In this edition of MedBound Times, Himani Negi and Dr. Akriti Mishra speak with Dr. Darshan Parikh, a general dentist skilled in oral implantology. Dr. Darshan Parikh, a graduate of the prestigious Nair Dental College, Mumbai. He maintains a curated boutique practice in the heart of Pune City. A Certified Mastercourse Instructor for the International Training Centre for Dental Implantology, Germany. He is currently the Program Director for IFZI in India, and trains dentists in practical Implantology. A regular marathon runner and sports enthusiast, he believes that correct training is what it takes to get across the finish line.
In the part 5 of this interview series at MedBound Times, conducted by Himani Negi and Dr. Akriti Mishra, Dr. Darshan Parikh breaks down what truly defines a successful implant and shares why long-term care matters just as much as surgery. He also discusses the importance of oral care and options available for patients today for oral rehabilitation.
Dr. Akriti: So, how do you define a successful implant case?
Dr. Darshan Parikh: If you refer to standard textbooks, particularly Carl Misch’s work, implant success has never been defined merely by survival. An implant that remains in the bone for 20 years is not automatically a successful implant. Survival only means the implant is present. Success means the implant has fulfilled the purpose for which it was placed A patient does not come asking for an implant; they come asking for a tooth. If you are able to place an implant and restore it with a functional, aesthetic tooth, that is success. Longevity then adds value to that success, but it is not the sole determinant. From a clinical standpoint, the commonly accepted benchmarks are the 5-year and 10-year checkpoints. If an implant-supported crown is in place at five years, functioning well, without biological or mechanical complications, it qualifies as a successful outcome.
Over time, however, we also recognize that complications can occur at multiple levels. These may include ceramic chipping, screw loosening, or even screw fracture. I have encountered all of these. Such cases cannot be labeled failures by default. The defining factor is whether the complication can be managed effectively. For example, if a patient presents with a fractured screw and you are able to retrieve it, replace the screw, restore the crown, and then maintain stability over the next three to five years, that case should still be considered a success. The ability to manage complications is an integral part of implant dentistry.
If we evaluate success more critically, we also need to consider objective parameters such as the White Esthetic Score (WES) and Pink Esthetic Score (PES). An anterior implant should look like a natural tooth. Merely placing a crown-shaped structure is not sufficient. A “chiclet” crown that does not harmonize with the surrounding dentition and soft tissue is not a successful outcome, even if the patient initially accepts it. Professional success is achieved when peers can evaluate your work and agree that it meets anatomical, functional, and aesthetic standards: when an incisor looks like an incisor and a molar looks like a molar. I have seen cases where an implant crown does not even contact the opposing tooth. In such situations, the implant has failed to fulfill function, regardless of its presence in bone.
True success requires all three pillars to be satisfied: form, function, and aesthetics. When these are achieved and maintained over time, typically five to ten years, the case can confidently be classified as successful.
Implant failures do occur, and they are part of clinical practice. I have personally had failures. In one case, I placed two implants for a friend’s mother. She developed an infection, and we decided to remove the implants. Further evaluation revealed a retained root fragment in an adjacent site as the underlying cause. Because the issue was identified early and managed appropriately, there was no lasting harm. We were able to place new implants a few months later and restore her teeth successfully. For me, that case is a success because the patient ultimately received the intended treatment outcome without long-term damage. Thus, success in implant dentistry also includes how well you handle failures.
Also see: Dental Implants vs Bridges vs Dentures: Dr. Darshan Parikh on How Dentists Decide (Part-3)
Dr. Akriti: What follow-up schedule do you suggest post implant therapy?
Dr. Darshan Parikh: To be very honest, we do not currently have a very rigid or formally documented follow-up policy in place. However, based on discussions with colleagues and established clinical norms, the ideal follow-up protocol after implant placement would include reviews at 3 months, 6 months, and 1 year, followed by annual reviews thereafter. In my clinic, most implant patients are old patients of the practice. They usually return within a year or two for routine oral prophylaxis or general follow-up, even if they are asymptomatic. Naturally, patients who experience any discomfort or concerns tend to report earlier on their own.
Over the last one to two years, we have consciously started formalizing this process. We now explicitly inform patients that although their cleaning or treatment has been completed, they are expected to return within the first year for a follow-up and professional maintenance. For implant patients in particular, we clearly communicate that annual check-ups are mandatory. During these visits, we assess occlusion, soft tissue health, and take a radiograph when indicated. In larger or more complex cases, we may recommend an OPG every two to three years to evaluate long-term bone levels and overall implant health. This shift in protocol is relatively recent, which is why we are now beginning to accumulate meaningful long-term follow-up data.
