Who makes a good candidate for dental implants?
Once a decision has been made that dental implants will be considered as a treatment option, the dentist must make a determination about the patient's suitability for them.
Factors that must be evaluated include:
1) Medical considerations that may conflict with implant placement.
a) Medical conditions that contraindicate the placement of dental implants.
There are a number of medical conditions that typically bar elective oral surgery, and therefore preclude the placement of dental implants.
Some of these conditions include:
Recent myocardial infarction (heart attack) or cerebrovascular accident (stroke).
Valvular prosthesis (artificial heart valve) surgery.
Immunosuppression (a reduction in the efficacy of the immune system).
Bleeding/Clotting problems. | Active treatment of malignancy (cancer).
Drug abuse. | Psychiatric (mental) illness.
Clearly any medical condition that places a dental patient at risk for further health deterioration has to be resolved before an elective dental procedure such as placing dental implants is considered.
b) Medical conditions that may interfere with an implant's success.
Any medical condition that impairs the normal healing process can compromise the outlook for the successful placement of a dental implant.
As an example, uncontrolled diabetes mellitus delays the process of wound healing and therefore people who have this condition are not good candidates for tooth implants.
However, the mere presence of a disease does not necessarily preclude the placement of tooth implants, or significantly alter their long-term outlook, if the medical condition is controlled by treatment or medication.
A dentist will need a complete listing of all of the medicines and supplements that their patient takes.
These items must be evaluated both in light of the effect they may have upon the implant placement procedure as well as the healing process that occurs afterwards.
Additionally, the dentist must evaluate these drugs in light of how they may interact with those drugs that the dentist typically utilizes when performing their treatment.
Drugs of concern.
High on the dentist's list of drugs of concern are those utilized in the treatment of cancer, drugs that inhibit blood clotting and bisphosphonates (a class of drugs used in the treatment of osteoporosis).
d) Age considerations.
As a general rule, placing tooth implants should be delayed until the age of 18 to 19 years. This age typically represents a time frame during which an adolescent's jaw growth and development can be considered to be complete.
Advanced age doesn't necessarily contraindicate the placement of dental implants but it can present challenges.
A failure to practice effective oral hygiene, a phenomenon that often accompanies advanced age, places the long-term survival of a tooth implant at risk.
However, in the case where an elderly patient has trouble wearing or cannot tolerate a removable appliance (partial or full denture), dental implants may be a reasonable option and one that makes it possible for them to maintain adequate nutrition where otherwise they could not.
2) Patient habits that may conflict with implant placement.
a) Smokers may have lower long-term implant success rates than nonsmokers.
Many (but not all) studies have reported that the long-term success rate of tooth implants for smokers is lower than that of nonsmokers.
Clearly among smokers there will be a wide variation in the way each person practices their habit and this may be the reason why the findings of some studies conflict with others.
It is, however, thought that smoking tends to reduce bone density and bone quality, as well as impair the wound healing process. It is easy to see how these factors could affect the long-term outlook for a dental implant.
This does not mean that a smoking habit should be considered to be an absolute contraindication for the placement of implants. Instead, smokers need to realize that if they do continue to smoke that they are probably at higher risk for implant failure.
If you do smoke.
Some treatment protocols that have been suggested call for smoking cessation one week prior to and then eight weeks following the placement of a dental implant, so to minimize the effects of smoking during the early stages of implant healing (osseointegration).
b) Bruxism (tooth clenching and grinding) may compromise dental implant success.
Bruxism is a term that refers to the habit of clenching and grinding one's teeth.
The act of bruxing can result in excessive forces being directed to the bone-implant interface. This type of biomechanical overload has been correlated with tooth implant failure.
A habit of bruxing should not necessarily be considered to be a contraindication for the placement of dental implants. But if a patient is not willing to address this issue, either by controlling their bruxism or wearing a mouth guard appliance that can help to lessen its effects, an implant may make a poor choice.
c) Poor oral home care.
Some research studies have reported a correlation between ineffective brushing and flossing and dental implant failure. This association, however, has yet to be definitively established.
It is known that if bacteria are allowed to colonize in the gum tissue surrounding an implant, their presence can lead to an inflammatory response called peri-implantitis. If this condition is left untreated, it can lead to a loss of supporting bone, a loss of implant osseointegration (bone-to-implant fusion) and ultimately implant failure.