Dr. Lakshmi Sailaja Sistla Discusses Success Rate and Longevity of Dental Implants (Part-1)
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.
She shares insights into her journey, experience as an implantologist, her viewpoint on implant procedures performed by periodontists, prosthodontists, and oral surgeons, evaluation of implant success, assessment of implant osseointegration, clinical and radiological indicators of a successful implant, and managing issues related to implants.
Dr. Tanneru Venkata Lakshmi Sahithi: Can you please introduce yourself to readers?
Dr. Lakshmi Sailaja Sistla: I am Dr. Lakshmi Sailaja. I specialize in Periodontics and practice oral implantology. I work as a Reader in the Department of Periodontology and am the co-founder of Sri Datta Multi-Speciality Dental and Implant Centre. I have been associated with both clinics and academics for eight years after my postgraduation and am an avid implantology practitioner. Additionally, I am trained in Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) by the American Heart Association. I also hold a certification in tobacco cessation from the Pierre Fauchard Academy.
Dr. Tanneru Venkata Lakshmi Sahithi: What made you choose Periodontology as a specialty? What additional procedures can periodontists perform apart from periodontal procedures?
Dr. Lakshmi Sailaja Sistla: The reason for choosing this specialty is that early on during my BDS, I identified my interest in the subject and the immense potential this field had in research. I personally believe that a clinically applicable field backed by research is a great combination.
Conventional periodontal procedures include scaling, surgeries to treat gum diseases, pink esthetic surgeries such as depigmentation of gums, surgical correction of excessive gum display, bone grafting, augmenting lost bone ridges, and procedures to surgically correct gum position.
Modern periodontology also includes the practice of implantology. Since periodontists are well-trained in bone biology and biochemistry, they are among the specialists qualified to practice implantology. With implantology comes other accessory procedures such as sinus elevation and peri-implantitis management.
Dr. Tanneru Venkata Lakshmi Sahithi: What is your viewpoint on implant procedures being performed by a periodontist, prosthodontist, and oral surgeon? Are their approaches to implant placement and management similar, or do they differ?
Dr. Lakshmi Sailaja Sistla: Implantology, by itself, is comprehensive. It requires knowledge of bone biology, surgical anatomy, surgical skills, and principles to restore occlusion. This allows periodontists, oral surgeons, and prosthodontists to be eligible to practice implantology.
Core specialties may influence the overall approach to treatment, but from what I see, implantology must be comprehensive. A prosthodontist may be more prosthetically driven, a periodontist may focus on bone availability and landmarks, and an oral surgeon may focus more on surgical landmarks. However, to be a successful oral implantologist, a balance of all three perspectives is necessary because, ultimately, every specialist aims for a favorable treatment outcome.
That said, a trained oral implantologist may not be influenced by their original specialty when it comes to implants because they understand that implantology is comprehensive, despite being a specialty on its own. That’s the beauty of it.
On a lighter note: "You can take the specialist out of implantology, but not the implantologist out of the specialist."
Built differently, but built to integrate.
Dr. Tanneru venkata Lakshmi Sahithi: What standards do you apply when evaluating an implant’s success?
Dr. Lakshmi Sailaja Sistla: I have a tiered approach when evaluating implant success. I first assess clinical immobility and confirm it radiographically. If bone loss is within an acceptable range, I am satisfied. I also check for any signs of infection, suppuration, or peri-implant tissue health. Next, I evaluate the functionality of the implant to ensure there is no pain or discomfort for the patient. Finally, I consider the patient's overall satisfaction.
I also specifically monitor lifestyle changes the patient adopts to maintain implant health in the long run, as I see this as equally important.
Dr. Tanneru Venkata Lakshmi Sahithi: What is the mechanism in an implant that promotes prosthetic placement? How do you assess osseointegration in your patients?
Dr. Lakshmi Sailaja Sistla: The mechanism that allows an implant to merge stably with the bone is called osseointegration, which is crucial for prosthetic loading. There are many methods to evaluate osseointegration. I rely on clinical evaluation of the ISQ value by RFA and radiographic evaluation using RVG/micro-CT. The ISQ RFA value is a minimally invasive clinical method for assessing osseointegration.
Dr. Tanneru Venkata Lakshmi sahithi: What are the most important clinical and radiological indicators of a successful implant?
Dr. Lakshmi Sailaja Sistla: Clinically, osseointegration can be assessed by tapping the top of the implant— a sharp-pitched sound indicates successful integration, whereas a dull sound suggests poor integration. During the second stage of surgery, while connecting the transmucosal components, a simple mobility test helps assess stability. Before making impressions, when the transmucosal components are tightened with a torque ratchet, a torque of >35 N is desirable.
There are devices available on the market that rely on RFA values, which are ideal if one can invest in them.
Radiographically, the implant should show no radiolucency, and minimal marginal bone loss (1.5–2mm) is acceptable.
Dr. Tanneru Venkata Lakshmi Sahithi: Have you encountered any implant-related issues in your clinical practice? How do you handle them?
Dr. Lakshmi Sailaja Sistla: Yes, some common problems I’ve encountered include smoking-related complications, systemic health issues, implant screw loosening, and peri-implant soft tissue inflammation.
To prevent issues, I focus on proper case selection whenever possible. However, in real practice, ideal scenarios don’t always present themselves. The biggest challenge I’ve faced is with smoking patients— we have had to counsel many patients to quit smoking and prevent relapses.
Crown loosening is another common issue, which is relatively easy to manage. We remove the crown, tighten the abutment screw, and replace the crown. Screw-retained prostheses have helped overcome some limitations.
For peri-implant soft tissue inflammation, I prescribe oral irrigation devices and train patients on their effective use for plaque control.
Abutment selection and inter-occlusal clearance also play a crucial role in prosthesis longevity. I prefer taking impressions with impression posts instead of abutments to avoid repeated tightening and loosening of abutment screws.
