[Necessary for dentists] Complications and treatment of 15 kinds of implant dentures in 4 categories

The process of implanting dentures to repair dentition defects is a complex process, involving oral and maxillofacial anatomy and physiology, biomechanics, surgery and other multi-disciplinary and interdisciplinary knowledge.

If a certain part of the operation fails to meet the requirements, a series of post-implantation complications may occur. For the complications in implant restoration, prevention should be the main focus.

Therefore, various possible complications should be considered before implant restoration, and preventive work should be done in all aspects of preoperative design, intraoperative procedures and postoperative maintenance.

Once the complications occur, they should be detected as soon as possible, and the correct treatment in time can often stop the development of the disease and even reverse the disease.

This article mainly discusses the complications and their treatment in the process of implant denture restoration from four aspects: intraoperative complications, early postoperative complications, late complications and complex additional surgical complications.

Intraoperative complications

01. Bleeding. Bleeding often occurs during the incision of soft tissues. Mucoperiosteal peeling damage is large, submucosal peeling is extensive, postoperative compression is poor, burrowing L is too deep and -l alveolar blood vessels, intrajaw tumor rupture, etc A common cause of bleeding. If affected by systemic factors, such as patients with bleeding tendency disease, bleeding can also occur during surgery. In addition to excessive bleeding caused by intraoperative bleeding, if blood flows back to the bottom of the body, it may also block breathing and cause suffocation. In order to avoid intraoperative bleeding, the trauma should be minimized during implant surgery. X-ray curved tomograms should be taken before surgery to understand the position and course of the mandibular canal, and design the implant depth and direction to avoid damage to the lower teeth. Groove blood vessels. In addition, screening for systemic systemic diseases should be carried out before surgery, indications should be selected, and contraindications should be avoided. The bleeding caused by general soft tissue injury can basically stop bleeding after 5-10 minutes of compression. Local congestion caused by blood oozing can generally be absorbed within a few days, and can be applied cold in the early postoperative period and warm in the late postoperative period. If the blood vessel of the inferior alveolar is injured or the tumor in the jawbone is ruptured, it should be exposed appropriately and ligated in time. Patients with bleeding tendency due to systemic factors should be treated symptomatically.

02. Maxillary sinus penetrating Maxillary sinus penetrating is an oral implant surgery, the drill or implant enters the maxillary sinus and penetrates the mucosa. It mostly occurs in the process of maxillary sinus lift and maxillary posterior dental implantation. It often causes postoperative infection. In severe cases, abscess occurs and causes pain in the patient's cheek. The main reasons for this include osteoporosis, weakening of the bottom wall of the maxillary sinus caused by alveolar bone resorption in the posterior maxillary area, excessive force during drilling or excessive implant placement. When the maxillary sinus is perforated, there is often bleeding at the penetrating hole. When the patient pinches the nose and inflates, air bubbles can be seen to leak out, and the penetrating hole can be detected by the probe. In order to avoid maxillary sinus perforation, X-rays should be taken before surgery, and based on this, the appropriate implants should be selected and the implantation depth should be determined. If the position of the maxillary sinus is too low, maxillary sinus elevation can be performed, and then implants will be placed. In some cases, the maxillary sinus can be avoided and implanted in the maxillary area. Small perforations do not require special treatment. Gelatin sponge can be placed at the perforation to seal the perforation. Large perforations are more likely to cause peri-implant inflammation. It is necessary to replant the implant after mucosal repair. For severe bleeding cases, it is still Maxillary sinus fenestration should be performed, and the perforation of the sinus floor should be sealed after hemostasis.

03. Alveolar ridge perforation Alveolar ridge perforation occurs mostly in the anterior tooth implantation area, and more common in the middle, one side or root of the alveolar ridge. The main reasons include the excessive absorption of the alveolar ridge due to the lack of teeth for too long, resulting in insufficient alveolar ridge width, improper drilling direction, underestimation of the bone undercut, and making the drill penetrate one side or root of the alveolar ridge. In addition, if the width of the blue alveolar ridge is insufficient, bone splitting is often used. If the operation is unskilled or excessive force at this time, the cortical bone may fracture or even fall off. It is generally believed that for perforations that do not affect the stability of implant implantation, implants should be implanted as usual after the perforation is treated with synthetic or autologous bone. If necessary, tissue membranes can be covered and soft tissues can be sutured. For larger perforations, if the initial stability of the implant cannot be obtained, implantation is not reluctant, and the wound can be closed by suture after implanting bone graft material at the perforation. The bone healing time is generally 6 to 12 months, and implants can be implanted after the bone has healed.

