Dental implants can be a very wise decision, particularly when you face imminent tooth loss or if you deal with the discomfort and loss of self-esteem that can accompany life with missing teeth.
Compared to other tooth replacement solutions such as dentures and bridges, dental implants are stronger, more natural-looking (and feeling), and more comfortable. In the long run, quite possibly more affordable, too.
Yet, as an implant dentist, a common question posed by my patients is this: “Is there a chance my dental implants could fail?”
Dental implant failure is a relatively infrequent circumstance. In fact, most accredited dental journals report a mere 3%-5% failure rate. However rare, implant failure can occur immediately following implant placement or even many months afterward.
What Can Cause Dental Implant Failure?
There are 4 types of dental implant failure:
1.Surgical Implant Failure – Dental implant failure is considered a surgical failure if it occurs within the first four to five months of insertion (before any restoration, be it temporary or final, is placed). Surgical failure occurs when an implant does not intimately heal with surrounding bone during the process known as osseointegration.
The causes of surgical implant failure are varied and include the following:
- Surgical technique of the dentist placing the implant.
- Inadequate bone in the implant site.
- Infection during wound healing.
- Compromised health of the patient such as poorly-controlled diabetes, advanced osteoporosis, compromised immune system, or frequent tobacco use.
- Allergy to titanium can lead to implant rejection (although this is very rare).
2. Early Dental Implant Failure – Early implant failure occurs within the six to eighteen-month period after the final restoration has been placed. Most frequently, early implant failure is related to excess forces being placed on the supporting implant. Excess forces can occur:
- If a patient’s bite is not properly refined.
- If the implant design or size doesn’t offer enough support for the replacement. tooth or teeth. (An example of this would be if a dentist used too small an implant to replace a molar, which is a big tooth that is subjected to a lot of chewing forces.
- If there wasn’t sufficient implant support provided – namely if there weren’t enough implants placed, the implants were too small, or they were not positioned in such a way as to “carry the load” of mastication (chewing). This is more common with complex restorations such as full upper or lower teeth replacement.
- If infection spreads from a neighboring tooth caused by a “dying” nerve, a failed root canal, or gum disease.
3. Late Dental Implant Failure – Understanding that dental implants are not immune to the biological and biomechanical processes that occur over time. Implants are placed to replace the roots of missing natural teeth. And, while the success rate of dental implants exceeds 95%, an implant still resides in the same environment as its predecessor, the natural tooth.
Implants occupy living tissue (gums and bone) in the oral cavity. It is a warm dark wet environment teeming with bacteria. These are the same bacteria that cause gum disease and can compromise the well-being of long-standing implants. Good oral hygiene, including proper and regular visits to the dentist, is paramount to the health of a dental implant.
Implantitis is a bacterial infection that can cause bone loss, and if left untreated can lead to implant loss. Trauma, bad occlusion, parafunctional habits like clenching and bruxism, smoking as well as poor medical health impact the long-term health and prognosis of an implant.
While implants are intended to last indefinitely, forever is a long, long time.
4. Obsolete Implant Techniques – Dental implant technology and materials have advanced significantly in recent years. This advancement has led to fewer and fewer implant failures. However, some dentists have yet to adopt the new technology because of the expense and training involved.
Here’s how to detect implant failure:
4 Signs of Dental Implant Failure
1.Your Implant Seems Loose – One of the main reasons patients opt for implants is because they feel so real. When an implant is appropriately placed in an area well-suited to receive it (i.e., there is adequate bone and healthy gums), you won’t even notice it’s there. But, if an implant has begun to feel wiggly or loose, you have a problem.
What often feels like a loose implant is actually a loose abutment screw. An abutment screw is what attaches the crown to the implant. Your dentist can tighten the screw and restore the stability of your implant.
If unaddressed, a loose screw can break, or even worse, your implant itself can break. (Although rare, a loose implant can also lead to infection, bone loss, and damage to your adjacent teeth and other implants).
2. You’re Having Trouble Biting and Chewing – If you feel pain or discomfort in the implant area when you bite or chew, dental implant failure could be imminent. You’ve invested significant time and money (as has your dentist) to be able to enjoy food again!
If you experience a problem, reach out to your dentist immediately and explain what’s going on. The implant you save may be your own.
3. Your Gums Are Red And Inflamed – It’s perfectly normal to experience some swelling and discomfort in the days immediately following implant placement. After all, it is a surgical procedure. However, if your gums remain inflamed and the discomfort doesn’t wane, you may have an infection.
If left untreated, this infection can become very serious. In some situations, a dental implant must be placed deeper in bone than the roots of its natural predecessor. Because of this, an untreated infection can spread to deeper tissues and create a pathway for bacteria to travel easily.
If you display signs of an infection (pain, swelling, or pus), it is critical to see your dentist immediately, and you will likely be put on a course of antibiotics and anti-bacterial mouthwash. On rare occasions, your dental implant may need to be removed and then replaced at a later date, after the infection has been resolved.
4. You Have Pain Long After The Procedure – For a few days after an implant is placed, it’s normal to experience a little bit of pain that comes and goes. However, if you’re still experiencing pain weeks or months after the procedure, that can be a sign of implant failure. Schedule a visit with your dentist as soon as possible.
To Avoid Dental Implant Failure, Here’s What You Can Do
Although rare, implant failure is most commonly associated with infection.
If you take good care of your mouth, you can avoid infection. Make sure you brush at least twice a day, floss regularly, avoid smoking, and see your dentist at regular intervals.
Note: In my practice, I recommend dental implants only if all the conditions are right.
So, while dental implant failure can occur, I make every effort to minimize the disappointment that comes with it by carefully evaluating my patient and the area which is to receive the implant using modern diagnostic imaging (CBCT), state of the art implant planning software, and proper surgical techniques.
Michael Sinkin practices cosmetic, implant, and restorative dentistry in New York City. He is known for the wonderful care he provides to his patients, and for his wicked sense of humor! To contact Dr. Sinkin, click here.
toby tousley says
I guess I hit the lottery I’m one of the 3-5%. I had an implant installed 5 years ago. I am a 60 year old male, never smoked, do not have diabetes or any other underlying conditions. In the last several months the implant started to hurt when I chewed. I have since had a cleaning, xrays and exam and was told I needed to have the implant removed. I was told the bone is deteriorating on one side of the implant. There is no evidence of infection. I floss and/or water pick faithfully. The hygienist has always told me that I have good dental hygiene. Should I get a second opinion? I have no reason to distrust the dentist but from everything I have read, I am an anomaly. Any thoughts would be appreciated
Michael Sinkin says
While the success rate of dental implants is around 96%, truth be told, the failure rate is not zero. I assume you visit your dentist regularly for periodic examinations and cleanings. What is curious is this: Did the crown loosen at any point? Is the implant fractured? Is the size of the implant appropriate for the size tooth that was replaced?
If you have pain upon biting and have experienced significant bone loss, it could be that the implant does need to be removed. As to whether you should go for a second opinion rests largely with your confidence in your dentist.
I wish you good health!
Michael Sinkin DDS