Abstract

The success lies in achieving and maintaining the stability of a dental implant. However, implant failures are common and among them the most serious issue is the implant mobility. This paper reviews on the implant mobility, its causes, methods to detect mobility and also possible treatment approaches.

Keywords: implant; implant failure; implant mobility; osseointegration.

Citation: Anil L, Sharma N, Vandana KL. Implant mobility: Revisited. J Clin Images Med Case Rep. 2021; 2(6): 1408.

Introduction

Dentistry has witnessed several changes in the past quarter century. Now that its scientific foundations have been laid, this branch of reconstructive dentistry has passed out of the phase of mere empiricism and sheer wishful thinking. Though the success rates reported with this form of therapy are relatively high, failures do occur. Hence, a thorough knowledge regarding the various aspects of failure is deemed necessary [1]. The longitudinal clinical studies have reported a success rate at 10 years ranging from 81% to 85%, for the maxilla and from 98% to 99% for the anterior mandible [2].

Esposito et al, 1998 have listed out the various criteria for success which were agreed upon at the 1st European Workshop on Periodontology. According to them absence of mobility, average radiographic marginal bone loss of less than 1.5 mm during the first year of function and less than 0.2 mm annually thereafter, absence of pain or parasthesia were to be considered success criteria for osseointegrated implants [3].

The most common diagnostic criteria employed for the evaluation of established implant failures (failed implants) are as follows: [1].

1. Clinical signs of early infection: During the healing period (3−9 months) complications such as swelling, fistulas, suppuration, early/late mucosal dehiscences, and oseteomyelitis, can occasionally be present and may indicate implant failure.
2. Pain or sensitivity
3. Clinical mobility
4. Radiographic signs of failure
5. Dull sound at percussion

Successful osseointegration is a prerequisite for functional dental implants, and primary implant stability is a prerequisite for successful osseointegration [4]. Rigid fixation describes the absence of clinical mobility in vertical or horizontal forces within 500 g. Osseointegration defines the surrounding bone that is in direct contact with an implant surface [5]. Over the years, rigid fixation and osseointegration have been used interchangeably. Today, the term “lack of mobility” may be used to describe implant movement, and is a clinical condition most often used to determine as to whether the implant is integrated.

Even an osseointegrated implant may move less than 75 m but appears clinically as zero mobility [6]. Clinical lack of implant mobility does not always coincide with a direct bone–implant interface [7]. However, when observed clinically, lack of mobility usually means that at least a portion of the implant is in direct contact with bone, although the percentage of bone contact cannot be specified [8]. This paper reviews on the implant mobility, its causes, methods to detect mobility and also possible treatment approaches.

Causes of mobility

Implant mobility can be observed either at the time of implant placement or after few months or years of implant placement. The reasons for this have been described in table 1.

Methods to detect mobility: Historically, the gold standard method used to evaluate the degree of osseointegration was microscopic or histologic analysis [9].

However, due to the invasiveness of this method and related ethical issues, various other methods of analysis have been proposed which includes use of blunt ended instruments, radiographs, cutting torque resistance, reverse torque and resonance frequency analysis (RFA). Table 2 describes the various methods of detecting implant mobility.

Table 1: Reasons for implant mobility.

Table 2: Methods to detect implant mobility

Treatment

In case of a loose dental implant, the only treatment is to immediately remove all components of the implant to avoid the progressive destruction of the surrounding tissues. Removal of the implant may vary according to the implant system and design. Granulation tissue, if any, should be carefully removed before further treatment [10]. The implant can then be reimplanted in adjunct to Guided bone Regeneration which is a routinely applied method in dental implantology.

Surface modifications of Ti implants using oxidation, acidetching, sand-blasting, ion implantation, laser ablation, surface coating with calcium phosphate, etc improves osseointegration. These methods alter the energy, charge and composition of the existing surface, but can lead to surfaces with modified roughness and morphology. Inorganic materials, such as the bioreactive calcium phosphate (CaP) coatings (or HA), have been extensively applied because of their chemical similarity to bone minerals. Several studies have shown that these coatings achieve a very intimate contact between the implant and bone [11,12]. Numerous different biologically functional molecules can be immobilized onto Ti surfaces to enhance bone regeneration at the interface of implant devices. The most promising candidates for osteogenic agents are the members of the transforming growth factor-β (TGF-β) superfamily, such as bone morphogenic proteins (BMPs).Others include polyelectrolyte (PE) multilayer (ML) surface modification involving the alternating adsorption of poly-cations (poly-L-lysine (PLL)) and poly-anions (poly- L-glutamic acid (PGA)) from aqueous solution onto a charged, solid surface.

Apart from all this, proper implant maintenance should be taken care by all the patients for the survival of the implant. Both at home and professional implant care have been summarized in (Table 1) [13].

Conclusion

Predicting the success of implant and advising proper maintenance care lies in the hands of a clinician. Appropriate case selection that is suitable for surgical as well a prosthetic circumstances reduces the clinical challenges. The ability to detect Osseo integration and the survival rate of an implant is a valuable tool in the implant dentistry.

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