04. Nerve injury is the most common and serious complication in dental implant surgery. Nerve injury can occur in the anesthesia, osteotomy and implant placement of implant surgery. According to reports in the literature, the probability of nerve injury during dental implantation is as high as 13%. The nerves that may be injured are mainly the inferior alveolar nerve and the mental nerve. Occasionally, damage to the tongue nerve can occur. If the nerve is injured during the operation, it can cause local paresthesia or unusual bleeding.

Early postoperative complications

01. Postoperative edema Postoperative edema is the most common complication after implantation. The main reason is that the operation time is too long and the operation trauma is too large. Postoperative edema occurs more than the first day after surgery, which can cause local swelling and pain often accompanied by increased body temperature. In addition, edema can also cause wounds to open and sutures to fall off, affecting wound healing. Mild edema does not require special treatment, and usually resolves spontaneously within 1 week after surgery. Patients with severe wound edema need cold compresses and antibiotics and hormone drugs. To prevent the occurrence of edema, the operation time and the trauma to the tissue should be shortened as much as possible during the operation.

02. Postoperative infections After dental implants, postoperative infections mostly occur in 2 to 3 weeks after surgery, and are one of the more serious complications that occur early after dental implants. Postoperative infection manifests as local redness, swelling, pain, wound dehiscence, purulent secretions, etc. In severe cases, it can cause abscesses around the implant, leading to failure of dental implantation. The main cause of postoperative infection is the failure to strictly observe the principles of aseptic operation during the operation and poor oral hygiene after the operation. In addition, Quirnen et al. pointed out that imperfect surgical wound suture, inappropriate implant placement, and excessive trauma can all cause infection after dental implantation. Therefore, in order to avoid infection after dental implant surgery, oral hygiene should be paid attention to before and after surgery. The principle of aseptic operation should be strictly observed during surgery. Antibiotics and other drugs should be routinely taken after surgery.

03. Early dehiscence or perforation of soft tissue flaps. Premature exposure of the upper part of the implant often occurs in the early dehiscence or perforation of soft tissue flaps after the first-stage operation of two-segment implant implants. Premolars and molars are more common. At present, it is believed that over-tight sutures lead to insufficient local blood supply, and the blood circulation disorder of the soft tissue flap covering the implant denture causes tissue necrosis to be the main cause of soft tissue flap dehiscence or perforation. Qiu Lixin et al. It is believed that the thinning of the mucoperioste of the alveolar ridge in the mandibular molar area is the main reason for the soft tissue flap opening or perforation in this area. Other studies have shown that the incision design in the mandibular molar area has a certain effect on soft tissue dehiscence or perforation, and dehiscence or perforation is more likely to occur when the incision in this area is designed as a partial lingual incision. Soft tissue valve dehiscence or penetration can affect wound healing, causing peri-implant inflammation and early exposure of the implant. Some foreign scholars have pointed out that the early exposure of the implant due to soft tissue cracking or perforation can also cause bone resorption at the neck of the implant. The mechanism is not clear. It may cause a blind pocket with the dehisced soft tissue flap, causing anaerobic bacteria. Breeding related. If there is a tear or perforation of the soft tissue, it is necessary to apply hydrogen peroxide solution and physiological saline for local washing, and then perform reduction suture or soft tissue transplantation. In order to avoid tearing or perforation of soft tissue flaps, try to avoid sutures under tension during surgery, and maintain oral hygiene after surgery.

04. Early loosening of implants Loose during implant placement or before the completion of the initial healing period (3 to 6 months after surgery). Acute inflammation of the implant area, premature loading of the implant and perforation of the side wall of the jaw can all cause the early loosening of the implant. It has been reported that osteoporosis or too large implant socket preparation can also lead to early loosening of the implant. The early loosening of the implant will prolong the healing period, affect the combination of the implant surface and the bone tissue, and cause implant failure. After the clinical discovery of early loosening of the implant, one should choose a larger implant to re-implant or take out the original implant, and another implant operation after the bone tissue is healed.

