Mohanad Al-Sabbagh, DDS, MS, Editor

The concept of osseointegration, introduced by Brånemark, has revolutionized the clinical practice of dentistry. Because studies have documented their predictability and successful long-term outcomes, dental implants are rapidly becoming an alternative to traditional prostheses and are one of the preferred treatment options for replacing missing teeth in both partially and completely edentulous ridges. Dental implants are a viable alternative for many patients in need of a dental prosthesis and are widely accepted in the field of dentistry because they provide the tripartite objective of function, esthetics, and comfort.

The implant industry has greatly advanced, and new dental implant systems have been introduced into the market. We have seen a huge increase in scientific knowledge about the biological and biomechanical factors associated with implant success. In recent years, the development of bone regeneration and sinus lift procedures and the evolution of implant surface characteristics have made implant therapy one of the most important treatment solutions in contemporary dentistry.

Although dental implants have improved the quality of life of many patients, a wide body of literature has reported their associated morbidity. Studies have also documented the association of complications with surgical implant procedures and prosthetic rehabilitation. Management of complications can be challenging and often requires a combination of surgical and prosthetic approaches.

The current issue of Dental Clinics of North America blends knowledge gained from clinical experience with knowledge obtained from the current body of dental literature to establish therapeutic guidelines for preventing and managing implant-associated complications. Through this effort, we aim to assist clinicians in identifying and treating undesirable presurgical, intrasurgical, and postsurgical problems associated with implant placement. In these 13 articles, we have attempted to describe and suggest management options for all of the reported implant complications. This issue is designed to serve as a guide for the thought processes involved in clinical decision-making so that dental practitioners can not only prevent complications but also manage them when they occur.

The article by Drs Al-Sabbagh and Bhavsar summarizes current knowledge about biological, biomechanical, and bacterial factors that have been linked with, or that contribute to, implant failure. Measures for determining the probable etiological factors that can facilitate appropriate treatment methods aimed at saving failing implants are also reviewed.

The next article, by Drs Dawson and Jasper, examines the evidence for systemic, environmental, and genetic risk factors associated with the failure of dental implants and with perimucositis and peri-implantitis.

Drs Yepes and Al-Sabbagh review current knowledge about the accuracy of cone-beam computed tomography (CBCT) for the short-term and long-term evaluation of implant health. The authors also review the use of CBCT in assessing implant placement and detecting implant failure as early as possible. They also discuss the advantages of CBCT over other imaging modalities for evaluating implant placement.

The article by Drs Camargo and Van Sickels elucidates some of the more common and a few of the more severe surgical complications that can occur during or shortly after the surgical placement of dental implants. The article also emphasizes the prevention and management of such complications.

Drs Al-Sabbagh and Kutkut address surgical exploration and the recommendations for osteotomy preparation for immediate implant placement. The authors also propose guidelines for immediate implant placement, provisionalization, and loading, as well as the prevention of complications associated with immediate implant placement.

The article by Dr Fugazzotto and coauthor provides a clinical decision-making protocol aimed at preventing the intraoperative and postoperative complications associated with sinus lift procedures and bone augmentation of the posterior maxillary ridge before dental implants are placed. The article also provides some guidelines for the management of such complications.

Dr Al-Sabbagh and coauthor review the documented association of sensory disturbances with the surgical implant procedure and the development of chronic persistent neuropathic pain and neurosensory disturbance. The article also describes the basic anatomy and pathophysiology associated with nerve injury. Moreover, it discusses the cause and diagnosis of persistent pain after implant placement.

The companion article by Dr Al-Sabbagh and coauthor provides insights into the prevention of nerve injury and the management of patients who report persistent pain long after the normal healing time for dental implant procedures has passed. The authors discuss both pharmacologic treatment and surgical nerve repair of such injuries.

Dr Romanos and coauthor provide information about various proposed therapeutic interventions for the management of peri-implant diseases and suggest guidelines for the management of peri-implantitis. The authors also address the cause of peri-implant diseases and the risk factors associated with these conditions.

The article by Dr Emecen-Huja and coauthor provides an overview of the microbial species found around healthy and diseased implants. It also discusses the biomarkers found in oral fluids that are related to the underlying biological phases associated with disease progression and failing implants.

Dr Sadid-Zadeh and coauthor review indexed publications related to the technical and mechanical prosthetic complications accompanied with implant-supported single and partial fixed dental prostheses.

The article by Drs Vahidi and Pinto-Sinai focuses on mechanical complications and failures associated with implant-supported overdentures and implant-supported removable partial dentures. The authors also provide some insight into the prevention and management of such complications or failures.

Finally, Drs Fuentealba and Jofré review some indices that determine the esthetic success or failure of implant-supported crowns. The article also reviews the more common pink-tissue esthetic failures and the less common white-tissue esthetic failures. It discusses the factors involved in these failures and their prevention and management.

Because our understanding of implantology is increasing and the biomedical literature is voluminous and constantly expanding, our knowledge is in a continual state of flux. The increasing volume of scientific literature makes it extremely difficult for busy clinicians and academicians to keep up with their professional reading. This difficulty is complicated by the fact that all clinicians have a responsibility to keep up with general medical advances, not just those related to their own specialty (if for no other reason than the ever-increasing array of drugs taken by our patients). This issue of Dental Clinics of North America can serve as a resource in clinical matters for our readers.

It is the editor’s goal to provide readers with a systematic method of assessing the complications associated with implant placement or restoration, to offer guidelines for selecting the most appropriate management method for dealing with specific complications, and to present suggestions for preventing surgical or restorative complications. Because of the clinical emphasis of the 13 articles presented in this issue, they should be of immense value to our readers.