Dentaltown June 2020 - 41

continuing
education
patients should experience lasting success
with reduced complications and failures.
This course covers principles and
techniques that can help minimize the
incidence of implant failure, including bone
density, implant width, implant placement
positioning, lab communication and followup appointments with the patient after
restorations have been delivered and placed.

Educational objectives
Upon completion of this course, participants should be able to achieve the following:
* Understand how the Hounsfield
unit measurements in the targeted
edentulous space should affect
treatment planning for implants.
* Understand the benefits of using
a wider-diameter implant as related
to increased surface area.
* Understand the unfavorable factors
that result if implants are not placed
perpendicular to the occlusal table.
* Understand the changes in bite-force
ability that various types of opposing
dentition can be responsible for.
* Understand the benefits of splinting
adjacent implant crowns together.

Introduction
Implants have allowed us to significantly
improve our patients' aesthetics and function
with fixed prosthetics over the past 30 years.
There are many CE curricula, courses,
articles and video techniques discussing ways
to learn and improve the surgical aspects
of implant placement, but information
on implants and their prosthetic aspects
pales in comparison. Could this lack of
information be why authors are becoming
concerned about failures and complications
in implant dentistry? 1,2 Studies have shown
that although implants are highly successful,
failures at the five- to 10-year mark are
between 4%-16%.3-7
Although not all failures can be foreseen,
there are indeed failures that can be reduced
or prevented by applying some rules and
principles to your restorative armamentarium.
Even if you are not performing the surgery,
having a key understanding as to what can

affect your prosthesis' long-term success
rate will allow you to communicate more
efficiently with your surgeon and, in turn,
decrease failure rates.
In this article, we will first deal with a few
principles to help minimize implant failure,
then discuss how to reduce postoperative
failures.

1. Bone density
Many independent groups have reported
higher failure rates in poor-quality bone
compared with high-quality bone.8-17 The
anterior mandible has greater bone density
than the anterior maxilla, and the posterior
mandible has poorer bone density than the
anterior mandible. The poorest bone quality
in the oral environment typically exists in
the posterior maxilla and is associated with
dramatic failure rates. Jaffin and Berman12
reported a 44% failure when poor density was
observed in the maxilla, with the majority
of failures noted at second-stage surgery.
Fifty-five percent of all implant failures
within their study sample occurred in the soft
bone type. The report documented a 35%
implant loss in any region of the mouth when
bone density was poor. Engquist et al.13 also
reported a high percentage (78%) of clinical
failures in soft bone types. Friberg et al.14
observed that 66% of their group's implant
failures occurred in the maxilla with soft
bone. The reduced implant survival most
often is related more to bone density than
location; however, the posterior regions of
the mouth have less dense bone than the
anterior regions of the maxilla and mandible.
Six independent clinical groups, following
a standardized surgical protocol and using
the same implant design, documented the
indisputable influence of bone density on
clinical success.18
Misch19 described four bone densities
found in the edentulous regions of the
maxilla and mandible. D1 bone is primarily
dense cortical bone, with a Hounsfield
unit measurement greater than 1250. 20
D2 bone has dense to thick porous cortical
bone on the crest and coarse trabecular
bone underneath, with Hounsfield unit
measurements of 850-1250. 20 D3 bone

Disclosure:
In the past 12 months, the
lecturer/speaker declares that he has
had a financial interest, arrangement
or affiliation within the field of
dentistry or health care with the
following: Clinical Mastery Series,
Yankee Dental Meeting, Greater NY
Dental Meeting, Ivoclar Vivadent,
Colorado Prosthodontic Society,
Academy of Operative Dentistry,
Virginia AGD, Nebraska Annual
Session.
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