05. Postoperative neurological dysfunction Postoperative neurological dysfunction mainly includes paresthesia, loss of pain, etc., which are often ignored in clinical practice. Paresthesias can be manifested as local numbness, burning sensation, acupuncture pain, ant walking sensation, etc., which can occur spontaneously or can be triggered by stimulation; analgesia refers to the loss of the ability to perceive pain. The end of the implant contacts the nerves such as the alveolar nerve, which causes the nerve to be compressed. The traction of the inferior alveolar nerve or mental nerve during inferior alveolar nerve transfer or mandibular premolar flap surgery is a common way to affect nerve sensory function the reason. The symptoms of nerve dysfunction caused by the pulling of the inferior alveolar nerve or mental nerve will generally gradually relieve, and usually can be fully recovered within 6 months. If the nerve dysfunction is caused by the compression of the end of the implant, the implant should be taken out immediately after taking pictures and eliminating other causes. In addition, tumor compression in the nerve path can also cause corresponding neurological dysfunction. At this time, it should be diagnosed and treated symptomatically. For nerve damage caused by implant surgery, failure to deal with it in time within 4 to 6 months will lead to deterioration of nerve function, so early treatment should be carried out within one month of nerve damage. In order to prevent postoperative neurological dysfunction, X-ray panoramic pictures should be taken before surgery to accurately measure the height of the jaw, select the appropriate implant, and determine the implant depth. The end of the implant is 2 mm away from the mandibular nerve tube. Is a safe distance.

Complicated additional surgical complications

01. After bone graft failure, the alveolar ridge often absorbs quickly after tooth loss. Insufficient bone in the dental implant area often restricts the progress of implant surgery. It is often necessary to perform different degrees of bone in cases with insufficient alveolar ridge bone before dental implantation. Incremental surgery, bone transplantation is one of the most common surgical procedures. Bone transplantation can be divided into white body bone transplantation and artificial bone material transplantation, and any method may fail. Infection and poor blood supply are the main reasons for bone graft failure. The postoperative infection caused by the rupture of the sinus mucosa during the maxillary sinus lift operation can cause infection, suppuration or even necrosis of the graft bone surface or itself due to the operation not according to the aseptic principle. The key factor for the success of bone transplantation is the adequate blood supply in the implanted area. Poor blood supply or poor granulation tissue in the implanted area will result in bone necrosis of the implanted white body and the human T-bone material may not be well integrated with the implanted area. Other studies have shown that poor blood supply in the recipient area can also lead to osteomyelitis. After bone graft failure, the necrotic bone should be removed as soon as possible, the wound should be washed repeatedly, and replanting or other repair methods should be considered after healing

Late postoperative complications

01. Peri-implant inflammation Peri-implant inflammation is an inflammatory process that affects the tissue surrounding the implant that has formed osseointegration and functions. It can lead to the loss of supporting bone and the failure of osseointegration. The clinical symptoms of peri-implantitis are similar to periodontitis, which mainly manifests as pain and local inflammation. Poor implant denture superstructure design, heavy load, and poor oral hygiene are the main causes of peri-implant inflammation. The most common clinical cause is excessive load. In addition, Haas et al. conducted a retrospective study of 366 implants in smoking patients and 1,000 implants in non-smokers and showed that smoking can lead to deep pockets around the implants, increased bleeding index and bone resorption around the implants, which greatly Increase the probability of peri-implant inflammation. In order to prevent the occurrence of peri-implant inflammation, you should pay attention to oral hygiene, quit smoking in time, and rationally design the superstructure so that the gums and abutment can be in close contact to avoid plaque accumulation, while appropriately reducing the burden on the denture, reducing the bite, and avoiding overload. In case of peri-implantitis, curettage and debridement should be used. Bone regeneration can be used for patients with bone resorption. If the implant has been significantly loosened, the implant should be removed in time, and the implant socket should be scraped and implanted after the bone has healed.