A dental implant is designed to be a permanent, stable replacement for a tooth, anchored firmly into the jawbone by a titanium post. When a secure implant suddenly feels loose, it requires immediate professional attention. A healthy implant should feel solid and unmoving, mimicking a natural tooth. Any sensation of movement, clicking, or shifting indicates a compromise in the system’s integrity and must be evaluated promptly to prevent serious complications.
Differentiating Crown Movement from Fixture Movement
The first step in understanding the problem is determining which component is causing the loose sensation. A dental implant system consists of three parts: the titanium fixture (the post in the jawbone), the abutment (the connector), and the crown (the visible tooth replacement). The implications and treatment for movement differ significantly for each part.
If movement is isolated to the crown, the underlying implant post is likely still secure. This often feels like the tooth is wobbling on a stable base. This issue is typically caused by a loose abutment screw, which connects the crown and abutment to the fixture, or by the failure of the dental cement holding the crown in place. This mechanical failure is generally considered the “best-case” scenario, as the foundation remains intact and the fix is often straightforward.
A far more serious situation occurs when the entire fixture, the titanium post itself, feels loose within the jawbone. This indicates a failure of the osseointegration process, meaning the bone no longer holds the implant post securely. This movement might feel like the entire tooth is shifting side-to-side when touched. This instability suggests significant bone loss or a complete failure of the biological bond between the metal and the jawbone.
Underlying Causes of Implant Instability
Implant instability falls into two main categories: mechanical issues involving the components, and biological issues involving the surrounding tissue. Mechanical failures are the most common cause of early looseness in the system’s upper parts. The small abutment screw that fastens the crown and abutment to the implant fixture can loosen over time due to the repetitive forces of chewing.
Screw loosening is a known complication that can occur even with proper torque, as micro-vibrations from daily use exert stress on the components. In rarer cases, a component may fracture, such as the abutment screw or the implant fixture itself. This fracture is often due to excessive pressure or a flaw in the component material. These mechanical problems require professional intervention to tighten or replace the affected piece.
Biological failure is primarily caused by peri-implantitis, the most frequent reason for fixture loosening. This condition is the implant equivalent of periodontal disease, where a bacterial infection causes inflammation of the gum tissue and subsequent destruction of the supporting jawbone. As the bone recedes, the implant loses its foundation and becomes unstable.
Peri-implantitis typically progresses slowly, often starting with inflammation and bleeding gums around the implant, known as peri-mucositis. If left untreated, bone loss accelerates, leading to a mobile implant fixture. Another factor contributing to instability is excessive force, or overloading, often caused by severe teeth grinding or clenching (bruxism) or accidental trauma. This excessive stress compromises the integrity of the bone-to-implant connection, leading to bone loss and subsequent loosening.
Immediate Patient Action and Clinical Solutions
If an implant feels loose, the most important immediate step is to contact the dental professional who placed or restored the implant as soon as possible. While waiting, patients should avoid chewing on the affected side and stick to soft foods to prevent further stress or damage. It is crucial to resist the urge to wiggle, pull, or attempt to tighten the implant or crown at home, as this can worsen the mechanical issue or introduce bacteria.
The clinical solution depends entirely on the diagnosis made through visual examination and X-rays, often including a cone-beam CT scan to assess bone levels. If the problem is a loose abutment screw, the dentist will access the screw, clean the internal threads, and re-tighten it to the manufacturer’s precise torque specifications. A loose cemented crown is simply removed, cleaned, and re-cemented onto the abutment.
If peri-implantitis is diagnosed as the cause of fixture movement, the treatment becomes more complex. Early-stage infection may be treated with non-surgical cleaning to remove bacterial biofilm and calculus from the implant surface, often combined with local or systemic antibiotics. If significant bone loss has occurred, surgical debridement may be necessary to clean the implant surface thoroughly and potentially use bone grafting material to regenerate the lost bone support. If the implant fixture has failed completely due to advanced bone loss or lack of osseointegration, the implant must be removed, the area allowed to heal, and possibly bone grafted before a new implant can be placed.