03 May Implants and Open Contacts: an overlooked issue
Dr Pasquale Venuti
I have been experiencing over the years two major complications with implants:
- open contact
- relative intrusion
Whilst relative intrusion is mainly an aesthetic concern, the open contact is a biological concern, because – owing to the food impaction – it increases the risk of caries of adjacent teeth, especially in patients with high caries risk profile (and often implants are placed in patient who have lost their own teeth owing to caries activity) and it can promote damage to the soft tissues and bone among the implants and the adjacent teeth.
We know from the anthropological studies that during life of homo sapiens, for compensating the occlusal and interdental wear, evolution has selected 3 main mechanisms:
- mesial drifting of posterior tech
- continuous eruption
- distal tipping of anterior teeth
Of course implants cannot move – because they are oseeointegrated – and cannot participate to these mechanisms. The adjacent teeth will move independently by them. Indeed, is more frequent to have the diastema on the mesial side of the implant rather than on the distal side (in consequence of the mesial drifting of the posterior teeth).
In my clinical practice the rate of open contact among implants and natural teeth at 10 years follow-up is around 80%. In literature the loss of interproximal contact is reported to be around 50%. This event is reported to occur as early as 3 months after prosthetic rehabilitation.
It is, therefore, paramount to continually monitor our implant patients at follow-up visits and to inform the patient of this side effect.
- Statistical analysis of the diachronic loss of interproximal contact between fixed implant prostheses and adjacent teeth. Hidehiro K., et al. Int J Prosthodont 2010:23:535-40
- Implant prostheses and adjacent tooth migration: Preliminary retrospective survey using 3-dimensional occlusal analysis. Wei H. et al. Int J Prosthodont 2008:21:302-304