The top five complaints - Implants

Advancements in implant materials, design and surgical techniques have led to dental implants becoming a standard treatment option for tooth replacement. The scientific literature reports high success rates and long-term stability. However, like any surgical procedure, complications can arise during or after dental implant treatment.

The volume of complaints reported to the ADA (SA Branch) regarding implant rehabilitations is reassuringly low. However, reports from other Australian States (where it is possible the uptake and prevalence of dental implant treatment has been greater) indicate the volume of implant-related complaints Australia-wide is high. In some states (such as NSW), the volume of implant-related complaints/claims is alarmingly high and specialists in these jurisdictions are reporting that they are now spending more time dealing with implant complications (and in explanting) – than in the placement of implants.  

So, where does this leave South Australia? The consensus of opinion from presenters at a recent (October 2024) nationwide dental convention was that implants, like all modalities in dentistry, require maintenance, upkeep and eventual replacement. It may be that the avalanche of problems reported in other Australian states is yet to manifest in SA. A prudent clinician will take note of this and be forward-thinking in their treatment planning - making sure patients are prepared at the outset for the inevitable ongoing cost and burden of care which we have good reason to expect will accompany their implant journey. 

Key take-away: Patients should not be advised that their implants will last a lifetime but given realistic advice to help set expectations around ongoing maintenance requirements. Patients should also understand the likelihood of implant componentry (including the superstructure or crown) requiring replacement.  Simple patient factsheets can be sourced at: Dental Implants | teeth.org.au

What can we learn from SA complaints data?

In this analysis of complaints relating to implant surgeries in SA, failures which occurred during the first 12 months were generally assessed as being operator-related. Many cases included elements of poor patient selection (periodontally compromised, medically compromised, smokers, poor dental hygiene, psychologically compromised). Complaints arose because the implants either fell out (or failed to integrate), could not be restored or where the surgery caused damage to adjacent structures. In summary, the general contributing factors included:

• The patient’s habits and their past and present medical and medication histories
• The quantity and quality of bone available.  For the placement of implants, the gold standard requires the use of pre-operative 3D imaging.  
• Surgical complications – paraesthesia, haemorrhage, fracture of the alveolus, devitalisation of adjacent teeth, inhalation/ingestion of components.
• Implants unrestorable – unable to load to the final positions of the prosthetic components.
• Unrealistic patient expectations - due to media/promotional material/advertising. 

High survival rates of the prosthetic componentry is important for the overall success of implant treatment, as failure of the prosthesis may result in failure of the entire implant rehabilitation. Complaints related to implant-supported prostheses were not included with this dataset.  However, the issues reported include the need for occlusal adjustments, prosthesis wear, chipping/fracture of crowns, de-cementation of crowns and loosening of abutment screws. Such complications are generally managed well in practice.  

An interesting observation regarding prosthetic complications is that the problems reported appear to be proportionate to the number of implants placed (ie: the more implants supporting the prosthesis, the more likely there will be prosthetic complications).  It has been postulated that, in part, such treatment failures can be attributed to occlusal factors. Patients loose proprioceptive feedback when their natural teeth and feedback mechanisms from the periodontal complex are lost.  Implants, once they are successfully integrated with bone, do not provide the same level of proprioception and patients will tend to occlude with greater bite force on implant-supported prostheses than they would on their natural teeth.   

Key take-away: Careful planning and treatment execution with excellent (documented) informed consent are key in managing patient expectations and complications when they arise.

Ethical and financial considerations – dentistry has been put on notice.

An article published in JADA in March 2025 by Harrel, SK et al raises ethical considerations in relation to implant treatment - noting there has been an observed trend in extracting potentially salvageable or minimally diseased teeth and replacing these with dental implants.  The authors point to a 2024 news report arguing that such practices are motivated by financial gain (profit) for practitioners rather than by delivering appropriate patient care.

There is an abundance of evidence-based literature supporting successful long-term retention of periodontally- or endodontically- compromised teeth and, prior to treatment, patients should be fully informed of all available treatment options applicable to their situation – including those that preserve their natural teeth. Extraction of teeth is, after all, an irreversible procedure and it is relevant to consider the patient’s journey as they transition into old age.  Medically compromised, frail and elderly patients may find rectification surgery challenging if they experience complications with their implant treatment in later life.  

Key take-away: Alternate treatment options to replace one or more missing teeth can include no treatment (leave a space), dentures (tooth or tissue supported) or fixed bridgework. Each treatment modality has advantages and disadvantages which should be considered at the outset and discussed with the patient.

Early release of superannuation (ERS)

In Australia, we have seen an increase in patients accessing funds through the Compassionate Early Release of Superannuation for their dental treatment.  Often, such applications are for high-end and expensive treatments such as fixed prosthodontics and implant treatment.  The dental regulatory authorities (such as Ahpra and the Dental Board) have issued a caution to practitioners that providing misleading information to support a patient’s request to draw from superannuation is potentially grounds for the Board to consider disciplinary action. The Board further indicates that any regulatory action against practitioners would be in addition to any action that the ATO may deem necessary.   

ADA resources on ERS include:

• Webinar: https://portal.ada.org.au/watch?videoId=924
• News article: Compassionate Early Release of Superannuation | South Australia
• Position paper: Resources | Australian Dental Association

The ADA Federal President, Dr Chris Sanzaro, makes the Association’s position clear: “The ADA believes it is unacceptable for any practitioner to exploit vulnerable patients by encouraging them to access their retirement savings…. for procedures that fall outside appropriate clinical indications.”

What to do if you receive a complaint

For confidential peer support, advice and assistance, please don’t hesitate to get in touch with your branch Peer Advisor. The service is free, confidential and supportive – the aim is to help, advise and guide you whenever a clinical or patient problem arises.

References:

Implant success and survival rates in daily dental practice: 5-year results
Beschnidt S.M, Cacaici C, Dedeoglu K et al: International Journal of Implant Dentistry: volume 4 2018

Long term implant survival and success: a 10-16 year follow-up of non-submerged dental implants:
Simonis P, Dufour T and Tenenbaum H: Clinical Oral Implants Research: volume 21, issue 14, PP 772-777) July 2010

Survival and complications: A 9- to 15-year retrospective follow-up of dental implant therapy:  Adler L, Buhlin K and Jansson L, Journal of Oral Rehabilitation, volume 47, issue 1, pp 67-77. 2020

Assessment of Complications in Dental Implant Surgery
Guruprasad Y.[1],   Ibrahim M.[2],   Singh K.[6],  et al  Journal of Pharmacy & Bioallied Sciences 
volume 16 issue Suppl 3 pages S2437-S2439 July 2024
(First published: 2024)

Patient assessment and diagnosis in implant treatment – Zitmann N, Margolin MD, Weiger R, Krastl, G: Australian Dental Journal 2008; 53:(1 Suppl): S3-S10

Exotic encounters with dental implants: managing complications with unidentified systems – Mattheos N, Schittek Janda M: Australian Dental Journal 2012; 57: 236-242