Periodontics · patient case question
Considering her risk profile, which factor is most strongly implicated in the failure of the implant at site 30?
Patient case: Deep pockets and a rising HbA1c
demo: 49-year-old female
chief: Bleeding gums and bad taste; she has noticed her front teeth are drifting.
history: Type 2 diabetes for eight years, most recent HbA1c 8.9 percent. Smokes half a pack a day. An implant placed at site 30 two years ago has recently begun to feel tender.
meds: Metformin, estradiol.
findings: Generalised probing depths of 5 to 6 mm with bleeding on probing at 62 percent of sites and no acute symptoms. Radiographs show generalised horizontal bone loss and saucer-shaped bone loss around the implant at 30 with bleeding and suppuration on probing.
Show answer and explanation
Correct answer: D. Smoking
- A. Age alone is not a risk factor for implant failure; healthy older patients osseointegrate well.
- B. Surface texture influences the rate of integration, but it does not outweigh smoking and poorly controlled diabetes as a cause of failure.
- C. Oestrogen therapy is not an established cause of implant failure. Antiresorptive agents such as bisphosphonates are the drug class of concern for the jaws.
- D. Correct. Smoking is the single strongest modifiable risk factor for implant failure and peri-implantitis. Nicotine causes vasoconstriction, carbon monoxide impairs oxygen delivery, and neutrophil function and fibroblast activity are both depressed, so wound healing and osseointegration suffer. Her uncontrolled diabetes compounds it.