From the Guidelines
The placement of a dental implant too palatally with exposed threads does not necessarily mean the implant will fail, but it requires prompt evaluation and possible intervention to prevent complications such as bone loss and infection. This situation can lead to plaque accumulation, inflammation, and potential bone loss around the implant, which may compromise the implant's success 1. Exposed threads can be managed with various treatment options, including covering the threads with a bone graft or soft tissue graft, or in some cases, removing and replacing the implant in a better position.
To minimize the risk of complications, it is essential to maintain meticulous oral hygiene, using a soft toothbrush and antimicrobial mouthwash like 0.12% chlorhexidine twice daily, and avoid chewing on that side. The success of an implant depends on several factors, including the amount of bone-to-implant contact, primary stability, and absence of infection 1. Even with some exposed threads, if there is adequate bone contact elsewhere around the implant and no infection develops, osseointegration may still occur successfully.
Some key considerations for the management of this situation include:
- The importance of maintaining a gap of at least 2 mm between the implant and the internal surface of the facial bone wall to allow for bone filler and blood clot formation 1
- The use of bone fillers with a low substitution rate, such as deproteinized bovine bone mineral (DBBM), to reduce post-surgical oro-facial bone resorption 1
- The need for a skilled implant surgeon with talent and experience to perform complex surgical procedures, such as flapless implant placement 1
- The potential risks and complications associated with immediate implant placement, including facial malposition of the implant and mucosal recession 1.
From the Research
Implant Failure Due to Palatal Placement
- Implant exposure due to faulty placement is a common reason for implant failure, as seen in a study published in the Journal of international oral health 2.
- The study found that implants placed too close to the buccal or lingual cortex can lead to exposure and failure.
- However, another study published in The International journal of oral & maxillofacial implants found that palatally positioned implants can be a viable alternative for rehabilitation of the atrophied maxilla, with a success rate of 97.8% 3.
Bone Grafting and Implant Survival
- Bone grafting is a well-accepted procedure required in one in every four dental implants, and can help reverse dental bone loss 4.
- A study published in Journal of stomatology, oral and maxillofacial surgery found that preventive antibiotic therapy can decrease the incidence of postoperative infections and improve implant survival rates 5.
- Another study published in Cell and tissue banking found that bone grafts impregnated with antibiotics can be used to treat infected implants in orthopedic surgery, with successful results 6.
Implications for Implant Placement
- The exposure of some threads due to palatal placement does not necessarily mean the implant will fail, as seen in the study on palatally positioned implants 3.
- However, the implant's survival rate may depend on various factors, including the quality of the surrounding bone, the implant's design and material, and the patient's overall health 2, 4, 5.