Contraindications to Implantology

Contraindications to Implantology

There are certain medical contraindications to implant therapy, as complications that may arise can be serious or even fatal in certain conditions. Contraindications may be classified into three categories:

  • Absolute contraindications: dental implants cannot be considered;
  • Relative contraindications: dental implants may be considered only after a specific problem has been solved;
  • Local contraindications: dental implants may be considered by taking extra precautions regarding problems involving the mouth or jaws.

Here is a non-exhaustive list of the most frequent local, relative and absolute contraindications.  It includes information about the risks of dental implants under these conditions, as well as possible solutions. It is worth noting that only a specialist can accurately assess the eligibility of a patient for dental implants, according to the information collected during the initial consultation with the patient (including known contraindications).

Major allergies

(Specifically to the anesthetic used during surgery)

 

Type: absolute

Risks:

  • Important post-operative swelling;
  • Anaphylactic shock;
  • Death.

Solutions:

  • Finding an anesthetic tolerated by the patient.
  • Finding an alternative to conventional dental implants.

Young age

Type: absolute

Risks:

  • Not enough space to insert the implant in the alveolar bone;
  • Insufficient space for the artificial crown of the implant;
  • Having to redo the procedure when growth is completed.

Solutions:

  • Wait until the growth of the jaws is completed (at the age of 17 or 18);
  • Finding an alternative to conventional dental implants.

Note: An advanced age does not pose problems if the patient is healthy.

Patients with a medical condition requiring organ transplant

Type: absolute

Risks:

  • Post-operative infection due to long-term treatment with anti-rejection drugs that suppress or slow down the immune system;
  • Osseointegration failure.

Solutions:

  • Finding an alternative to conventional dental implants.

Autoimmune diseases like AIDS or patient whose immune system is weakened or suppressed

Type: absolute

Risks:

  • Osseointegration failure.
  • Post-operative infection.

Solutions:

  • Finding an alternative to conventional dental implants.

Osteoporosis and other bone diseases

Type: absolute

Risks:

  • Osseointegration failure.
  • Premature loss of the implant.
  • Fracture of the jaw.

Solutions:

  • Finding an alternative to conventional dental implants.

Cancer

Cancer that is not in remission, has been treated with bisphosphonates or required radiotherapy treatments in the jaw area is a contraindication.

Type: absolute

Risks:

  • Osseointegration failure.
  • Post-operative infection.
  • Altered or slow healing.

Solutions:

  • Cancer with radiation therapy: use strict asepsis during the procedure, under general anesthesia, and work together with the radiotherapy team.
  • Finding an alternative to conventional dental implants.

Cardiovascular disease (e.g.: recent myocardial infarction, valvular disease, heart failure)

Type: absolute

Risks:

  • Death

Solutions:

  • Finding an alternative to conventional dental implants.

Smoking, drug addiction, and alcoholism

Type: relative

Risks:

  • Post-operative infection;
  • Longer healing time;
  • More complex healing process;
  • Decrease in the effectiveness of the immune system to fight gum and bone diseases;
  • Osseointegration failure.

Solutions:

  • Stopping smoking, drinking alcohol or consuming drugs before the procedure, at least a week after and ideally during the convalescence and even beyond

Pregnancy

Type: relative

Risks:

  • Parts of the procedure that can endanger the fetus:
    • use of local or general anesthesia;
    • X-rays.

Solutions:

  • Wait until after childbirth to perform implant surgery.

Uncontrolled diabetes

Type: relative

Risks:

  • Post-operative infection;
  • Onset of periodontal or dental disease;
  • Longer healing time.

Solutions:

  • Managing diabetes;
  • Use strict asepsis during surgery;
  • Take antibiotics before the procedure to reduce the risk of infection.

Illness requiring anticoagulants (blood thinners)

Type: relative

Risks:

  • More abundant and uncontrollable bleeding (during and after surgery).

Solutions:

  • Consult the physician who prescribed blood thinners to see if they can be stopped or changed before and during surgery;
  • Take extra precautions during the procedure to prevent bleeding.

Autoimmune disease (e.g.: lupus, rheumatoid arthritis, etc.)

Type: relative

Risks:

  • Post-operative infection;
  • Longer healing time.

Solutions:

  • Take antibiotics before the procedure to reduce the risk of infection;
  • Use strict asepsis during surgery.

