failures in implants 种植失败的原因.docx
- 文档编号:13950544
- 上传时间:2023-06-19
- 格式:DOCX
- 页数:16
- 大小:454.45KB
failures in implants 种植失败的原因.docx
《failures in implants 种植失败的原因.docx》由会员分享,可在线阅读,更多相关《failures in implants 种植失败的原因.docx(16页珍藏版)》请在冰点文库上搜索。
failuresinimplants种植失败的原因
Failuresinimplants
Abstract
Theburningproblemthatalltheimplantologistsareconfrontedtodayisthecomplicationsandfailuresoccurringwiththetreatmentofosseointegratedimplants.Tofurtheroptimizethetreatmentoutcome,etiologiesandfactorsassociatedwithimplantfailuresshouldbeelucidated.Conceivablysuchknowledgeisneededfordevelopingadequatetreatmentandpreventionstrategies.Hence,thispaperisintendedtoprovideaninsightregardingvariousaspectsoffailuresthataffectdentalimplants.
Keywords:
Classificationoffailures,implantfailures,peri-implantitis
Definitions
Implantfailure
•Implantfailureisthefirstinstanceatwhichtheperformanceoftheimplant,measuredinsomequantitativewayfallsbelowaspecifiedandacceptablelevel.[1]
•Implantfailureisdefinedasthetotalfailureoftheimplanttofulfillitspurpose(functional,estheticorphonetic)becauseofmechanicalorbiologicalreasons.[2]
•Implantfailureistheinadequacyofthehosttissuetoestablishortomaintainossiointegration.
Iatrogenicfailureandbiologicfailure
Iatrogenicfailureisonecharacterizedbyastableandosseointegratedimplant,butduetomalpositioningitispreventedfrombeingusedaspartoftheanchorageunit.[1]
Biologicalfailurecanbedefinedastheinadequacyofthehosttissuetoestablishortomaintainosseointegration.[1]
Ailingimplants
•Animplantthatmaydemonstratebonelosswithdeeperclinicalprobingdepthsbutappearstobestablewhenevaluatedat3-4monthsinterval.[4]
•Ailingimplantsarethoseshowingradiographicbonelosswithoutinflammatorysignsormobility.[5]
Failingimplants
•Animplantthatmaydemonstrateboneloss,increasingclinicalprobingdepths,bleedingonprobing,andsuppuration.Bonelossmaybeprogressive.[4]
•Failingimplantsarecharacterizedbyprogressiveboneloss,signsofinflammationandnomobility.[5]
Failedimplants
•Animplantthatdemonstratesclinicalmobility,aperi-implantradiolucency,andadullsoundwhenpercussed.Afailedimplantisnon-functionalandmustberemoved.[4]
•Failedimplantsarethosewithprogressiveboneloss,withclinicalmobilityandthatwhicharenotfunctioningintheintendedsense.[5]
Survivingimplants
SurvivingisatermdescribedbyAlberktsonthatappliestoimplantsthatarestillinfunctionbuthavenotbeentestedagainstsuccesscriteria.[5]
SuccessandFailureStatistics
Thelongitudinalclinicalstudieshavereportedasuccessrateat10yearsrangingfrom81%to85%,forthemaxillaandfrom98%to99%fortheanteriormandible.[2]Despitehighsuccessrates,failuresdooccur.Espositoetal.reportedthebiologicallyrelatedimplantfailurescalculatedonasampleof2812implantsandfoundafailurerateof7.7%overa5yearperiod.[1]
BainandMoy(1993),reviewedtheoutcomeof2194Branemarkimplantsplacedin540patientsovera6yearperiodandreportedafailurerateof5.92%.Fribergetal.conductedastudycomprising4641Branemarkdentalimplantsforaperiodof3yearsandreportedafailurerateof1.5%.[6]
WhentoSayanImplanthasFailed?
Theindividualpractitionerandcertifyingagenciesarepresentedwithabewilderingseriesofchoicesindeterminingwhichimplantsystemsprovideanadequateprognosistowarranttheiracceptanceforclinicaluse.Tomakethesecriticalselections,asetofcriteriaforsuccessbasedonscientificinvestigationsisessential.[7]
Considerationmustbegiventoevaluatingthefollowingcriteria:
•Durability
•Boneloss
•Gingivalhealth
•Pocketdepth
•Effectonadjacentteeth
•Function
•Esthetics
•Presenceofinfection,discomfort,paraesthesiaoranesthesia
•Intrusiononthemandibularcanal
•EmotionalandpsychologicalattitudeandsatisfactionofthepatientSmithandZarb[7]havereviewedthesuccesscriteriagivenbydifferentauthors.
SchnitmanandSchulman
•Mobilitylessthan1mminanydirection.
•Radiologicallyobservedradiolucencygradedbutnosuccesscriteriondefined.
•Bonelossnotgreaterthanonethirdoftheverticalheightofthebone.
•Gingivalinflammationamenabletotreatment.
•Functionalservicefor5yearsin75%ofpatients.[7]
Chainin,SilverBranch,Sher,andSalter
•Inplacefor60monthsormore.
•Lackofsignificantevidenceofcervicalsaucerizationonradiographs.
•FreedomfromhemorrhageaccordingtoMuhelman'sindex.
•Lackofmobility.
•Absenceofpainandtenderness.
•Nopericervicalgranulomatosisorgingivalhyperplasia.
•Noevidenceofawideningperi-implantspaceonradiograph.[7]
Mckinney,Koth,andSteflik
Subjectivecriteria
•Adequatefunction.
