Dental implant demand is expected to grow at an annual rate of 11% between now and 2028. The market is expected to be valued at $8 billion by then. Patients want teeth that are stable, efficient, and esthetically pleasing. If their natural teeth do not meet those desires, then many will make the investment in dental implants. The majority of implant cases will meet, or exceed, the patient's expectations. However, just as multiple local and systemic risk factors can decrease the probability for survival of natural teeth, those same risk factors will be present for dental implants and jeopardize their long-term success.
Along with a large number of implants being placed, the future will also bring complications. Dental implant complications will include technical, mechanical, and biological issues.1 Technical and mechanical complications include abutment screw loosening, fracture of the overdenture prostheses, activation of retentive clips, ceramic chipping, fractures, etc. Biological complications include peri-implant mucositis, mucosal enlargement, peri-implantitis (bone loss), pain, inflammation, possible implant loss, and more.2 Undoubtedly, every implant dentist reading this editorial can relate to all of these complications. Simonis et al,3 found that on follow-up of implants ≤16 years, there was a cumulative survival rate of 82.94% and a cumulative complication rate of 48.03% (biological 16.94%, technical 31.09%). The majority of implant losses and biological complications were concentrated in a small group of patients. Technical/mechanical complications were spread out over a larger number of patients. Consequently, there were many successes with a smaller number of patients experiencing most of the complications. This translates to considerable additional chairside time being spent on nearly half of the cases after placement. This is a mutual problem for both patients and clinicians.
Currently, complications are a widespread problem as witnessed by the large number of complication-related articles in peer-reviewed journals. A PubMed search on all dental journals between January 1, 2019 and April 23, 2021 revealed that there are 1176 articles published on the topic of dental complications. In that same time-period, JOI published many implant complication-related articles that include peri-implantitis; intraoperative, systemic medication effects; sinus surgery; genetic effects; all-4-screw prosthesis; prosthetic; plus others.4–12
Patients and clinicians would both benefit if the implantologist could take the complication rate from 48% to near zero. Medical comorbidities and perioperative risks for patients will become increasingly complex as patients live longer. Our colleagues in orthopedics are making collaborative efforts to decrease surgical orthopedic complication rates. Steps being taken by orthopedists include prudent presurgical assessments regarding indications, risks, and benefits. They have concluded that an organized, systematic, coordinated, multidisciplinary approach to the perioperative management of patients have resulted in decreased complications.13
Implant dentistry's complication rate will diminish if researchers, manufacturers, and clinicians work together to discover evidence-based solutions. Clinicians should focus on (i) prevention that includes thorough diagnoses and treatment planning, (ii) precise placement/restoration techniques, and (iii) early detection with proper treatment of complications. Patients also have a responsibility in this near-zero complication goal by practicing state-of-the-art daily oral hygiene with proper diet considerations.
