Dental Implant Failures and Dealing with Patient Anxiety

Dr. Michael Sonick is a full time practicing periodontist and implant surgeon in Fairfield, Connecticut. He is also an active teacher, clinical researcher and author. He is a diplomate of the American Board of Periodontology and on the Editorial Board of Contemporary Esthetics and Restorative Practice. He currently is a Guest Lecturer at New York University School of Dentistry in their international dental program and was previously a Clinical Assistant Professor in the Department of Surgery at Yale University School of Medicine.

OsseoNews, Inc. (ON): Dr. Sonick, do you see many implant failures?
Dr. Sonick: No, quite the contrary. I rarely see failing implants among the cases I treat with my referring dentists. Our success mirrors the literature. We have an overall success rate of 97 percent. Our success rate in the mandible is higher, close to 99.5 percent. Most of our failures are in the posterior maxilla. This is attributed to the poor quality of bone in that region and the proximity to the maxillary sinus. However, our success rate in the posterior maxilla is still in the ninetieth percentile.

ON: What do you attribute your high level of success to?
Dr. Sonick: Much of our success can be attributed to good teamwork and meticulous treatment planning. I am fortunate to work with an excellent group of restorative dentists. They are knowledgeable in the restoration of dental implants and produce high quality implant restorations. I am very confident in the longevity of dental implants. In fact, I provide a lifetime guarantee for all the implants I place. With the expense and time involved in this kind of treatment, patients are reassured that if there are problems, I will always be there for them. This “guarantee” gives patients confidence and is most appreciated.

ON: What kinds of protocols do you employ for easing patient tension and making your patients feel more comfortable during the surgical placement of implants?
Dr. Sonick: I place most of my implants under some type of sedation, either oral or intravenous. I have an anesthesiologist (Dr. William MacDonnell) in my office two days a week, who provides IV sedation. We can also deliver antibiotics, steroids and other medications through the IV line. In addition, the patient is well monitored; giving us an added level of security. We are able to do all the necessary treatment in one visit, all the while keeping the patient very comfortable. The patient is at ease and treatment flows more smoothly. Implants are easier to place and there is no patient anxiety. It has been shown that patients who are free from anxiety heal better. In my experience, sedated patients experience less post operative pain, and less swelling and bruising. My patients appreciate this service very much. Most of my patients are going through this procedure because they have had bad dental experiences. Doing something that will last a lifetime in one painless visit is a “wow” experience for the patient. I highly recommend sedation for extensive implant surgical procedures. Patients are extremely satisfied and refer other patients willingly.

ON: What implant configuration has the best long-term prognosis for molars?
Dr. Sonick: The easiest and most predictable design is for one free-standing molar is a wide platform implant. The optimal diameter is 5.0 mm. I believe that the 6.0 mm diameter wide platform is simply too wide for most situations and can result in compression necrosis. Placing two standard (4.0 mm diameter) implants is difficult unless you have about 17mm of mesial-distal space, which you generally do not have. It is also more difficult and costly to restore, for you have two separate or splinted restorations.

ON: Have you seen more success with screw or cement retained implant prostheses?
Dr. Sonick: Both types of restorations are successful. However, in my opinion, cement retained prostheses have many advantages over screw retained restorations. More importantly, cement retained restorations are more user friendly to the restorative dentist. Close adaptation between the components is not as difficult to achieve as with screw retained prostheses. My preference is for screw retained custom abutments with cement retained crowns. Among my referring dentists this seems to be the procedure that yields the most predictable long-term success.