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Dental Implant Warnings
Dental implant placement, in its most straightforward form, is not particularly traumatic.  
People obviously differ in their response to dental implant placement as they do to any
surgical procedure.

It is a surgical procedure so it won’t be painless afterwards however the post-operative stage won’t be as sore as
if a difficult wisdom tooth has been removed.

The incidence and severity of problems post-op in part relate to the complexity of the procedure and the
individual’s response to it.

Not all possible complications or risks can be foreseen in any medical or surgical treatment and this is the case
for dental implant surgery.

These are the commoner risks.  There may be other unusual risks that have not been listed here.

Please ask your Oral Surgeon if you have any general or specific concerns.
Last Updated 20th May 2015
Less Common Surgical Consequences:


Numbness / Tingling / ‘Burning’ of the Lip, Chin and / or Tongue.  The nerves that supply feeling to the tongue,
lower lip and the chin run within the lower jaw, close to where the root-ends of the lower molar teeth were and
exit onto the gum close to the roots of the
premolars / bicuspids.  There is a risk that when implants to replace
molars ± bicuspids are placed, these nerves can be crushed, bruised, compressed by bleeding or stretched
resulting in numbness (at the worse end of the scale) to altered sensation (at the other end of the scale) in the
region of the
lower lip, chin and / or tongue.

If this is apparent after the local anæsthetic has worn off, you need to contact the Oral Surgeon immediately as
prompt action is needed so that the nerve damage is not permanent.  If it occurs, the nerve damage is often
temporary but normal sensation can take quite a few months before it returns.

Bleeding into Cheeks / Lips / Floor of Mouth.  Swelling that does not resolve within a few days may be due to
bleeding into the cheek / lips / floor of mouth.

The cheek swelling will feel quite firm.  Coupled with this, there may be limitation of mouth opening and bruising.  
If an implant is being placed in the front of the mouth, there is a chance of bleeding into the lips.

Also, if an implant is being placed in the lower jaw, there is a chance of bleeding into the floor of the mouth.  This
can look and feel quite alarming.  In a worst-case scenario, swelling of the floor of the mouth secondary to
bleeding can compromise the patient’s breathing.  This scenario needs to be respected and the patient should
have a low threshold to contact the Oral Surgeon, should this happen.

Both the swelling, bruising and mouth opening will resolve with time.

Mouth-Sinus Communications.  The floor of the (maxillary) sinus can often been in close proximity to the upper
jaw; this is more likely if upper molars and pre-molars have not been present for awhile (i.e. the sinus expands).  
Hence, when upper implants are placed, the level of the sinus floor has to be checked to see if there is enough
bone (height) to place an implant.  If there is not, certain stubby types of implants can be used or if, there is not
enough bone height even for these, bone has to be placed in the area to provide the bone height for the implants.

There is a chance, with upper jaw implant surgery, that a hole can be created from the mouth to the sinus.  This is
sometimes is not evident at the time of operation but may develop several weeks afterwards.  If this ’hole’
persists or is left un-repaired, every time you drink, fluid can come out of the nose and you may develop a marked
sinusitis.  This ‘hole’ if small enough, can spontaneously close.

Dental Implants in the (Maxillary) Sinus.  Whilst placing implants in the upper jaw, the implant can end up in the
sinus.  If this happens, then it needs to be retrieved as it represents a ‘foreign object’ in the sinus and the sinus
responds to its presence.

The removal of the implant, if deemed necessary, may entail making a bony window in the upper jaw to remove
the implant.  Alternatively, the Ear, Nose & Throat Surgeons can remove wayward dental implants with a different
approach.   It is quite possible that a chronic sinusitis will result that can take awhile to settle.

Dental Implants in the Nasal Floor.  Whilst placing implants in the upper jaw especially towards the front of the
mouth, there is a small chance that the implants may perforate through the floor of the nasal cavity.  If this
happens, then it needs to be retrieved as it represents a ‘foreign object’ in the sinus and the sinus responds to its
presence.  The removal of the implant, if deemed necessary, may entail making a bony window in the upper jaw
to remove the implant.  It is quite possible that a chronic sinusitis will result that can take awhile to settle.

Oro-Nasal Communications.  

Incisive Neurapraxia.  


