Editorial | Vol. 6, Issue 2 | Journal of Dental Health and Oral Research | Open Access |
Gráinne McCloskey1*
1Abbey Dental Clinic – Principal Dentist and Owner, 620-630 Shore Road, Whiteabbey, Ireland
*Correspondence author: Gráinne McCloskey, Abbey Dental Clinic – Principal Dentist and Owner, 620-630 Shore Road, Whiteabbey, Ireland; E-mail: [email protected]
Citation: McCloskey G. Permanent Implants the Permeant Solution to Losing Teeth? J Dental Health Oral Res. 2025;6(2):1-4.
Copyright© 2025 by McCloskey G. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
| Received 05 August, 2025 | Accepted 24 August, 2025 | Published 31 August, 2025 |
Editorial
Dental implants are a reliable and successful method of replacing missing teeth in the adult dentition helping to improve function, aesthetics and mental well-being. Some patients describe it as life changing and their self-esteem greatly improves. Teeth have become not only a functional but aesthetic concern. As dentists, we must be prudent not to develop a mindset of outlet aesthetics for teeth at the detriment of the natural dentition.
The survival rate over 10 years is in the range of 96.4% according to Howe, et al., [1]. The prediction intervals were between 91.4% and 99.7%. The over 65 age group had a lower success rate than the younger age groups partly due to the slower healing response. Howe, et al., found a survival rate of 85% in implant retained full arch patients with an average pre failure functional load of 7 years. Clinicians and patients often expect dental implants to integrate successfully on the first attempt though this is not always achieved. They also expect implants to be complication free for many years without maintenance. This is not the case. Sometimes uncomfortable conversations with the patient must be had on several occasions to ascertain that they are fully aware of the lifespan and maintenance required to increase longevity of a dental implant.
Implant survival is not the same as implant success. Implant survival is purely the implant still present intra orally. Implant success represents lack of signs and symptoms of pain, inflammation and bone loss. Research has shown that 22% of all implants placed experiencing peri-implantitis at 5 years [2]. The estimations for this can vary, depending on baseline bone probing depths and implant morphology and is complicated by patient factors such as oral hygiene routines, manual dexterity, underlying systemic disease (diabetes) and lifestyle choices such as smoking and vaping.
Given the fact that implants are susceptible to gum disease or periodontal issues and occlusal overload, the importance of maintenance and regular oral hygiene, appointments with hygienist, therapists or dentist will help increase the lifespan and decrease the likelihood of implant failure [2].
Keywords: Dental Implants; dentists; implant failure
Lifespan of Implants
Implants typically last 8 to 15 years and are not permanent. Nothing is truly permanent. Implant failures due to loss of osseous-integration, screw, or fixture fractures require removal after failure. With implant failure comes bone loss. Early failure (within a year) may require simpler procedures such as Guided Bone Regeneration (GBR). Implant failure at a late stage may requires the addition of bone grafts, bone blocks or more complex techniques such as sinus lifts, Khoury plates or zygomatic implants. Many clinicians now think in terms of cycles of implant treatment over time and it is prudent to discuss this with the patient prior to starting treatment. Costings of further reparative work must be discussed with the patient and agreed prior to treatment along with warranty terms and conditions. If a patient fails to maintain their implant restoration and comply with your advice – should the cost and reparative work be carried out by the clinician free of charge? When there is a plethora of reasons an implant may fail, is it solely the clinician’s responsibility to assume responsibility for failure. These are mechanical pieces that we are inserting into a jawbone and like hip joints they have complications and failures (Table 1).
Category | Complications/Factors | |||
Biological | Peri-implantitis/mucositis, Failure to attain osseointegration, Failure to maintain osseointegration, Patient factors: systemic health (e.g., uncontrolled diabetes), smoking and vaping, radiation therapy, Insufficient bone volume/quality Osteoporosis | |||
Mechanical | Implant fracture, Screw fracture, Abutment fracture, Screw loosening, Prosthetic component fracture (e.g., crown/porcelain, denture attachments) | |||
Iatrogenic | Bone overheating, Failure to degranulate site and introduction of soft tissue, Malpositioning in the 3-D plan, Nerve damage/Paraesthesia, Damage to adjacent teeth/structures (e.g., sinus perforation), Retained cement | |||
Functional | Design of prosthesis (e.g., lack of passive fit), Functional overload, Occlusal interferences, Parafunctional habits (e.g., bruxism) | |||
Aesthetic | Soft tissue recession/gingival recession, Unfavourable soft tissue contour/black triangles, Unsatisfactory restoration aesthetics (colour, shape, size, metal show) | |||
Table 1: Reasons for implant failure.
