Dental implants are a highly predictable and successful treatment that has revolutionized dental care and improved the lives of millions of people who were missing some or all of their teeth.
According to studies, dental implant surgery boasts a success rate of 95% or better. However, most studies that support such resounding successes are performed in controlled clinical research environments that exclude many of the variables seen in general clinical practice (i.e., the real world).
Implant dentistry is reliably and predictably successful, but some dental implants do fail.
Take me as an example. About a year and a half ago, one of my teeth had to be extracted because it was fractured. The tooth was removed, and a bone graft was placed to make ready for future implant placement. Bone grafts need time to mature and solidify before an implant can be inserted.
After the required six months of healing, my implant was deftly placed by my friend and colleague, Dr. John Como. I know he did a great job because I watched him the entire time with a hand mirror!
After another six months of healing time which allowed the implant to integrate with my bone, it was ready to be restored. By restored, I mean a crown (that looks just like my natural tooth) would be placed, and the space between my teeth could once again be occupied by something more substantial and functional than air. (I did not enjoy missing a tooth – especially with my being a dentist and all.)
So I returned to the office of my good buddy ready to have the implant restored. But as things turned out, that was not to be the case. Dr. Como discovered that the implant had not fully integrated with the bone and in fact had experienced significant bone loss around it. The surgery failed, and the implant was removed, and the area was regrafted. But why did it fail?
Many variables could cause an implant to fail. Here are the most common ones:
6 Reasons Why Dental Implants Fail
1.Poor Bone Quality – Implants fail when something causes the quality and quantity of bone in the area to be compromised, such as:
- Severe gum disease, which can cause bone loss around the missing tooth or teeth.
- Physical trauma to the mouth such as a blow to the face, which can break teeth and damage the surrounding bone.
- Dental infections often negatively impact bone quality.
- Previous dental surgery such as surgical root canal (apicoectomies) or traumatic extractions.
2. Certain Medical Conditions – Certain medical conditions such as uncontrolled diabetes or patients with weakened immune systems caused by chemotherapy or certain autoimmune diseases). Implants do not heal as well as with healthy individuals and are more prone to infection. Unfortunately, such individuals are generally not candidates for implant surgery.
3. Inferior Implant Quality or Improper Implant Selection – Hundreds of companies manufacture implants, and there is a wide variety of styles, shapes, sizes, designs, and materials to choose from. And there is a wide range of quality, as well. No universal implant exists that is appropriate for every clinical situation. Implants fail when they are not the “appropriate fit” for the task at hand.
4. Poor Surgical Technique – Technique is a huge factor in the success or failure of an implant. Proper presurgical planning is critical to ensure success. “Begin with the end in mind” and “Measure twice, cut once” may just be clichés, but they are precepts for success in implantology. Appropriate instruments, sterile techniques, and avoiding unnecessary trauma to the surrounding tissues (gum and bone) are vital for predictable outcomes.
5. Poor Patient Compliance – Sadly, a frequent reason implants fail involves patients that don’t take their doctor’s postoperative instruction seriously. Successful implants rely upon taking the prescribed medications – especially the antibiotics and antiseptic rinses, no smoking, practicing good oral hygiene, and avoiding trauma to the surgical site.
6. Infection – The mouth is loaded with all kinds of bacteria that can cause infection. Even under the best of circumstances post-operative infections do occur and can be caused by any of the above. The good news is if an infection develops, it can often be successfully treated without negatively impacting the implant. However, once in a while an infection leads to its loss.
So why did MY implant fail? My circumstances were ideal
• Plenty of healthy bone
• A superb implant dentist
• Superior implant quality and design
• A healthy patient
• A very compliant patient (that be me).
It should have been a slam dunk, right? Nope.
My implant failure was entirely unanticipated, unexpected, inexplicable, and alas- poor me- undeniable. As I already stated, my implant was removed, the site was re-grafted, and I am now in the midst of another six-month waiting period before the new one can be placed.
After ruling out everything else, Dr. Como and I settled on the theory that I had developed undetected chronic infection. There were no signs, no symptoms – and no bone developed.
As refined as some disciplines of medical and dental surgery have become, as much as our knowledge of wound healing has expanded, there always remains a surgical risk that something untoward can occur even under the best of circumstances. Biology is not always predictable, and it is arrogant to think otherwise. With dental implants boasting a 95% success rate, we can’t ignore the 5% of implants that fail. I fell into that 5%.
In dentistry, as in medicine, no surgery is 100% fool-proof. Complications can arise. But, I have little doubt that my new implant will be successful.
I sure wish I had been in the 95% successful group!
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