The lifespan of implant treatment depends not only on surgery but also on the planning and care of the prosthetic structure on top. In the literature, prosthetic complications are classified separately from surgical complications (Resnik & Misch, 2018; Sadid-Zadeh et al., 2015).

Commonly reported problems

• Screw loosening or fracture
• Porcelain fractures (chipping)
• Problems related to cementation; outcomes of cemented and screw-retained restorations have been evaluated in a systematic review (Chaar et al., 2011)

Frequency and risk factors

The frequency of complications varies with studies; private-practice results and risk factors have been reported (Kourtis et al., 2004; McDermott et al., 2003). As the observation period gets longer, the likelihood of prosthetic problems can increase (De Boever et al., 2006).

Prevention

• Correct planning and bite (occlusion) adjustment
• Night guard (if clenching/grinding)
• Regular check-ups and cleaning around the implant (see implant aftercare)

Types of prosthetic structures and their risks

A single crown, bridge or denture can be made on an implant. Each structure has its own advantages and risks. While screw loosening or porcelain chipping is discussed more often in single crowns, load distribution and cleaning difficulties can come to the fore in large bridges and dentures (Sadid-Zadeh et al., 2015).

Difference between cemented and screw-retained restorations

Screw-retained restorations can be removed, which can make maintenance and repair easier. In cemented restorations, the risk of cement residue around the implant is discussed. Systematic reviews report that both methods have their own complications (Chaar et al., 2011). The choice is made according to the angle of the implant, the aesthetic expectation and the dentist’s preference.

What is done if a complication occurs?

• Crown loosening: Contact the clinic without forcing it; the screw can be tightened or replaced.
• Porcelain chipping: Polishing, repair or renewal is planned according to its size.
• Denture problems: Maintenance is done for attachment wear or fracture.

Long-term follow-up matters

Long-term follow-up studies have shown that prosthetic complications increase over time (De Boever et al., 2006); therefore regular check-ups, bite adjustment and cleaning around the implant should be part of the plan. The frequency and risk factors of surgical and prosthetic complications have also been examined in private-practice data (Kourtis et al., 2004; McDermott et al., 2003).

Frequently asked questions

What should I do if the crown loosens?

Contact the clinic without forcing it.

Can a porcelain fracture be repaired?

Polishing, repair or renewal is planned according to the situation.

Do these problems occur in every patient?

No; risk varies with the person and the plan.

Is screw loosening dangerous?

It is not harmful but causes the crown to move; early visit is important.

Is porcelain chipping common?

Frequency varies with the study; measures such as a night guard can reduce the risk.

Does a complication make you lose the implant?

Most prosthetic problems affect the prosthetic part, not the implant; however, the health of surrounding tissue should also be monitored.

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References

• Resnik, R. R., & Misch, C. E. (2018). Misch’s avoiding complications in oral implantology. Elsevier.
• Sadid-Zadeh, R., Kutkut, A., & Kim, H. (2015). Prosthetic failure in implant dentistry. Dental Clinics of North America, 59(1), 195–214. PubMed ↗
• Chaar, M. S., Att, W., & Strub, J. R. (2011). Prosthetic outcome of cement-retained implant-supported fixed dental restorations: A systematic review. Journal of Oral Rehabilitation, 38(9), 697–711. PubMed ↗
• De Boever, A. L., Keersmaekers, K., Vanmaele, G., Kerschbaum, T., Theuniers, G., & De Boever, J. A. (2006). Prosthetic complications in fixed endosseous implant-borne reconstructions after an observation period of at least 40 months. Journal of Oral Rehabilitation, 33(11), 833–839. PubMed ↗
• Kourtis, S. G., Sotiriadou, S., Voliotis, S., & Challas, A. (2004). Private practice results of dental implants. Part I: Survival and evaluation of risk factors—Part II: Surgical and prosthetic complications. Implant Dentistry, 13(4), 373–385. PubMed ↗
• McDermott, N. E., Chuang, S.-K., Woo, V. V., & Dodson, T. B. (2003). Complications of dental implants: Identification, frequency, and associated risk factors. International Journal of Oral & Maxillofacial Implants, 18(6), 848–855. PubMed ↗

Note: Book chapter references follow the page ranges of the publisher’s edition; article links open the matching PubMed record.

This article is for information only and is not medical advice. See your dentist for diagnosis and treatment; no outcome is guaranteed.

This page was reviewed by Dr. Dt. Mehmet Fuat Bozaba, periodontist.