Implant surgery complications are frequent occurrences in dental practice and knowledge in the management of these cases is essential. The aim of this
review was to highlight the challenges of treatment plan-related, anatomy related, and procedure related surgery.
The clinical implication of the biologic width is that there is typically more initial bone loss around submerged implants than around non-submerged implants. However, after the first year in function, it appears that bone levels are equally stable in both implant types. There is usually a greater distance from the implant to the gingival margin with submerged implants than with non-submerged implants, so it is easier to create the desired emergence profile for the final
Additionally, there is a greater risk in the aesthetic zone that a non-submerged implant will become visible if there is any supporting tissue loss after implant placement according to Lutz dentist Dr Daniel Wahba.Implant angulation is yet another determinant for implant success.
Proper angulation should be determined according to the future prosthesis with the consideration of bucco-lingual, apico-coronal, and mesio-distal positions. To place implants based on available bone often results in poor esthetic outcomes as well as long-term biomechanical instability. Although, there are many rescue techniques for restoring cases placed outside of the occlusion (eg , having to be with custom and angled abutments), the surgery should be planned for suitable angulation at the onset. Surgical guides can
help control the implant placement angle if they are made and used correctly.
Both cement-retained and screw-retained prostheses have been validated in clinical studies, and each type of retention has particular advantages and disadvantages. Historically, screw-retained prostheses were widely used on dental implants because the restorations could be retrieved for eval-
uation of the underlying implants and repair of any possible complications. Cemented restorations are now widely used as they allow a more aesthetic restoration to be created. While they are not as readily retrieved as a screw-retained prosthesis, cementing restorations with provisional cement
allows a degree of retrievability. There is some evidence that cement-retained fixed prostheses have fewer prosthodontic complications after delivery.
Restorations may be difficult to restore due to tongue impingement or incorrect opposing positions. In the posterior mandible, limited mouth opening prevents the drill and implant carrier from fitting correctly in the vertical direction. Teeth adjacent to implant sites and surgical guides with long drill channels, often require the use of drill extensions and maximum opening by the patient which may be strenuous. Short breaks to relieve muscle tension, using a bite block and having the patient shift their jaw to the opposite side can help ensure the correct angulation.
Preoperative measurements and planning are essential to achieve an ideal implant placement that facilitates future implant prosthesis. Placing an
implant in the wrong location is a frustrating, embarrassing and avoidable complication (Fig. 3). Measurements (eg , interocclusal, interdental, ridge height, and ridge width) confirm whether implants are indicated in the first place. The spatial orientation should be in line with the occlusal plane and centered according to the opposing occlusion to prevent cross-bites or additional stresses on the prosthesis. Many times fixtures are ideally intended for one specific position to be in the proper occlusion. If more than one implant is to be placed, a diagnostic wax-up should be used to determine the correct implant locations.