Early Surgical Failure:

Implant Failure.  Even though implants have a high success rate, they can still fail.  The failure can be due to a
number of factors including medical conditions (such as uncontrolled diabetes, smoking,
bisphosphonate use,
steroid use, osteopetrosis), infection, poor quality bone (especially in the upper jaw), the wrong position (leading
to stresses and strains that the dental implants aren’t designed to cope with), bone death due to being
overheated when the implant was placed and the wrong implant components.

Peri-Implantitis.  Peri-implantitis, due to poor hygiene or excessively thick soft tissue interface and pre-exisiting
perio problems

Peri-Implant Abscess.

Wrong Position.  Improper implant positioning, causing prosthetic compromise.

Bone Augmention.  This is done by grafting or supplementation.  

Gum Recession.

Loss of Interdental Papilla.  This can result in inter-proximal ("black triangles" between teeth) spaces due to
tissue deficiencies and incisions and reflection of the tissues

Infection (acute or chronic).

Lower Jaw / Mandibular Fracture.

Loss of Bone Graft / Augmentation Material.  This can result in implant failure.

Implant not restorable.

Hyperplastic Soft Tissue Response.

Idiopathic Generic Failure.


Late Surgical Failure:

Implant Failure.  See above in Early Surgical Failure.

Peri-Implant Abscess.  See above in Early Surgical Failure.

Peri-Implantitis.  See above in Early Surgical Failure.

Crestal Bone Loss.  This is due to inadequate available crestal bone, dehiscences at the time of surgical
placement, or exceeding of the load threshold.

Gum Boil / Parulis Formation.  This is due to loose restoration, inadequate hygiene or cement entrapment.

Fenestrations / Dehiscenes of Labial Bone.  This is due to labial plate collapse after tooth extraction, to
resorption after implant placement or to anatomic labial concavities.

Unstable Dental Implant.

Excessive vertical and horizontal bone loss.

Infection (acute or chronic).  See above in Early Surgical Failure.

Lower Jaw / Mandibular Fracture.  See above in Early Surgical Failure.

Loss of Bone Graft / Augmentation Material.  See above in Early Surgical Failure.

Implant not restorable.  See above in Early Surgical Failure.

Hyperplastic Soft Tissue Response.  See above in Early Surgical Failure.

Idiopathic Generic Failure.  See above in Early Surgical Failure.


Restorative Complications:

Implant unrestorable.

Æsthetic Compromise.  This is usually due to tissue deficiencies, poor alignment or trajectory of implant or poor
prosthetics.

Discolouration of Gum.  Supra-gingival (above the gum) visibility of portions of the implant or abutment, due to
crestal bone loss or gingival recession.

Implant / Implant Component Fatigue.  Loose restorations related to loose or fractured abutment screws, due to
inadequate tightening of screws.

Overdenture Clip / Attachment Loosening.

Overdenture Fracture.

Opposing Prosthesis Fracture.

Æsthetic Complication with Prostheses.

Disproportionate Size of Restoration compared with Adjacent Teeth.  This occurs due to tissue deficiencies.


Useful Websites:

Association of Dental Implantologists UK

British Society of Oral Implantologists

Figure 1


Useful Articles:

Dental Update 2002.  Implant Complications and Failures - The Fixed Prosthesis

BDJ 2008.  Endoscopic Trans-Nasal Removal of Migrated Dental Implants

BDJ 2009.  Massive Sublingual Haematoma following Osseo-Integrated Implant Placement in the Anterior
Mandible

J Oral Maxillofac Surg 2009.  Characteristics of Early Versus Late Implant Failure - A Retrospective Study

J Oral Maxillofac Surg 2009.  Inflammatory Implant Periapical Lesion. Etiology, Diagnosis & Treatment —
Presentation of 7 Cases

Evidence-Based Dentistry 2009.  Smoking increases Dental Implant Failures & Complications

J Oral Maxillofac Surg 2010.  Occurrence of a Pyogenic Granuloma in Relation to a Dental Implant

Dental Update 2010.  Peri-Implant Diseases

BDJ 2010.  Dental Implant Failure Associated with a Residual Maxillary Cyst

BDJ 2010.  Risk Management in Clinical Practice. Part 9. Dental Implants

BJOMS 2011. Early Dental Implant Failure - Risk Factors

In Tech 2011.  Implant Complications

Cochrane Review 2012.  Review.  Interventions for Replacing Missing Teeth - Treatment of Peri-Implantitis

