Interview with Dr Tabanella
Nobel Biocare: Dr. Tabanella, what are the most common causes of mistreatments or treatment failure?
Dr. Tabanella: “At our clinic, we have seen that around one-third of complications are related to endodontic failures; one-third are related to periodontal failure or mistreated periodontal disease; and one-third are due to implant failures, which includes surgical, biomechanical and prosthetic failures. These are the three main reasons for re-treating patients.”
What makes those cases so challenging to re-treat?
Dr. Tabanella: “First of all they may be associated with biological limitations. For example, when there is loss of the periodontal ligament of the neighboring dentition, the blood flow may be reduced for bone augmentation. Limitations such as this make re-treatment difficult.
Another limiting factor is the psychological aspect of these patients. They want to be re-treated but have lost trust in the medical profession.
Also, we are seeing an increasing demand for a reduced healing time as well as a minimally invasive approach in tissue regeneration or repair. This is why we have introduced a buccal pedicle flap technique to boost the peri-implant mucosa without the need of multiple connective tissue (CT) grafts. Furthermore, if an ailing implant needs to be removed, the surgical approach has to be gentle enough to allow the placement of a new implant without disrupting the alveolar bone. To help achieve this, we increasingly now use a resorbable collagen membrane like creos xenoprotect in addition to the new flap design.
What are the most important considerations for decision making of re-treatment cases?
Dr. Tabanella: “First of all, patient compliance. We often deal with patients who have lost trust in dental treatment, and we need to regain that trust to at least some degree. Even though they really want to be treated, they may still be reluctant at the same time. So patient compliance becomes a priority.
We also have to assess the risk of treating these patients. We need to define the factors for success – the predictors of peri-implant bone loss, for example – which need to be evaluated prior to treatment commencing.