Dr. Lakshmi Sailaja Sistla Talks Success Rates, Failures, and What Lies Ahead (Part-2)
Dr. Lakshmi Sailaja Sistla is a Periodontist and Implantologist. She completed her BDS in 2013 from CKS Theja Institute of Dental Sciences, Tirupati, Andhra Pradesh, India. Later, she completed her MDS in 2017 at SVS Dental College, Mahabubnagar, Telangana, India. She has seven and a half years of experience as a clinician and academician. She is the co-founder of Sri Datta Multi-Speciality Dental and Implant Centre, KPHB Hyderabad. She is currently working in academics as a Reader at K.M. Shah Dental College and Hospital, affiliated with Sumandeep Vidyapeeth (deemed to be a university), Vadodara, Gujarat, India.
Dr. Sailaja is additionally trained in BLS, is ACLS certified by the American Heart Association, and is also a Tobacco Cessation Counselor (PFA).
In this interview with Dr. Lakshmisahithi Tanneru of MedBound Times, Dr. Lakshmi Sailaja Sistla discusses the success and longevity of Dental Implants.
In this interview she shares insights about the soft tissue role in the success of the implant, how occlusions on implants is evaluated, important factors for long term success, how gradual loss of bone is tracked, variations in implant survival rates, how we can handle implant failures, how occasional failures occur and future of Implant dentistry.
Dr. Tanneru Venkata Lakshmi Sahithi: Does soft tissue health play a role in the success of the implant?
Dr. Lakshmi Sailaja Sistla: Yes, peri-implant soft tissue health is extremely important. I'd say that it is the neglected zone. Soft tissue acts as a barrier against the spread of inflammation to the underlying bone. According to me, vestibular spaces and soft tissue attachments (called frenum) around the implant are very important in maintaining peri-implant tissue health.
Another important factor is tissue thickness. When soft tissues around implants are thin and the vestibule is compromised, this can pull the margins of soft tissue away from the implant and accumulate more plaque, which can compromise implant health. Soft tissue health around implants is more sophisticated than it tends to be.
Thinner tissues surrounding implants are also less resistant to infections and inflammation. Such sites recede to expose the implant, which can affect its longevity and function. We have managed such cases with PRF and soft tissue autografts. Soft tissue management and its importance in implants is a very vast area to explore.
Dr. Tanneru Venkata Lakshmi Sahithi: How can appropriate occlusion in restorations supported by implants be evaluated and guaranteed?
Dr. Lakshmi Sailaja Sistla: Occlusion can be considered the lifeline of the periodontium. Peri-implant tissue is less resistant to forces than the periodontium due to its anatomic constitution. Occlusal forces fall directly on the bone, so any prematurities in occlusion or improper contacts can lead to accelerated bone destruction. Proper implant-level impressions can ensure a more accurate recording of the implant’s deeper position, which can guide appropriate loading force through the restoration to the implant.
Avoiding cantilever designs and supporting the prosthesis with a sufficient number of implants in sound bone can effectively help in strain and stress distribution. Bite registration and occlusal record-taking can reciprocate occlusal patterns accurately. In multiple units or complex cases, it is better to go for a facebow transfer. A metal bisque trial can help verify occlusal anatomy and make changes if required at the earliest stage.
Digital impressions can help—they are less cumbersome compared to conventional methods but require proper training. Digital software can assess the occlusal anatomy before final preparations. CAD-CAM milled designs can be more accurate than cast wax patterns and can compensate for potential distortions.
Take-home points:
Digital impressions predict and reciprocate occlusion accurately.
Implant-level impressions provide better spatial positioning of the implant, ensuring improved occlusal design and load distribution compared to abutment-level impressions.
To evaluate occlusion:
Articulating paper
Advanced T-scan (very expensive to own)
Dr. Tanneru Venkata Lakshmi Sahithi: Which elements, in your opinion, are most important for long-term implant success?
