Diet and Implant Complications

Figure 1. Preoperative radiograph of the first molar site shows a well-pneumatized sinus, limiting available bone volume. Figure 2. A scintered (5 mm × 7 mm, Innova) implant was placed with an osteotome sinus-floor elevation technique. An amount of new bone formed, the abutment was placed, and the definitive crown was placed. There was a large implant fixture to crown ratio, and the patient followed a raw vegetable diet. The implant failed under the occlusal load 6 years later. The amount and/or quality of native and formed apical bone were inadequate to support the dietary occlusal load. Figure 3. The (5.7 mm × 10 mm, Implant Direct) implant was replaced with an osteotome sinus-floor elevation technique and has had uneventful function for 6 years. The bone surrounding the large-diameter fixture is apparently adequate to resist the dietary occlusal forces. Figure 4. A long span (4 unit) fixed partial denture was supported by 2 implants. The patient has a 1200 N bite-force capability, and the anterior implant failed early under the load. Figure 5. The failed implant was removed, the site debrided, and a larger diameter implant immediately placed. Figure 6. A definitive fixed partial denture was fabricated and cemented. It has been in function uneventfully for 2 years. Figure 7. After 12 years of function a single implant body fractured. The patient has had a daily popcorn consumption habit for decades.

Figure 8. The osseous collagen polymer allows for minor molecular interpolymeric bond breakage thereby preserving the main chain and allowing bone to “stretch.” The interpolymeric bonds can break leaving the main polymeric chain intact. This gives bone a toughness and an ability to not completely fracture under load. This is characteristic of a greenstick fracture. Figure 9. A lateral force causes a rotation of the fixture around a point near the platform. When there is adequate osseous support, no appreciable movement occurs. The bone resists the compressive, shearing, and tensile forces, and the fixture does not move. Figure 10. Thin facial cortex or poorly calcified grafted bone allows the implant fixture to move under a lateral force, thus causing a luxation and subsequent interstitial hemorrhage and epithelial down-growth. Figure 11. When the osseous cortex is thick there is better resistance to loading. When there is a thin cortex there may be a risk for a late failure under load.