental implants.