Untreated psychiatric or psychological problems

Type: relative

Risks:

  • Compromised security of the surgeon or the patient during the procedure;
  • Patient dissatisfaction with the final result because of unrealistic expectations.

Solutions:

  • Evaluating the psychiatric or psychological problem to determine if it can be controlled by medication (in collaboration with the patient’s physician);
  • Finding an alternative to conventional dental implants.

Other diseases (e.g.: severe sinusitis, HIV)

Type: relative

Risks:

  • Post-operative infection;
  • Longer healing time.

Solutions:

  • Waiting until the disease is cured, as in the case of sinusitis;
  • Finding an alternative to conventional dental implants.

Lack of motivation from the patient for the treatment and postoperative follow-up

Type: relative

Risks:

  • Osseointegration failure;
  • Post-operative infection;
  • Longer healing time.

Solutions:

  • Making the patient aware of the rigorous discipline required for a successful treatment;
  • Finding an alternative to conventional dental implants.

Insufficient alveolar bone density or volume

Type: local

Risks:

  • Fracture of the jaw;
  • Perforation of the maxillary sinuses;
  • Osseointegration failure.

Solutions:

  • Performing a bone graft or sinus lift before the procedure (healing time varies from a few weeks to a few months);
  • Finding an alternative to conventional dental implants

Insufficient gum quality and/or quantity (e.g.: gingival recession or other periodontal disease)

Type: local

Risks:

  • Post-operative infection;
  • Osseointegration failure;
  • Premature loss of the implant.

Solutions:

  • Performing a gum graft (healing time varies from a few days to several weeks);
  • Treating the periodontal or gingival disease in order to stabilize it or eradicate it;
  • Finding an alternative to conventional dental implants.

Bruxism (teeth grinding or clenching)

Type: local

Risks:

  • Premature damage of the artificial crown on the implant or of the implant itself;
  • Osseointegration failure.

Solutions:

  • Wearing a device to prevent damage to the teeth and implants during the night;
  • Finding an alternative to conventional dental implants.

Unfavourable position of the lower alveolar nerve and other anatomical structures of the mandible

Type: local

Risks:

  • Altered sensation (paresthesia or numbness) in various parts of the face, like the lower lip and chin, as a result of inferior alveolar nerve damage during the procedure.

Solutions:

  • Take extra precautions before inserting an implant in the mandible (use of 3D x-rays and other measurement tools);
  • Finding an alternative to conventional dental implants.

Unfavourable maxillary sinus anatomy

Type: local

Risks:

  • Perforation of the maxillary sinuses.

Solutions:

  • Evaluating the position and anatomy of the maxillary sinuses and taking extra precautions when inserting implants in the upper jaw;
  • Performing a sinus lift;
  • Finding an alternative to conventional dental implants in the upper jaw.

Poor oral hygiene or tooth infection near the site of the implant

Type: local

Risks:

  • Post-operative infection;
  • Longer healing time;
  • More complex healing process;
  • Osseointegration failure.

Solutions:

  • Treating the infection before the procedure;
  • Improving oral hygiene habits before the procedure.

Lesions in the mouth (oral dermatosis)

Type: local

Risks:

  • Post-operative infection;
  • Longer healing time;
  • More complex healing process.

Solutions:

  • Treat the lesions before the procedure;
  • Use strict asepsis during surgery.

Malocclusion

Type: local

Risks:

  • Insufficient space to insert the implant in the alveolar bone;
  • Insufficient space for the artificial crown of the implant due to teeth that have moved towards the toothless space or extrusion of opposing teeth into the edentulous space;
  • Premature wear and tear of the artificial crown on the implant or of the implant itself;
  • Damage to the roots of adjacent teeth.

Solutions:

  • Undergo an orthodontic treatment before the installation of the implant.

Are orthodontic treatments a contraindication to implants?

An orthodontic treatment is not a contraindication to dental implants. However, if a patient with a malocclusion is considering the insertion of dental implants, it is important to consult an orthodontist beforehand. This specialist will determine the best time to proceed with the implantology treatment in order not to impair the orthodontic treatment, as a dental implant cannot be moved with braces.

In addition, an orthodontic treatment may, in some cases, prevent the need for dental implants. The patient will therefore benefit from consulting an orthodontist in the first place!

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