Dr. Lakshmi Sailaja Sistla: There are many, but the most important factors for implant success include:
Osseointegration
Atraumatic surgical placement and prosthetic angulation
Choice of abutments to ensure proper stress distribution
Occlusion
Patient factors, habits, and systemic health—mainly smoking, bruxism, and diabetes
Dr. Tanneru Venkata Lakshmi Sahithi: How is the gradual loss of bone surrounding implants tracked?
Dr. Lakshmi Sailaja Sistla: Periodic follow-up and radiographic analysis are important for the long-term maintenance of implants. RVG helps, but CBCT/Micro CT are more reliable to measure the rate of bone loss. A practically pocket-friendly approach is RVG with a grid or IOPA with a grid.
OPG is a no for me, considering the distortion, and it’s a definite no for anterior teeth. A grid is pocket-friendly—it can be secured with the RVG sensor or IOPA film, and even if shortening or elongation of the image happens, the grid also distorts proportionally. CBCT adds to the cost of the treatment.
Dr. Tanneru Venkata Lakshmi Sahithi: Have you noticed any variations in implant survival rates according to surface treatments or implant brands?
Dr. Lakshmi Sailaja Sistla: In my experience so far, I have noticed that case selection, patient maintenance, and surgical skill are more pertinent to implant survival than the brand of implant. However, surface treatments or implant brands do help in some complex cases.
Implant surface coatings, etc., are useful in poor-quality bone. Implant micro-design, like active threads and surface coatings, are good for use in immediate implants.
Dr. Tanneru Venkata Lakshmi Sahithi: How do you handle cases where implant failure occurs?
A: Dr. Lakshmi Sailaja Sistla: Implant failure cases are typically tough to handle. I prefer not to go heroic with treatment outcomes and expectations. I don’t make guaranteed treatment outcome promises.
A failed implant feels like wasted time, effort, and expense to the patient. It’s important to counsel and explain that every surgery has its setbacks, and if a contributing patient factor is identified, we must rectify it. Most failures are avoidable with a transparent treatment plan and a compliant, honest patient.
Dr. Tanneru Venkata Lakshmi Sahithi: What’s the reason behind the success or failure of implants that you’ve noticed in your clinical practice? How often have you encountered occasional failures in your practice or in the hospital sector?
Dr. Lakshmi Sailaja Sistla: The most common reasons for failure, in my opinion, are not respecting bone biology and biophysics, and poor case selection.
Overheating drills and traumatic drilling protocols
Improper abutment and prosthesis selection
Poor case planning—insufficient number of implants and cantilever designs
Poor patient maintenance (systemic health and habits)
For implant success: Proper surgical skills and patient maintenance go hand in hand. Systemic disease is not as concerning as uncontrolled disease. It’s difficult to make sustainable lifestyle choices, and that is one major setback a clinician must focus on apart from surgical skill. The clinician’s best asset, in my opinion, is their ability to talk convincingly but honestly. That is a challenge too. Lifestyle choices are too ingrained and don’t suddenly vanish.
Dr. Tanneru Venkata Lakshmi Sahithi: What is the future of implant dentistry?
Dr. Lakshmi Sailaja Sistla: When we look into the future of implant dentistry—a recent news report about Japanese researchers finding a method to regrow adult teeth has created a buzz. Further research and enough trials are needed for this to be practically implemented. So far, an implant is the best analogous replacement for the root form of a natural tooth—but of course, not the same. The periodontium has four tissues, whereas peri-implant tissues are just two.
Multiple research efforts have been going on for quite some time to regenerate lost periodontal tissues, but the sophistication surrounding periodontal healing has limited their use. The concept of tooth regeneration is unprecedented. It would take some time for that to materialize and be put into practice. Of course, if that happens, it could replace implants—but I see that happening gradually over a long period.
That still gives implants a huge amount of time. For the time being and the unforeseeable future, implants are still standing—and in fact, with great success.
MedBound Times expresses sincere gratitude to Dr. Lakshmi Sailaja Sistla for sharing her valuable insights on our platform.
