A dental implant is a titanium post surgically placed into the jawbone to replace the natural tooth root. Implant failure signifies a serious complication where the implant loses its essential support structure within the jaw. While dental implant treatment has a high success rate, a failing implant can often be salvaged through timely intervention. This process requires a precise diagnosis to determine the underlying cause and the extent of damage to the surrounding bone and gum tissue.
Recognizing the Signs of Implant Failure
Patients should monitor for symptoms distinguishing a healthy implant from one experiencing distress. Early implant failure typically occurs within the first three to four months following placement, before the implant has fully fused with the jawbone (osseointegration). Signs of this early issue include persistent pain that worsens instead of subsiding, and noticeable movement or instability of the implant fixture.
Late-stage failure can happen years after integration, often tied to infection or excessive mechanical stress. Patients may observe bleeding upon gentle probing, prolonged redness, or swelling around the implant. More advanced signs include visible recession of the gum line, which can expose the metal threads, or a discharge of pus from the surrounding gum pocket. The most severe sign is mobility, indicating a near-complete loss of bone support.
Common Reasons for Implant Deterioration
The primary cause of late-stage implant deterioration is peri-implantitis, a progressive disease comparable to periodontitis in natural teeth. This condition is an inflammatory response to bacterial biofilm (plaque) accumulation on the implant surface, leading to the destruction of supporting bone and soft tissues. Uncontrolled diabetes, poor oral hygiene, and smoking are significant risk factors that accelerate this infection.
Another common reason for failure is the lack of initial osseointegration, a primary cause of early failure. This occurs if there was insufficient bone volume or density at placement, or if the surgical site became contaminated. Mechanical overload, often due to improper bite alignment or teeth grinding (bruxism), places excessive force on the implant, disrupting the bone-to-implant connection and causing bone loss. Incorrect implant placement, such as positioning the fixture too close to a nerve or at an unfavorable angle, can also compromise long-term stability.
Treatment Pathways for Salvaging a Failing Implant
The goal of treatment is to eliminate the source of inflammation and regenerate lost tissue to stabilize the implant. For mild cases, known as peri-implant mucositis, non-surgical therapy is the first approach. This involves a meticulous professional cleaning using specialized instruments, such as plastic curettes or titanium brushes, to remove plaque and calculus from the exposed implant surface. Local or systemic antibiotics may be administered to control the bacterial infection.
If non-surgical efforts fail or if bone loss has occurred, surgical intervention is required to access the implant surface directly. The surgeon opens the gum tissue to gain visibility and thoroughly decontaminates the implant surface, often using techniques like laser application or chemical agents. For contained bone defects well-suited for repair, a regenerative approach is used. This involves packing the area with bone graft material and covering it with a barrier membrane to encourage new bone growth.
If the implant surface is rough and heavily contaminated, implantoplasty may be performed. This procedure involves smoothing and polishing the exposed threads, creating a surface that is easier to clean and less hospitable to bacteria. For significant gum recession, a soft tissue graft may be necessary to cover the exposed threads and improve gum health. The success of any salvage procedure depends heavily on the extent of bone loss and the patient’s ability to maintain excellent oral hygiene afterward.
When Removal is Necessary and Next Steps
The decision to remove a failing implant is made when the damage is too severe to be predictably reversed. Removal, known as explantation, becomes necessary if the implant exhibits severe mobility, massive bone loss, or if the implant fixture itself is fractured. Explantation is a surgical procedure, often performed using specialized instruments that reverse-torque the implant out of the bone socket.
Once the failed implant is removed, the area must heal completely before replacement is considered. To prepare the site for a future implant, a bone graft or socket preservation procedure is typically performed immediately following explantation to rebuild lost jawbone volume. The healing period following bone grafting takes between three to six months, ensuring the bone is dense enough to support a new fixture.
After the site has fully recovered and the underlying causes of the initial failure have been addressed (e.g., controlling diabetes or quitting smoking), a new implant can be placed. The replacement implant may be slightly wider or positioned in a different location to engage healthier bone. If a new implant is not possible due to persistent bone deficiency, alternative tooth replacement options, such as a dental bridge or a removable partial denture, are considered.