Osseointegration. Complications. Prevention, recognition, treatment

Practitioners often have delayed responses to the problems involved with complications. This was especially true in the first years of endosseous implantology. Eventually, hindsight becomes insight. This maturation is a necessary and normal process. It can be enhanced by careful documentation of the procedures and process of care such as numerous clinical photographs during treatment, and treating patients with several members of the team present (example: the prosthodontist scrubbing with the surgeon on very early or complex cases.) It is possible to improve the quality of care. Postsurgical case management conferences are invaluable. It is also important that each team member not only see his or her own role, but also the responsibility to see that the entire treatment is adequately done. Each individual must have a sense of responsibility for the management of the entire case. It is important that the practitioner not take a defensive posture regarding his or her own treatment. Reformatted computerized tomography (CT) including radiographic bone density measurement (Houncefield units) can be very valuable in determining bone quality and anatomy and will provide insight into where and where not to place fixtures. In the event of a complication, it is important that it be recognized early that it not be "covered up" and that the damage be contained and prevented from causing a secondary complication and further morbidity to the patient.