Dental implants are a highly successful, long-term solution for replacing missing teeth. However, a component may loosen or the entire implant may fail, which can be alarming. Understanding the implant’s structure is the first step in addressing the situation. The replacement tooth is a system composed of three parts: the fixture (the titanium post placed into the jawbone), the abutment (the connector piece), and the crown (the visible, tooth-like restoration).
Component Identification: What Actually Came Out
The severity of the situation depends on which part of the three-component system has dislodged. The least urgent scenario is when only the crown, the artificial tooth portion, detaches. This usually signifies a failure of the cement or the retention screw holding the crown onto the abutment, indicating a simple mechanical issue.
A more concerning situation is finding the crown attached to a small metal post, meaning the abutment has also come out of the fixture. The abutment’s detachment is caused by the loosening or fracture of the internal abutment screw.
The most serious situation occurs when the entire titanium fixture, the post embedded in the jawbone, is mobile or comes out. This indicates that the necessary fusion between the titanium and the jawbone, known as osseointegration, has failed. When this happens, the entire structure is compromised, and the problem is biological rather than mechanical.
Immediate Emergency Protocol
If any part of the implant system comes out, remain calm and immediately locate the dislodged component. Preserve the part, as the dental professional will need to examine it and potentially reuse it. Place the component in a clean container, ideally submerged in saline solution or milk, avoiding tap water or alcohol.
Do not attempt to clean the component with harsh chemicals or reinsert it into the mouth yourself. Doing so risks contaminating the site or damaging surrounding soft tissues. Refrain from chewing on the side of the mouth where the implant was located to prevent further injury to the exposed gum and bone.
Gently rinse the mouth with warm salt water several times a day to keep the area clean and soothe any irritation or bleeding. Contact your dental professional immediately to schedule an emergency appointment. Clearly describe which component has come out so the dentist can prepare for the specific repair needed.
Primary Causes of Implant Failure
Implant failure is broadly categorized into two types: early failure, which occurs before osseointegration is complete, and late failure, which happens after the implant has been in function. Early failure is related to a lack of proper fusion between the titanium fixture and the bone. This inadequate osseointegration can be caused by poor bone density at the surgical site or excessive movement of the implant during the initial healing phase.
Underlying health conditions, such as uncontrolled diabetes or a history of smoking, can interfere with the body’s ability to heal and integrate the implant. The presence of infection or surgical trauma during placement can also prevent the successful bonding of the implant to the surrounding bone tissue.
Late failure is attributed to either biological or mechanical factors. Biological failure centers on peri-implantitis, a progressive inflammatory disease similar to periodontitis around a natural tooth. This condition begins with bacterial plaque accumulation around the implant, leading to inflammation of the surrounding gum tissue.
If left untreated, the inflammation progresses to cause a loss of the supporting jawbone around the fixture, resulting in the implant becoming loose. Mechanical failure involves issues with the hardware, such as the loosening or fracture of the abutment screw or the prosthetic crown. Excessive biting forces, often associated with teeth grinding (bruxism), place stress on the components, leading to component failure.
Professional Diagnosis and Treatment Paths
The dental professional will conduct a thorough examination, assessing the implant site for mobility, swelling, and signs of infection. A radiograph (X-ray or CBCT scan) is essential to determine the extent of bone loss around the fixture. Probing the gums measures pocket depth, which helps evaluate the severity of any potential peri-implantitis.
If the issue is isolated to the crown or abutment, the fix is generally straightforward. The dentist will re-cement the crown or tighten the internal screw connecting the abutment to the fixture. If the abutment or crown is fractured, new components will be fabricated and attached to the existing implant.
Treatment for peri-implantitis depends on the disease’s progression. Early stages are managed with non-surgical deep cleaning and debridement to remove bacterial deposits. Advanced cases require surgical intervention, involving lifting the gum tissue to fully clean the contaminated surface and potentially performing bone grafting to regenerate lost bone support.
The most complex treatment is required when the entire fixture has failed and must be removed. This step is necessary if the implant is mobile due to lack of osseointegration or severe, untreatable peri-implantitis. After removal, the site must be thoroughly cleaned and often prepared with a bone graft to restore the volume and density of the jawbone. A healing period is required before a second attempt at implant placement can be made.