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to explain to patients when you expect
full sensation to return following the
administration of local anaesthetic. Should
the patient experience numbness beyond
this, they should be instructed to contact the
practice immediately. However, as normal
postoperative swelling develops, patients
can also feel this as a numb sensation and,
therefore, it is important to be able to
distinguish between the two. A phone call
to patients the day after surgery and access
to an out-of-hours service is an important
part of postoperative care.
2. Incorrect placement of implant
Implant success is dependent upon accurate
implant positioning. Figure 2 shows an
Fig 4: Poor plaque control
implant that was not placed at the correct
angulation and later required removal as
its restoration failed. A contributing factor
to its failure may have been the patient’s
limited opening, which then impacted
upon the angulation of the handpiece that
was possible for preparing the osteotomy.
Care is needed to avoid over preparation
and excessive force in placing an implant.
This can lead to overheating of the bone
and subsequent failure of the implant to
integrate. In the posterior maxilla, excessive
force can result in an implant being
Fig 5: Malposition of implants LR6 and LR7, Fig 6: Non-cleansable implant restoration in displaced into the maxillary sinus.
which are convergent and too close together upper left molar region – the implants were
splinted in a single molar shape restoration,
but access could not be gained around them 3. Implant failure
Early implant failure can occur before
integration is achieved and patients can
present a number of weeks following
surgery with an implant that has been
completely lost from the site. Usually this is
relatively painless (similar to the exfoliation
of a deciduous tooth) and soft tissue healing
occurs quickly. At exposure, removal of
the closure screw through a reverse torque
test serves to check the integration of an
implant. If an implant has failed, pain will
occur during the removal of the closure
screw and the implant will be seen to rotate.
This can also be the case if the implant fails
at subsequent restorative stages.
4. Infection
The authors do not routinely prescribe
antibiotics for implant placements, unless
bone augmentation is being undertaken,
and consider postoperative infections to be
Fig 7: Photo of this restoration showing lack of a cleansable space a rare occurrence.
Dental Practice i July-August 2023 i Vol 19 No 4 39