BDJ 2013.  Dental Implant Complications – Extra-Oral Cutaneous Fistula

N Engl J Med 2013.  Dental Implant in the Ethmoid Sinus

Dent Update 2013.  Treatment of Peri-implant Diseases.  A Review of the Literature & Protocol Proposal

BDJ 2014.  Peri-Implantitis.  Part 1.  Scope of the problem

BDJ 2014.  Peri-Implantitis. Part 2. Prevention & Maintenance of Peri-Implant Health

BDJ 2014.  Peri-Implantitis.  Part 3.  Current Modes of Management

BDJ 2014.  Dental implants in patients affected by systemic disease

BDJ 2014.  Pre- & Post-Operative Management of Dental Implant Placement.  Part 1. Management of Post-
Operative Pain

BDJ 2014.  Pre- & Post-Operative Management of Dental Implant Placement. Part 2.  Management of Early-
Presenting Complications

Dental Update 2015.  Peri-Implant Diseases - An Overview
The medico-legal landscape of consent has been shaped by a number of cases, such as Chester v Afshar
[2004], Montgomery v Lanarkshire Health Board [2015], Duce v Worcestershire Acute Hospitals NHS Trust [2018]
amongst others, so that it is more patient-centred.

Many of the legal claims in surgical (& medical) cases occur as a result of “failure to warn”, i.e. lack of
adequately documented and appropriate consent.

A pre-requisite for obtaining consent for a surgical (medical / dental) procedure from a patient, is a full
exchange of information regarding any risks, drawbacks and limitations of the proposed treatment and any
alternatives to it (even non-treatment).

The clinicians should provide the patient with as much information as is appropriate and relevant, that it should
be in terms the patient understands & the risks should be personalised for that individual patient.  Also, there
should be enough time for the patient to understand the information given and get a second opinion if needs be.
The following list of warnings regarding dental implant placement is neither exhaustive nor is it predictive.  You
are to have a
dental implant placed.

You can expect the following:

Common Surgical Consequences:

Pain.  As it is a surgical procedure, there will be soreness after the implant placement.  This can last for several
days.  Painkillers such as
Ibuprofen, Paracetamol, Solpadeine or Nurofen Plus are very effective.  Obviously, the
painkiller you use is dependent on your medical history & the ease with which the dental implant was placed.

Swelling.  There will be swelling afterwards.  This can last up to a week.  Use of an icepack or a bag of frozen
peas pressed against the cheek adjacent to the operation site will help to lessen the swelling.  Avoidance in the
first
few hours post-op, of alcohol, exercise or hot foods / drinks will decrease the degree of swelling as well.

Bruising.  Some people are prone to bruise.  Older people, people on aspirin or steroids will also bruise that
much more easily.  The bruising can look quite florid; this will eventually resolve but can take several weeks (in
the worst cases).

Stitches.  The implant site will be closed with stitches.  These dissolve and ‘fall out’ within 10 – 14 days.

Limited Mouth Opening.  Often the chewing muscles and the jaw joints are sore after the procedure so that
mouth opening can be limited for the next few days.  If you are unlucky enough to develop an infection afterwards
in the operation site, this can make the limited mouth opening worse and last for longer (up to a week).

Post-Op Infection.  You may develop an infection in the operation site after the procedure (even if on antibiotics).  
This tends to occur 2 – 4 days later and is characterised by a deep-seated throbbing pain, bad breath and an
unpleasant taste in the mouth.  This infection is more likely to occur if you are a smoker, are on the Contraceptive
Pill, on drugs such as steroids and if bone has to be removed to facilitate tooth extraction.  If antibiotics are given,
they are likely to react with alcohol and / or the Contraceptive Pill (that is, the ‘
Pill’ will not be providing protection).

Should the infection develop, you need to contact the Oral Surgeon post-haste as an infection at the op site can
lead to the implant failing.

Surrounding Teeth.  The surrounding teeth may be sore after the procedure; they may even be slightly wobbly but
the teeth should settle down with time.  It is possible that the fillings or crowns of the surrounding teeth may come
out, fracture or become loose.  If this is the case, you will need to go back to your dentist to have these sorted
out.  
Every effort will be made to make sure this doesn’t happen.

In a worse case scenario, the blood supply of adjacent teeth may be compromised with the result that these die
off.  If this happens (the tooth may change colour or become spontaneously painful), they may need endodontic
(root-canal) treatment to salvage them.

Periodontal complications.