Informing Patient of Implant Failure?

I am a periodontist that places about 400-500 implants per year and when it occurs I just suck it up and redo the procedure. I can't imagine it is any different than having a restoration or endo go south. If you do the procedure you own it regardless of your specialty.

I wonder when a hip replacement fails, it is replaced by the orthopedic surgeon gratis. Everything we do will fail, and when they do , it is a new problem in a new unit of time. Depending on the time frame, if it fails after 5+ years, I reassess and author a new treatment plan. We do our best, and when any dental procedure does not work out well, we do not have to feel we are guilty of any wrongdoing and stress over it. Dental treatment does not come with unlimited warranty. And as stated, everything we do will in time fail. Nothing lasts forever

Make sure to include the risks clearly in the INFORMED CONSENT before surgery so if you have failure it’s not a surprise for the patient .

Re: Hip implants. These do not "fail," these require "revision surgery." I don't know about now, but 20 years ago patients were told, before the first surgery, that they would probably need "revision surgery" in five years, because they would "wear the implant out." I always discuss implant failure at the consultation and pre-op appointments. It's just a simple ‘sometimes they don't work and if it does not integrate we will remove, graft and replace at no charge.' That's not what an MD or hospital would do, but dentists have been using "guarantee" words, i.e. permanent crown or cement, etc., for so long that it is part of the public's expectation. I also tell them that after it is restored, it should last for awhile, but that depends on a lot of factors. "After all, you were able to mess up you own teeth, and God made those. I'm good, but not that good." Then what happens . . . . depends. A good patient who has kept all their appointments and had other work done, if it "fails" even awhile after the implant was restored, I may place a bridge, or re-do the case, at no charge. For the others, if I want to give them a break, I'll do it for "just the implant and lab fee" which just happens to be about 80% of my regular fee. So I cut my profit margin by 50%, from 40% to 20%, but avoid hassle, bad talk and an angry patient.

Great question. There's no right or wrong so I'll ramble some thoughts. Assuming you've treated state of the art i.e. done a risk assessment (smoking, diabetes etc.), given informed consent, taken care of all infections prior to implantation, carefully treatment planned considering implant position in the bone relative to the tooth, occlual factors and anatomy of the restoration, use of CT scan and computer guided planning and placement, use of new burs and plenty water cooling etc., then your conscience is clear that you've done your best. In such a case you owe the patient nothing more than some empathy, look them in the eye and tell them like-it-is, plan the next stages from scratch and move on. Having said that I asked a dentist working for a malpractice company the same question once and she answered that" it's best just to redo it and stay out of trouble ". What ballony! I think she was just trying to avoid a legal case to prevent a settlement which costs the insurance company money. Few cases go to trial. It's too risky. There's a difference between justice and the law so they opt for settlements and avoid judges. I think take every case on its merits/demerits (If there's such a word). If it failed in first healing prior to uncovering and restoration, consider redoing at no cost or just expenses as a gesture. If it fails later, consider the case, time spent and decide what your conscience wants , remembering that you did your best and it's not your fault. What you decide is your own choice. No-one can give you a right or wrong answer. Hopefully it is rare in your office and not the norm. Even from the failures you will learn and get better. I hope the above thoughts help.

I am in agreement with Peter and Dan. I feel the dental community over the years has oversold itself to the point of being ridiculous. There is “painless dentistry “ = ridiculous (in fact if patients ask me if I am painless, I laugh and say NO, are you serious.?They usually laugh back and say at least you are honest). Any treatment we do is supposed to last “forever” = ridiculous. The medical community is unapologetic about failures. If a joint replacement fails, it not considered the surgeon’s or the device’s fault, it is just the best that can be done. Medical devices fail. That’s just reality. I believe it is a real problem in the dental community where we are overpromising specific results. Personally, on my consent form, I delineate that if an implant fails during the integration process, I will replace it at no cost. After one year, up to five years, I charge 50%. After five years, there are no discounts.

I agree with Dan totally but you must ensure that your consent fully explained the risks. The best consent documents also include the financial implications of problems that may arise and any additional costs that may be incurred if implants fail. Then look at your clinical records and surgical technique as though through the eyes of a litigation lawyer and if you are confident that you cannot be criticised then apply additional charges according to those outlined in your consent. Personally I charge 50% of my initial fee but I make it clear the fees will not be refunded if they choose not to proceed further.

Like any other procedure it is normal that the implant also fail not a big problem but depend on the previou discusion with the patient and i see the patient of implant should be different and should be selected and read the patient mind well before you put the implant inorder to when there is a failure it is not suprise to the patient and i tell the patient that the implant is failure and we try for second time

When explaining the risks involved my mentor would use the analogy of planting seeds. "Twenty seeds are planted in twenty different pots using the same batch of soil. Each are nurtured, watered and exposed to the same conditions. Often, nineteen will germinate and flourish and one will fail. So when there is a failure the problem lies with the seed ( the patient) and not the gardener ( the dentist) Nice explanation.

Implants can fail for many reasons. It’s frustrating when our prosthesis installation techniques expose the patient to unwanted risk factors such as the implant-abutment misfit and the advent of residual subgingival cement. I guess the surgeon may be faced with good will treatment that results from Prosthetic induced complications. I guess that’s teamwork. Shouldn’t we be able to consistently optimize the implant-abutment connection? :-)

Great thread! As with any procedure we do there are going to be failures. I always try to under sell and over deliver. Very clear to let my patients know that 1:20 will fail and I don't not what number they are. I've heard from most attorneys that speak on malpractice, the number one reason a patient takes their case to a lawyer is poor communication.

Appreciating the comments, the original question was about the patient. Dentistry has created the aura that implants do not fail and we are now understanding that it is definitely more than 1:20 or else implantitis management would not be a popular CE course. When a patient loses an implant, their attitude and perception is different losing a tooth from an endo, perio, or restorative procedure. Differences in cost,perceptions of "forever" and salvation come into play. Let's consider more that simple empathy and take a moment and appreciate their perspective especially with Middle Class America.