•Absenceofdiscomfort.
•Patientbeliefthatesthetics,emotional,andpsychologicalattitudeareimproved.
Objectivecriteria
•Goodocclusalbalanceandverticaldimension.
•Bonelossnogreaterthanonethirdoftheverticalheightoftheimplant,absenceofsymptomsandfunctionallystableafter5years.
•Gingivalinflammationvulnerabletotreatment.
•Mobilityoflessthan1mmbuccolingually,mesiodistally,andvertically.
•Absenceofsymptomsandinfectionassociatedwiththedentalimplant.
•Absenceofdamagetoadjacenttoothorteethandtheirsupportingstructures.
•Absenceofparasthesiaorviolationofmandibularcanal,maxillarysinus,orfloorofnasalpassage.
•Healthycollagenoustissuewithoutpolymorphonuclearinfiltration.[7]
Successcriteria
Providesfunctionalservicefor5yearsin75%ofimplantpatients.
RevisedCriteriaforImplantSuccess
Alberktson,Zarb,Washington,andErickson
•Individualunattachedimplantthatisimmobilewhentestedclinically.
•Radiographthatdoesnotdemonstrateevidenceofperi-implantradiolucency.
•Bonelossthatislessthan0.2mmannuallyaftertheimplant'sfirstyearofservice.
•Individualimplantperformancethatischaracterizedbyanabsenceofpersistentand/orirreversiblesignsandsymptomsofpain,infections,necropathies,paraesthesia,orviolationofthemandibularcanal.
•Incontentofcriteriamentioned,asuccessrateof85%attheendofa5-yearobservationperiodand80%attheendof10-yearobservationasaminimumcriterionforsuccess.[7]
Further,in1998Espositoetal.havelistedoutthevariouscriteriaforsuccesswhichwereagreeduponatthe1stEuropeanWorkshoponPeriodontology.[1]
Accordingtothem-absenceofmobilityandanaverageradiographicmarginalbonelossoflessthan1.5mmduringthefirstyearoffunctionandlessthan0.2mmannuallythereafter,absenceofpain/parasthesiaweretobeconsideredsuccesscriteriaforosseointegratedimplants.Itwasalsosuggestedthatprobingdepthsrelatedtoafixedreferencepointandbleedingonprobingshouldbemeasured.[1]
Severalauthorshaveexpressedmanycriteriatoassessthesuccessofafunctionalimplant.Thesuccesscriteria,whichwereinitiallytargetedforevaluationas5yearssurvivalhaschanged.Withtheimprovedtechnologyandunderstandingofthetissuebehaviorthecriteriaaresetwithatargetof10-yearsurvivalrate[1].
FailingV/SFailedImplants
Whileitispossibletoclearlydifferentiatebetweenasuccessfulandafailedimplant,itstillremainsdifficulttoidentifyfailingimplants.Theparameters,whichhavebeenemployedclinicallytoevaluateimplantconditionswerediscussedbyEspositoetal.[1]withtheattempttoidentifythemostreliableones.
Themostcommondiagnosticcriteriaemployedfortheevaluationofestablishedimplantfailures(failedimplants)areasfollows:
Clinicalsignsofearlyinfection
Duringthehealingperiod(3-9months)complicationssuchasswelling,fistulas,suppuration,early/latemucosaldehiscences,andoseteomyelitis,canoccasionallybepresentandmayindicateimplantfailure.Signsofinfectionoccurringduringatanearlystageofhealingismorecriticalthaniftheyoccuratalaterstage.Thisisbecause;theinfectionoccurringatanearlystagewillleadtodisturbanceintheosseointegrationoftheimplanttothesurroundingbone.
Painorsensitivity
Painordiscomfortisoftenassociatedwithmobilityandcouldbeoneofthefirstsignswhichindicateanimplantfailure.
Clinicaldiscerniblemobility
Mobilityisalwaysaclearsignoffailure.Oncetheclinicianhasdistinguishedbetweenthemobilityofapoorlyconnectedabutmentandthemobilityoftheunderlyingimplant,theimplantmustbesuspectedtobesurroundedbyafibroustissuecapsule.
Severaldifferenttypesofmobilityhavebeenrecognizedasfollows:
[8]
•Rotationmobility
•Lateralorhorizontalmobility
•Axialorverticalmobility.
Occasionally,clinicallydiscerniblemobilitycanbepresentwithoutdistinctradiographicbonechanges.Therefore,mobilityisthecardinalsignofimplantfailure.[1]
Radiographicsignsoffailure
Therecanbetwowell-distinctradiographicpictures:
athinperi-fixturalradiolucencysurroundingtheentireimplant,suggestingtheabsenceofadirectbone-implantcontactandpossiblyalossofstability,andanincreasedmarginalboneloss.
Sincethedistinctionbetweenthetworadiographicpicturesisnotalwaysclear,whenasuspectedperi-fixturalradiolucencyorexcessivemarginalbonelossisobserved,itisrecommendedtoremovetheprostheticconstructionandcheektheimplantsforstability.Clinicallydiscerniblemobilityafterbridgeremovalcanconfirmthepresumptiveradiographicdiagnosisofimplantfailure.
Dullsoundatpercussion
Ithasbeensuggestedthatasubduedsounduponpercussionisindicativeofsofttissueencapsulation,whereasaclearcrystallizationsoundindicatessuccessfulosseointegration.[1]
Althoughitisarathersubjectivetestwithoutasolidscientif
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- failures in implants 种植失败的原因 种植 失败 原因
![提示](https://static.bingdoc.com/images/bang_tan.gif)