Clinical management of failing dental implants: four case reports

Two-stage, endosseous dental implants have become a clinically acceptable treatment modality for the restoration of function and esthetics in edentulous areas. One system (Biotes, Nobel-pharma) currently has full approval from the ADA for use in full edentulous cases, while several other systems have provisional approval. Several professional journals and lay magazines have published information about implants, and this has stimulated interest on the part of both the dentist and the patient. Many different brands of implant systems are now available for the clinician to utilize, and the manufacturers of these implants have established training programs designed to teach both the generalist and the specialist the correct placement and restoration of their particular implants. With an increase in the number of implants being placed, it is inevitable that the number of complications will likewise rise. While current implant literature is replete with information concerning the concept of osseointegration, success rates, and examples of restorative techniques, there is very little information available on guidelines for patient evaluation and selection, clinical maintenance homecare, or treatment considerations for system failure. It is conceivable that an implant that was correctly placed and exhibited all the criteria for success at the time of surgical exposure may develop problems subsequent to restoration. Since the investment for the patient is significant in terms of time, finances, and trust in the practitioner(s), the periodontist may be called upon to intervene in such cases to improve the prognosis. The purpose of this paper is to present four case reports that illustrate several treatment modalities for the clinical management of implant problems that developed at the time of, or following, exposure.