The two most important things necessary for success of a dental implant is good health and good bone. Many people are in excellent health and have good bone, for them implants are a great option and can easily and predictably be placed. For others with health problems or habits that affect their health we need to take a closer look.
The following is a list of health conditions that must be addressed or that may affect the proper bonding of the implant to the bone:
Smoking is the number one cause of dental implant failure. The nicotine causes a 50% reduction in oxygen to the bone. Implants require oxygen to bond to the bone. Nicotine patches and gums have the same effect as smoking on the bone and healing. While smokers can still have implants succeed, the success rate drops to about 75%. If a person stops smoking the tissues slowly recover.
Alcohol also affects the body’s ability to heal. Those that drink excessively are at much higher risk for infections and even cancer. For some reason home care goes down and this also affect the long term outlook for implants.
Diabetes, in its uncontrolled state puts the patient at a much higher risk for infections. These can at times be life threatening. When the diabetes is properly controlled, the person is just like any other person in terms of their healing abilities and their resistance to infection.
Osteoporosis can result in reduced bone mass and bone volume. It is made worse if the teeth are lost because there is no longer the necessary stimulation to encourage the bone to remain strong and the jaw bone can atrophy. Although osteoporosis can affect the success of the implants, usually if the implant is buried initially in the bone and undesturbed for six months the bone can bond to the implant and as the implant is used it can stimulate bone development and strength. Certain medications like Vitamin D, Calcium and Estrogen can help increase the bone mass.
Heart disease normally does not affect dental implants as long as normal oxygenation of the tissues is occuring.
HIGH BLOOD PRESSURE
High blood pressure does not normal affect dental implants.
Arthritis normally does not affect implants, but some of the arthritis medications like methotrexate which is used in severe cases can cause implant failure. This usually only occurs when the implants are placed. If the implants are already in and bonded to the bone, there usually is no problem.
Chemotherapy as used for the treatment of most cancers involves using a chemical which kills rapidly growing cells. While cancer cells are normally rapidly growing and therefore subject to attack, areas of new growth such as around recenly placed implants can also be subject to attack. This can often cause the loss of the implant. We normally recommend that patients wait at least one year after chemotherapy before placing implants.
Radiation therapy also kill rapidly growing cells, but only if they are in the path of the x-ray beam. If a person is having radiation in a distant part of the body, there is usually no problem. If the radiation is in the area around the cells it can cause implant failure. If a patient has had radiation to the jaws the walls of the blood vessels thicken and the amount of oxygen that gets out to the cells is substantially reduced. Hyperbaric oxygen can be used to stimulate blood vessel growth and development and may allow a person to receive implants successfully. There is little research available on this so it should be undertaken knowing that there are risks to both the implant and the bone. The risk to benefit must be carefully studied in this area with a competent medical professional and prosthodontist working together.
If a person does not have enough bone then a there are techniques which can be used to grow new bone.
A sinus lift is a very effective way to increas bone mass for implants in the upper posterior region. Click here to see a presentation that we use for explaining how a sinus lift is done. There is usually minimal discomfort and most patients are back to work the next day. Sinus infections do occur on occasion and can cause the loss of the bone graft. This usually occurs only about 3% of the time. Click here to see our list of instructions for patients that will be having a sinus lift bone graft. Usually we wait about six months after the graft before placing the implants unless there is at least 5 mm of bone to stabilize the implant. If there is 5 mm of bone and the implant can be stabilized, the implant can be placed at the same time as the graft. We like to allow the implant to bond to the grafted bone for nine months before uncovering and restoring the implant.
An onlay graft can be done if there is not enough width or height of bone. The donor site is often the chin or the posterior portion of the jaw although bone from the hip or shin can also be used. The bone graft is attached to the ridge with titanium screws. Often it is allowed to bond to the ridge for six to nine months before implant placement.