Signs a dental implant is failing, and what can still be done

Early failure and late failure are different problems

Early failure happens in the first weeks or months, before the crown is fitted or soon after. The bone never properly fused to the implant. It usually shows as an implant that moves, or pain that does not settle. Causes include infection at the time of placement, too little bone, smoking, or putting load on the implant too soon.

Late failure happens years later, after the implant has worked well. It is most often peri-implantitis, an infection of the gum and bone around the implant that behaves very much like gum disease around a natural tooth. This is the one people search for after five or ten years, and it is the one that gives warning.

The warning signs, earliest first

• Bleeding from the gum around the implant when you brush
• The gum looking red or puffy compared with the gum around your other teeth
• A bad taste, or pus when you press the area
• The gum pulling back, sometimes showing grey metal or the thread of the implant
• Food trapping around it that never used to
• Pain or tenderness when you bite
• Finally, movement of the implant itself

An implant has no nerve inside it, so there is often no pain until late. That is exactly why bleeding around an implant should never be ignored.

A loose crown is not always a failed implant

This is the most common false alarm, and it is worth knowing before you panic. The crown is attached to the implant by a small screw or by cement. When that screw loosens, the tooth feels wobbly, but the implant in the bone can be completely fine. Retightening or replacing the screw is usually a short, simple appointment.

The way to tell them apart is an examination and an X-ray. Do not wait to find out, though, because a loose crown left long enough can damage the parts underneath.

What makes an implant fail years later

• A history of gum disease. People who lost teeth to pyorrhea are at higher risk around implants too.
• Smoking
• Diabetes that is poorly controlled
• Cleaning that misses the implant, particularly the side facing the tongue or the palate
• Excess cement left under the gum when the crown was fitted, which irritates the tissue for years
• Grinding or clenching, which overloads the implant
• An implant placed in a poor position, which makes it hard to clean
• Missed reviews, so the early bleeding was never noticed

Caught early, it is reversible

The stage before peri-implantitis is called peri-implant mucositis. The gum is inflamed and bleeds, but no bone has been lost. Treated at this point with professional cleaning and better home care, it is fully reversible.

Once bone starts to go, it has become peri-implantitis, and treatment becomes more involved. The difference between the two is often simply how long the bleeding was ignored.

What can be done, stage by stage

• Mucositis. Thorough cleaning around the implant, and a review of how you clean at home. Reversible.
• Early peri-implantitis. Decontaminating the implant surface below the gum, sometimes with antibiotics placed locally, followed by closer reviews.
• Moderate peri-implantitis. The gum is opened so the implant surface can be cleaned directly. Where the bone defect has a suitable shape, it can sometimes be rebuilt with bone graft material.
• Advanced bone loss. Where too little bone remains, the implant is removed, the site is allowed to heal or is grafted, and a new implant can often be placed later.

A failed implant is not the end of the road. Replacement implants placed after proper healing and grafting do well in many cases.

If your implant was placed somewhere else

This is common, and there is nothing awkward about it. Many patients come for a second look at an implant placed years ago by a dentist who has since retired, moved away, or who they simply cannot get back to. Bring whatever you have: X-rays, the name of the clinic, and above all the implant brand if you know it, often written on a card you were given at the time.

The brand matters because every system uses its own screws and parts. A known system such as Straumann, Nobel Biocare or Osstem can be identified and serviced by any dentist. An unbranded implant can make even a simple screw replacement difficult.

Preventing it

• Clean around each implant every day with interdental brushes, not only a toothbrush
• Keep your review appointments, even when nothing hurts
• Stop smoking, or at least cut down
• Keep diabetes well controlled
• Wear a night guard if you grind your teeth
• Have bleeding around an implant checked the same week you notice it

See dental implants in Ghatkopar, or if your gums bleed elsewhere too, pyorrhea treatment.

Common questions

What are the first signs of dental implant failure?

Bleeding from the gum around the implant when brushing is usually the earliest sign, followed by redness, swelling, a bad taste or pus, and the gum pulling back from the implant. Pain and movement tend to come late.

Can a failing dental implant be saved?

Often, if it is caught early. Inflammation without bone loss is fully reversible with cleaning. Early bone loss can be treated by decontaminating the implant surface, and some defects can be rebuilt with bone grafting. Implants with severe bone loss usually need removing and replacing.

Why would a dental implant fail after 10 years?

Late failure is most often peri-implantitis, an infection of the gum and bone around the implant. Risk factors include a history of gum disease, smoking, poorly controlled diabetes, excess cement under the gum, teeth grinding, and missed check-ups.

Is my implant failing if the crown feels loose?

Not necessarily. A loose crown is often caused by the small screw that connects it to the implant, while the implant in the bone is fine. It is usually a simple fix, but it should be checked promptly.

Can a failed dental implant be replaced?

In many cases, yes. The failed implant is removed, the site is allowed to heal or is grafted with bone, and a new implant is placed afterwards.

What is peri-implantitis?

Peri-implantitis is an infection of the gum and bone around a dental implant, similar to gum disease around natural teeth. Without treatment it causes progressive bone loss and can lead to the implant loosening.