Table of Contents

1. Introduction

2. Literature Review
2.1 Statements and Recommendations Obtained from the 4th and 5th ITI Consensus Conferences
2.1.1 Proceedings of the 4th ITI Consensus Conference 2008
2.1.2 Proceedings of the 5th ITI Consensus Conference 2013
2.2 Literature Review: Biological Complications
2.3 Literature Review: Hardware Complications and Failures
2.3.1 Mechanical and Technical Risks
2.3.2 Effect of Improved Components on Complications and Failure Rates
2.3.3 Complication and Failure Rates with Cemented versus Screw-retained Reconstructions
2.3.4 Complication and Failure Rates with Metal versus Ceramic Abutments
2.3.5 State of the Art of CAD/CAM-assisted Production of Implant-supported Reconstructions
2.3.6 Overdentures
2.3.7 Survival Rates of Reconstructions Obtained from Systematic Reviews

3. Etiology and Risk Factors: Biological Complications
3.1 Peri-implant Infections
3.1.1 Peri-implant Biofilms
3.1.2 Risk Factors for Peri-implant Infection
3.1.3 Hardware Complications Presenting as Biological Complications
3.2 Non-plaque-related Biological Complications
3.2.1 Complete Loss of Osseointegration and Occlusal Overload
3.2.2 Other Theories for the Etiology of Loss of Osseointegration
3.2.3 Non-plaque-related Oral Mucosal Disorders

4. Etiology and Origin of Hardware Complications
4.1 Materials and Interfaces
4.2 Absorption of Kinetic Energy and Biomechanical Risks
4.3 Hardware-related Complications and Failures
4.3.1 Implant Body
4.3.2 Implant Body/Abutment Interface
4.3.3 Abutment Screw
4.3.4 Abutment Body
4.3.5 Retention of Superstructures: Screw-retained and Cemented
4.3.6 Closure Screws, Healing Abutments, Mucosa Formers
4.3.7 Attachment System for Overdentures
4.3.8 Mesostructures
4.3.9 Reconstruction

5. Management of Biological Complications
5.1 Treatment of Peri-implant Mucositis
5.2 Treatment of Peri-implantitis
5.2.1 Pre-treatment Phase
5.2.2 Non-surgical Debridement
5.2.3 Early Reassessment
5.2.4 Surgical Intervention
5.2.5 Immediate Postsurgical Care
5.2.6 Maintenance
5.2.7 Implant Removal
5.2.8 Concluding Remarks
5.3 Non-plaque-related Biological Complications

6. Management of Hardware Complications
6.1 Hardware Complications
6.1.1 Fracture and Loss of Implants
6.1.2 Unfavorable Three-dimensional Position of the Platform
6.1.3 Complications Related to Abutments
6.1.4 Complications Related to Abutment Screws
6.1.5 Complications Related to Retention
6.1.6 Complications Related to Healing Abutments
6.1.7 Complications Related to Systems for Overdentures
6.2 Superstructure-related Complications
6.2.1 Denture Teeth and Acrylic
6.2.2 Wear and Attrition
6.2.3 Ceramic Chipping
6.3 Iatrogenic Reasons

7. Prevention of Biological Complications
7.1 Prevention of Peri-implant Infections
7.1.1 Treatment Planning
7.1.2 Preparation of the Patient
7.1.3 Preparation of the Recipient Site
7.1.4 Implant Placement
7.1.5 Prosthesis Design
7.1.6 Supportive Care
7.1.7 Diagnostic Monitoring of the Peri-implant Tissues
7.1.8 Frequency of Recall
7.2 Prevention of Loss of Osseointegration Due to Occlusal Overload
7.3 Prevention of Non-plaque-related Oral Mucosal Disorders
7.4 Concluding Remarks

8 Prevention of Hardware Complications
8.1 Prevention of Complications Related to Components and Reconstructions
8.1.1 Implant Body
8.1.2 Implant/Abutment Connection
8.1.3 Abutment Body and Abutment Screw
8.1.4 Third-party Components
8.1.5 Retention: Screw-retained and Cemented
8.1.6 Closure Screw, Healing Abutment, Mucosa Formers
8.1.7 Attachment Systems for Overdentures
8.1.8 Mesostructures
8.1.9 Superstructures
8.2 Risk Management

9. Clinical Case Presentations

Biological Complications:
9.1.1 Iatrogenic Complications Managed by Replacing Prosthetic Components: Non-surgical Approach
9.1.2 Peri-implantitis Treated with Access-Flap Surgery
9.1.3 Excess Cement Resulting in Peri-implant Infection Presenting as a Draining Sinus Tract
9.1.4 Peri-implantitis Modified by Submucosal Excess of Cement: Regenerative Peri-implantitis Therapy and Six-year Follow-up
9.1.5 Peri-implantitis Treated by an Antimicrobial and Regenerative Approach
9.1.6 Recurrent Peri-implantitis Leading to Implant Removal

Biological Complications (Other than Infections):
9.2.1 Removal of a Malpositioned Implant and Direct New Implant Placement with Simultaneous Contour Augmentation using GBR
9.2.2 Oral Lichen Planus Associated with the Peri-implant Mucosa
9.2.3 Peri-implant Carcinoma
9.2.4 Peripheral Giant-cell Granuloma Associated with Peri-implant Tissues
9.2.5 Peri-implantitis Resulting in Bisphosphonate-related Osteonecrosis of the Jaw
9.2.6 Metal Allergy

Hardware Complications:
9.3.1 Management of a Fractured Implant Supporting a Screw-retained Metal-ceramic Restoration
9.3.2 Retreatment of a Patient with Multiple Biological and Technical Complications and Failures
9.3.3 Management of a Technical Complication Caused by a Fractured Zirconia Abutment
9.3.4 Repeated Acrylic Fractures on a Mandibular Fixed Full-arch Implant-supported Metal/Acrylic Prosthesis

10. Etiology, Management, and Prevention of Hardware Complications with Implant-supported Reconstructions

11. Conclusions

12. References

ITI International Team for Implantology
ITI Headquarters
Peter Merian-Strasse 88
4052 Basel

Phone +41 61 270 83 83
Fax +41 61 270 83 84

ITI International Team for Implantology | Peter Merian-Strasse 88 | 4052 Basel | Switzerland | Phone +41 61 270 83 83 | Fax +41 61 270 83 84 |

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