Ideally, the follow-up timeline would look something like this:
On the day of surgery, postoperative instructions are given.
A short-term review at 2–3 days, if required, to assess healing and manage any immediate concerns.
A visit at 7–10 days for suture removal.
Follow-up during the second-stage surgery, if applicable.
Reviews during the prosthetic phase, depending on the number of steps involved, culminating in crown delivery.
Subsequent recalls at 3 months, 6 months, and 1 year.
Annual follow-ups thereafter.
This structured approach can help us monitor healing, occlusion, prosthetic integrity, and peri-implant tissue health over time, and make the patients realise that implant therapy is not a one-time procedure but a long-term commitment to maintenance and care.
Dr. Akriti: After implant placement, what lifestyle modifications or precautions do you usually advise patients to follow to ensure long-term success?
Dr. Darshan Parikh: Personally, I do not impose too many rigid lifestyle restrictions after implant placement, largely because, in reality, patients tend to forget instructions beyond a point. Immediately after surgery, when they are in pain or discomfort, they remember everything. However, one or two months later, that awareness fades, and two to five years down the line, most patients do not even remember that a surgical procedure was done. In my experience, I do not know many patients who have followed every instruction to the letter over the long term. That said, there are a few key points that we do emphasize. We advise patients to be cautious about biting on very hard substances. Specifically, habits such as chewing bones or extremely hard nuts are discouraged, as these can compromise implants at any stage. We have encountered one or two complications directly related to such habits, so this is something we clearly warn patients about. Apart from avoiding excessively hard foods, we do not place extensive dietary restrictions.
The core recommendations remain fairly straightforward: brushing twice a day, maintaining good oral hygiene, and coming in regularly for professional cleaning and follow-up. These basic measures go a long way in maintaining implant health.
Smoking, however, is an important factor to address. It is well established that smoking is associated with poorer implant outcomes. Having said that, we have had patients who smoke and still show good implant integration and stable long-term results. Despite this, it is essential to clearly communicate the risks associated with smoking. During the consultation and in the consent form, we make it clear that if a patient smokes and a complication arises that can be linked to smoking, responsibility for that outcome does not lie with the clinician. This point needs to be explicitly stated or documented, because patients may not always disclose their smoking habits accurately. Some may choose not to share this information initially, even though it has a direct bearing on treatment outcomes.
Dr. Akriti: For readers who are not from a dental background, what message would you like to share about modern oral rehabilitation and the range of dental treatment options available today for maintaining long-term oral health?
Dr. Darshan Parikh: One important thing for the general audience to understand is that dentistry today has become extremely modern and advanced. We now have multiple solutions for most dental problems which are way more predictable, comfortable, and long-lasting than people imagine. This is why regular dental checkups are so important. This will allow problems to be identified early and help bring the mouth to an optimal state of oral health, rather than waiting for pain or discomfort to force treatment.
The second, and perhaps more important, point is that oral health is closely linked to overall health. Increasing research continues to show strong connections between the health of the mouth and the health of the rest of the body. We often say that the mouth is the entryway to the body, and this idea exists not only in modern medicine, but also in traditional systems like Ayurveda. Proper chewing supports digestion, nutrition, and overall wellbeing. Beyond that, scientific evidence has linked poor oral and periodontal health to conditions such as cardiovascular disease, diabetes complications, adverse pregnancy outcomes like low birth weight, and even neurodegenerative conditions such as Alzheimer’s disease. Many of these links have been known for decades, particularly in relation to gum disease and systemic health, but awareness among the general public is still limited.
Unfortunately, as humans, we tend to neglect our health until something starts hurting. We do not worry about the heart until there is chest pain, or about digestion until there is severe discomfort. Oral health often falls into the same category. It gets ignored because dental problems do not always cause immediate pain. However, that does not mean damage is not occurring beneath the surface. In today’s world, where we are already dealing with challenges such as air pollution, lifestyle-related diseases, and environmental stressors, overall health needs a more holistic approach. Oral health is an important and relatively easy part of that equation to manage.
Simple preventive care, such as a professional scaling once a year comes at a relatively small cost but offers significant long-term benefits. Investing a small amount of time and money in maintaining healthy teeth and gums can go a long way in supporting not just your smile, but your overall health and quality of life.
In this part, Dr. Darshan Parikh reminds both clinicians and patients that modern implant care is not a one-time procedure, but a long-term partnership built on awareness, maintenance, and informed decision-making. In the final part, Dr. Parikh reflects on the lessons that only time and clinical experience can teach, ranging from how implant dentistry is evolving to the mindset young dentists need to build a confident, ethical, and sustainable practice.