48
Surgical complications
Surgical complications are uncommon and can be minimized (Box 48.1).
Box 48.1 General factors that may prevent surgical complications
- Training of surgical staff
- Knowledge of anatomy
- Preoperative imaging (CT scan)
- Thorough medical examination
- Thorough presurgical planning
- Aseptic environment
- Knowledge of the working equipment
- Dental implant size, shape, and dimension
- Atraumatic and planning surgical procedures
- Incisions in the keratinized tissues
- Limited extent of flap reflection
- No high vertical releasing incisions
- Deep sutures and flap adaptation
- Safety margin of 2 mm between the implant body and any nerve canal
- Duration of intervention no more than 2.5 hours (local anesthesia)
- Strict postsurgical follow-up
Perioperative Complications
Dental Implant Mobility
When primary stability is lacking (horizontal mobility) (Box 48.2), the dental implant may be replaced by a wider and/or longer self-tapping implant. When primary stability is questionable (ongoing rotation after the final tightening), it is sometimes possible to retain the implant with new implant surfaces. In this case, the healing period must be extended. If the dental implant is still loose, it must be removed, and the surgical placement postponed by at least 2 months.
Box 48.2 Factors that may negatively influence primary stability
Overworking of the Implant Bed
Prevention
- Sequential and controlled drilling
- Use of osteotomes in conjunction with drilling
Poor Bone Quality (Class IV)
Prevention
- Use of imaging (CT scan) to determine the regional bone quality
- Use of self-tapping implants dedicated to poor bone quality
- Underdimensioned bed preparation
Implant Placement in Fresh Extraction Sockets
Prevention – see Chapter 27
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