Implant indications

Nothing lasts forever, and there are very few things which last for life. Teeth should last most people a lifetime, but this is not always the case. Implants were supposed to last decades, but complications can often reduce their intended life-span and cannot always be successfully resolved.

Patients’ expectations about the longevity of implant restorations can be unrealistic, based on the complexity and cost of the therapy required. Careful planning, treatment and maintenance are required to prevent complications arising.

“Patients’ expectations about the longevity of implant restorations can be unrealistic”

The chairs described a clinical situation in which the patient had severe periodontitis and had received implants, and peri-implantitis had subsequently occurred. This situation invites a number of questions and challenges regarding the outcomes of the treatment and the restoration, and regarding the maintenance of the affected teeth and implants (Figures 1–5). The chairs invited the speakers to consider these questions.

They asked: if the patient were to receive adequate treatment, how long could their oral health be maintained? How long can the teeth be maintained – 5, 10 or 20 years? Are implants indicated in patients with periodontitis, and is this patient a suitable candidate for implant placement? And to what extent can periodontal breakdown be prevented?

How long could the treated peri-implantitis be kept under control? Is there a treatment protocol available which is better than others? What type of prosthesis would be the best option for this patient? Do implant surfaces and designs influence implant longevity? For how long could implants be maintained? And which approach would be easier to maintain in the long term: compromised teeth or implants?

“How long could the treated peri-implantitis be kept under control?”

If the patient had a fixed restoration in the lower arch on teeth, which prosthesis would a prosthodontist prefer to maintain: an implant-supported or tooth-supported fixed prosthesis? Is it the materials we choose or the design of the prosthesis which are most critical for longevity? In terms of a full-arch rehabilitation, does the length of cantilever have an impact on the longevity? With all the chipping we have seen in this patient, is it better to have a segmented reconstruction or a full-arch reconstruction?

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