Dental implants have become a popular and effective way to replace missing teeth. They are designed to provide a strong, stable foundation for replacement teeth that look, feel, and function like natural teeth. However, like any surgical procedure, dental implants do have the potential for failure. Implant failure is relatively uncommon, with success rates generally over 95% for the initial surgical placement of the implant. However, identifying signs of implant failure quickly is important to avoid potentially complicated and expensive remediation or replacement procedures. This article will cover the most common signs that may indicate a dental implant is failing or at risk of failure.
What is a dental implant?
A dental implant is composed of three main components:
– The implant body or fixture – This is the titanium post that integrates with the jawbone through a process called osseointegration. The implant body effectively replaces the root portion of a natural tooth.
– The abutment – This implant component is screwed into the implant body and connects the replacement tooth to the implant. It extends the implant above the gumline.
– The crown – This is the visible tooth portion that is supported by the implanted root and abutment. It is custom-made to match the natural teeth.
The implant body is surgically embedded into the jawbone, where it fuses with the bone over a healing period of 3-6 months. The other components are then attached to complete the implant. A proper integration between the implant and bone is necessary for long-term success.
Signs of dental implant failure
There are several signs that may indicate an underlying problem with a dental implant:
Persistent pain or discomfort around the implant
Some sensitivity or mild discomfort is normal during the initial healing process after implant placement surgery. However, persistent or unexplained pain, especially when biting or chewing, is a red flag. It typically means the implant has not fused properly with the bone or an infection may be present.
Visible implant mobility
A successfully integrated implant should be firmly fixed in the jawbone, similar to a natural tooth. Any visible rocking, pivoting or other movement of the implant likely means failure of osseointegration. However, it is important to note that minor mobility immediately after implant surgery does not necessarily indicate failure.
Peri-implant bone loss visible on x-ray
Dental x-rays are an important tool for monitoring bone levels around an implant. Loss of peri-implant bone over time may be indicative of progressive implant failure. While a small amount of initial bone loss is expected, ongoing resorption can compromise the implant’s stability and prognosis. Annual x-rays are recommended to monitor implant sites.
Loosening of the abutment
The abutment is tightened into place with an abutment screw. If this screw loosens recurrently and requires re-tightening, it usually means insufficient osseointegration is present to firmly anchor the implant.
Changes in occlusion or feeling of bite
Patients should not notice any difference between the way an implant crown meets their other teeth compared to a natural tooth. Any observed changes to the bite could be a sign of implant failure. Additionally, a general uncomfortable feeling of irregularity indicates a problem.
Receding gums around the implant
The gums around implant teeth should appear full, pink, and healthy. Receding or shrinking gums often occur due to inflammation from bacteria infiltrating a failing implant site.
A loose or ill-fitting crown
Well-integrated implants should be able to securely support the custom crown attached to them. A crown that lacks stability, lifts away from the site, or has a poor fit may be a red flag for implant failure. However, temporary crowns are more likely to loosen.
Chronic inflammatory lesions in the gums
Inflammation, swelling, or pus around an implant site that persists for more than 2 weeks after oral hygiene treatment may indicate infection and failure. This occurs when bacteria penetrate the implant surface, often in a poorly integrated implant.
Formation of a fistula tract
In some cases, the body may form an abnormal channel or fistula from the oral mucosa to the compromised implant in an attempt to drain infection. Fistulas may ooze pus or other fluids and indicate implant failure.
Increased mobility in adjacent natural teeth
If natural teeth next to a failing implant become loose or mobile, it can mean there is advanced loss of bone around the implant that is affecting adjacent teeth. This scenario has a poor prognosis.
A periapical abscess or infection visible on x-ray
Chronic infection around the apex of an implant can lead to bone loss and failure. Symptoms include pain, swelling, and sensitivity to pressure. Diagnostic x-rays may reveal a dark spot around implant apex indicating an abscess or infection. Prompt antibiotic treatment and implant removal is usually required.