Alternatives to Implant Treatment
Other options to replacing missing teeth should be discussed with the patient initially,
All are viable options, but on some occasions, it is the authors opinion that dental implantologists choose to restore with implants without taking into consideration the patients’ medical history, ability to maintain dental implants and adjacent tooth status. The adage is true – every implantologist sees an implant space; every prosthodontist sees a bridge. Our in-built desire to do surgery and place an implant sometimes clouds our decision-making processes ad biases us towards surgery. The pull of consumerism and possibly ego of the surgeon can drive the process towards surgery as opposed to patients’ best interests. This is an ethical dilemma, especially, in cases where patients have some remaining sound teeth, but a full arch implant retained prosthesis is requested by the patient. 76% of the patients would prefer the implant prothesis to be fixed as opposed to removable [3]. This percentage is greater in women than men. Wang, et al., found that the degree of satisfaction was higher in patients with foxed prostheses than with removable, although presence of moderate to severe peri-implantitis brought this rating down [4].
Treatment Planning
Certain factors will need to be considered prior to placement of an implant and maintenance of an implant:
Careful surgical planning and prosthetic planning will increase the lifespan of the implant and decrease the risk of future complications such as enamel chipping, screw fracture, abutment fracture, implant fracture or untimely implant loss. Koati Ettel, in 2015 mentioned that the likelihood of screw loosening in implant placements after 5 years to be at 35% when looking at 565 patients. This is an inconvenience to the patient but also an inconvenience to the clinician. It may be best, if possible, to replace the internal screw if the tooth continues to loosen.
Failure to not adhere to the guidelines will undoubtedly reduce the lifespan and increase the complication risk. Careful evaluation of the Cone Beam Computed Tomography (CBCT), intraoral scans and digital photography overlaid in a digital smile design treatment planning software can help identify any defects in bone and soft tissue which will needs to be addressed in the planning stage.
The role of dental implants in some situations is invaluable, such as a single tooth implant with sound adjacent teeth mesially or distally, or in the position of Kennedy Class 1 or class 2 with a posterior edentulous ridge [5]. Then the addition of an implant can make the retention of an upper or lower denture more favourable and more desirable/acceptable to the patient. In the maxillary arch though, there tends to be D3/D4 bone making placement of an implant and osseointegration of an implant more problematic [6].
Maintenance and Examination
For a new patient that presents to practice we should initially take
Discussion and Conclusion
This paper is a very short delve into the permeant solution to missing teeth that is dental implants. As briefly mentioned, dental implants are not without their failings and do require further commitment from the patient and the clinician to ensure a long and healthy osseo-integrated implant. It is very important to have these conversations with the patient prior to implant placement. The patient must be made aware of factors that may decrease the lifespan of an implant and increase the likelihood of infection or complications and their ownership and responsibility for maintaining the health of the implant must be conveyed and understood fully.
Conflict of Interest
There are no conflicts of interest that may have influenced the research, authorship or publication of the article.
Financial Disclosure
No financial support was received for the writing, editing, approval or publication of this manuscript.
Ethical Statement
This project was exempt from IRB review as it did not qualify as human subject research under federal regulations.
References
Gráinne McCloskey1*
1Abbey Dental Clinic – Principal Dentist and Owner, 620-630 Shore Road, Whiteabbey, Ireland
*Correspondence author: Gráinne McCloskey, Abbey Dental Clinic – Principal Dentist and Owner, 620-630 Shore Road, Whiteabbey, Ireland;
E-mail: [email protected]
Gráinne McCloskey1*
1Abbey Dental Clinic – Principal Dentist and Owner, 620-630 Shore Road, Whiteabbey, Ireland
*Correspondence author: Gráinne McCloskey, Abbey Dental Clinic – Principal Dentist and Owner, 620-630 Shore Road, Whiteabbey, Ireland;
E-mail: [email protected]
Copyright© 2025 by McCloskey G. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation: McCloskey G. Permanent Implants the Permeant Solution to Losing Teeth? J Dental Health Oral Res. 2025;6(2):1-4.
