Dental implants are a widely used and effective method for replacing missing teeth, offering stability and a natural appearance. While success rates are consistently high, complications can arise that threaten the long-term health of the implant. When a problem develops, the question is whether the implant fixture—the titanium post integrated into the jawbone—can be rescued, a process known as implant salvage. The ability to save a failing implant depends on the underlying cause, the stage of failure, and the surrounding bone health. Recognizing the first indications of trouble is important for preserving the implant.
Recognizing Signs of Implant Failure
A failing implant presents with noticeable symptoms categorized by their timing. Early failure occurs within the first few months following placement, usually before the permanent crown is attached. This is often linked to a failure of osseointegration, where the bone does not fuse to the implant surface, resulting in a lack of initial stability or persistent discomfort.
Late failure happens months or years after the implant has integrated, frequently due to chronic infection or excessive mechanical stress. Common symptoms include persistent pain or throbbing that does not improve after initial healing. Patients may also observe swelling, redness, or bleeding of the gum tissue around the implant, signaling an infection.
Other physical signs include gum recession, which exposes the metal surface, or the presence of pus or discharge. Any perceived mobility of the implant or attached crown is concerning, as it indicates a loss of bone support. Difficulty or pain when chewing can also signal instability.
Assessing the Potential to Save the Implant
Clinical evaluation requires a systematic approach to determine the extent of damage and the prognosis for salvage. Dentists use diagnostic imaging, such as X-rays and Cone-Beam Computed Tomography (CBCT) scans, to precisely measure the level of bone remaining around the implant.
The severity of the soft tissue condition is assessed by measuring the probing depth, which is the distance from the gum margin to the base of the tissue pocket. Increased probing depths, often six millimeters or more, combined with bleeding, are hallmarks of infection. This helps distinguish between peri-implant mucositis (inflammation of soft tissue without bone loss) and peri-implantitis (inflammation combined with destructive loss of supporting bone).
Implant mobility is a fundamental deciding factor for salvage potential. An implant that exhibits noticeable movement is generally deemed unsalvageable because it signifies a complete failure of bone-to-implant fusion. If the implant is stable but bone loss is present, the degree of destruction dictates the treatment path. Mucositis is reversible, and early-stage peri-implantitis is more treatable than advanced bone loss.
Non-Surgical and Surgical Salvage Procedures
Non-Surgical Treatment
For less severe cases, particularly peri-implant mucositis, non-surgical procedures offer a conservative path to recovery. This approach focuses on thorough deep cleaning and debridement of the implant surface, removing plaque and bacterial biofilm from the exposed collar. Localized or systemic antibiotic therapy may be used alongside cleaning to control the bacterial infection. The patient’s commitment to improved oral hygiene is paramount, as poor home care is a frequent cause of infection.
Surgical Intervention
For cases that have progressed to peri-implantitis with moderate bone loss, surgical intervention is often required to access the infected implant surface completely. This typically involves flap surgery, where the gum tissue is temporarily lifted to expose the entire infected area and the surrounding bone defect.
Once exposed, the implant surface must be decontaminated to remove tenacious bacterial biofilm and endotoxins. Methods employed for cleaning include:
- Specialized titanium curettes
- Air-powder abrasive devices
- Lasers and photodynamic therapy
A procedure called implantoplasty may also be performed, which involves smoothing and polishing the exposed roughened threads of the implant to create a surface less prone to bacterial accumulation. Surgical salvage may also incorporate regenerative procedures to restore lost bone support. Bone grafting materials are placed into defect areas around the implant to encourage the jawbone to regrow and re-establish connection. This combination aims to halt disease progression and preserve the implant.
Removal and Replacement Considerations
When an implant is mobile or bone loss is so extensive that salvage is unlikely, removal is necessary. Extensive bone loss compromises the stability and health of the surrounding jaw structure, making removal the safest option to prevent further destruction. Specialized, minimally invasive tools, such as trephine burs or reverse-torque devices, are used to remove the implant while preserving surrounding bone.
Removal is followed by a required healing period for tissues to recover from the infection and extraction. A bone graft is often placed during this phase to repair the defect and build a foundation for future restoration. The timeline for replacement depends on the extent of the graft and bone maturation, ranging from a few months to over a year.
Once healed, a new implant can be placed in the same or a more favorable location. This replacement process offers an opportunity to address the original factors that led to the initial failure. If a new implant is not possible, alternative restorations like a dental bridge or removable prosthesis can be considered.