Sinus issues, especially when an upper back molar is replaced
Implants placed into the upper jaw sometimes protrude into the maxillary sinuses. Infections or sinusitis following implant placement could compromise integration and lead to failure, especially for back teeth near the sinuses.
Neurological complaints like numbness or tingling
Very rarely, an implant may impinge on or damage a nerve. Resulting neuropathy as evidenced by numbness, tingling, pain, or altered sensations in the face, lips, chin, or tongue could indicate an underlying implant problem or failure. This warrants immediate evaluation.
Risk factors for dental implant failure
Certain factors can increase the risk of dental implant complications and failure:
– Poor oral hygiene leading to gum disease or excessive plaque accumulation
– History of gum disease, tooth loss, or chronic periodontal inflammation
– Medical conditions like uncontrolled diabetes that compromise healing
– Osteoporosis or other causes of low bone density in the jaw
– Heavy smoking, which is strongly correlated with higher failure rates
– Orthodontic tooth movement close to implant sites
– Poor primary stability of the implant due to low bone density
– Inadequate keratinized gingiva (gum tissue) surrounding the implant
– A lack of adequate attached gingiva around the implant-supported crown
– Major parafunctional habits like teeth grinding or clenching
– Ill-fitting restorations or crowns causing excessive bite force
– Premature overloading of the implant before complete healing
– Poor implant positioning or alignment
– Inadequate bone width, length or height at the implant site
– Previous radiation treatment to the head or neck area
– Autoimmune disorders requiring medications that inhibit healing
– Young age, especially during active jawbone growth
– Heavy forces in high stress areas like molar sites
Treatment for a failing dental implant
If a failing or failed implant is detected in time, there are some potential treatment options to try and save the implant:
– Administer antibiotics to treat infection and inflammation
– Perform a soft tissue grafting procedure to protect exposed implant surfaces
– Regenerate lost bone via grafting around the implant
– Surgically clean infected implant surfaces
– Adjust occlusion by altering the crown to prevent excessive biting forces
– Remove, clean, and re-integrate an infected implant through a process called implant debridement
However, if these salvage procedures fail, the implant will need to be removed completely. After adequate healing, it may be possible to replace the failed implant with a new one, either immediately or after regenerating lost bone. Therefore, early detection gives the best chance of being able to save or replace a failing implant.
Preventing dental implant failure
While some risk factors for implant failure can’t be controlled, many steps help avoid problems and improve the prognosis:
– Select an experienced surgeon with advanced implant training and a high success rate
– Have the implant site fully assessed with 3D imaging before surgery
– Ensure adequate bone density and volume for implant placement
– Utilize guided implant surgery techniques for very precise positioning
– Allow several months for complete healing and osseointegration before tooth replacement
– Have crowns, bridges, and dentures properly fitted to avoid excessive force
– Practice excellent oral hygiene around the implants and abutments
– Get regular dental checkups and professional cleanings
– Stop smoking or tobacco use before and after implant surgery
– Avoid alcohol consumption for at least 48 hours post-surgery
– Take antibiotics or disinfectant rinses as prescribed after surgery
– Follow all post-op care instructions carefully to support healing
– Wear a nightguard if grinding or clenching occurs, especially during sleep
Proper implant placement, patient selection, and excellent aftercare give the best results and longevity. But even so, staying vigilant for any signs of implant failure is key for early intervention if issues arise.
Conclusion
Dental implants can be an excellent tooth replacement solution with high long-term success rates. However, implant failure is possible in a small percentage of cases. Being aware of signs like persistent pain, visible mobility, bone loss on x-ray, loose abutments or crowns, infection, altered sensation, or poor fit can help detect problems early when salvage may still be possible. Preventive steps like careful surgical planning, proper osseointegration time, well-fitted restorations, excellent oral hygiene, regular dental visits, and avoiding smoking optimize outcomes. Acting quickly if any concerns arise offers the best likelihood of addressing implant failure and retaining a functional restoration.
