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Understanding Dental Implants and Addressing Failures

Hi, I’m Brett Langston. I’m a prosthodontist. I’m the owner of Dental Implant and Aesthetic Specialist here in Brookhaven, Georgia. So you’ve gotten implants, and unfortunately, they’re failing. A lot of questions we get are: “How do I know when it’s failing?”, “Why is it failing?” “What do I need to do to correct this?” and “Is this the end of the world for my mouth?” I can assure you that while implant failure is rare and not very common, single-tooth implants are one of the most successful things we do in dentistry. But failures can happen. Before we go down the road of what a failure is, I want to remind everybody of the process and how it works. I think once you understand that, it’ll be a little bit easier to understand what happened and why it failed. 

The Implant Process

An implant is basically a titanium screw that goes down in your bone. Once we place it in there, we’re waiting for a process called osseointegration, where the bone cells, your actual bone cells, will grow onto the surface of that titanium implant. That process takes time. It takes about eight to 12 weeks. In that process, the bone in your jaw, where the implant is, will start to die away slowly. And as it’s dying, it’s replaced with new healthy bone that grabs onto that implant. That first eight to 12 weeks is a really critical timeframe where we don’t want to disturb the implant because it needs the cells to grow onto the surface. 

Common Causes of Implant Failure

The majority of implant failures that we see are within that first three-month range because, for whatever reason, the implant was disturbed. Usually, what happens is whether it’s overload, if you try and put a tooth on there too soon, or if the surgical site isn’t clean, or if it’s unhealthy bone, there are a lot of different varieties if your body doesn’t heal the way it should. We’ve got some great videos on this topic that I don’t want to dive into, but you can check out this link and see those. But instead of getting the bone cells to grow on the implant, you actually get a layer of tissue that creeps in between the bone and the implant, and that tissue is just not strong enough to hold the implant in place. 

Signs and Symptoms of Implant Failure

The symptoms you’re going to have are typically after an implant is placed, the first day or so, and any kind of dental surgery is going to be a little sore and tender. But after that first day or so, you really shouldn’t feel anything. I like to call it passive healing because what’s going on is underneath the gum tissue, underneath the bone. It’s not like a cut on your hand that you’re going to constantly be looking at. It’s not secret, but it’s out of sight. So, within that first couple of days, some soreness, but after that, you really don’t feel or know that your implant’s there. If it’s sore or tender, that’s not a good sign. You definitely want to follow up with your implant team to make sure that everything’s okay: redness in the area, swelling of the tissue. Obviously, any kind of puss or discharge, any kind of foreign taste that doesn’t feel right, are all not good signs. So, you definitely need to come back and see your implant team for a follow-up. 

Long-Term Implant Monitoring and Care

Now, if you have a longstanding implant that’s failing, that’s a different story because usually, when implants fail, they lose a little bit of bone at the top and slowly lose bone over time. You may not even notice that an implant’s failing because you’re not symptomatic or you’re not feeling anything. That’s one of the reasons why it’s really important to have dental care and dental follow-up. For all of our patients who have implants, we take radiographs every six months. We check the amount of bone, and we check everything around there just to make sure we’re not having any bone loss because it’s one of those things where if you catch it early and my periodontal colleagues can do some amazing stuff, whether it’s bone grafting, whether it’s cleaning the service of the implant, they can do a lot of really neat things to maintain and prevent that bone loss so that the implant lasts a lot longer. 

Reasons for Implant Failure

Unhealthy Mouth

One of the reasons for implant failure is an unhealthy mouth. If you try to put an implant in an unhealthy mouth, you’re asking for failure because what happens is the same periodontal disease, and the same bacteria that grow on unhealthy teeth will grow on the surface of that implant. 

So, if you’ve got a mess of unhealthy teeth in your mouth and you’re missing one tooth, and we try to put an implant right there, we have no way of preventing those unhealthy cells from attacking that implant. The first step is making sure you have a healthy mouth. 

Your Body’s Response to Implants

The second thing is how your body responds to that implant. Unfortunately, if you have uncontrolled diabetes, if you’re on bisphosphonate therapy, or if you have a history of cancer treatment, these are all things that will impact your body’s ability to heal because, as you remember, it can take up to 8 to 12 weeks to recover. It’s really important for the new healthy cells to grow onto the surface, and if your body’s not capable of doing that, the implant’s not going to integrate, and we’re going to have failures. 

So the next question is, okay, my implant failed. What do I do?

If it’s a longstanding implant with a lot of bone loss, that’s a little bit more problematic because when an implant fails, if we have to remove it, unfortunately, a lot of times we have to take away a little bit of bone around that implant. Now, usually, what happens is that one of our great oral surgeons puts a bone graft in there. We let everything heal. We come back in and put in a new implant, which is pretty straightforward. A lot of times if you have an implant that fails on the front end of treatment, it’s the same process. We clean the unhealthy implants out and ensure the area’s nice and clean. We’ll put bone tissue, and we’ll kind of graph that area to make sure it’s healthy. You have to wait about two to three months, and then we’ll come back and try it again. So as long as we’ve eliminated the factors of an unhealthy mouth, the body’s response, a lot of times that second time will have a lot more successful chance. 

Sensations and Signs of a Healthy Implant

Another question we get is, what is my implant supposed to feel like? And that’s a great question. On a natural tooth, you’ve got the tooth anchored in bone, but you’ve got a thin lining of what’s called the periodontal ligament that acts almost like a shock absorber. So when you bite, your tooth kind of compresses a little bit, and that’s the natural feeling. So when you bite, you’re not going to have the natural tooth kind of cushion feeling. So when you chew with an implant, you shouldn’t have any kind of sensation. And so that’s one of the big signs of a failing implant, which is when it’s painful to chew. Obviously, if the tooth or the implant is moving or has any kind of mobility, that’s a sign of failure. 

Importance of Prompt Response to Discomfort

But one of the big things we tell our patients is if something feels wrong or something feels off, they should absolutely call us. We get those multiple times a week, and I would much rather have my patients come in, let us take a look, and reassure them everything’s okay. Because nine times out of a hundred, the mouth is a weird place, and everything is fine. But you don’t want to have that one time where the implants failed, and you’re like, eh, should I come in? It’s not that bad. It hurts every once in a while, but if something’s going wrong and we don’t address it sooner rather than later, it can lead to a lot bigger complications. So, the rule of thumb is if it’s hurting you and it doesn’t feel right, please come see us. We would love to have you in, and we’ll take a look for you. 

Proper Planning and Care by the Implant Team

Implant therapy is one of my favorite things to do, and we do a lot of implants in our office. Dr. Meyer and I spend a lot of time planning out and making sure every implant case is very thoroughly predictable, accurate, start to finish, kind of spaced out. Now, having said that, we do still get occasional failures. Minimal doesn’t happen very often. It’s very rare, but it does happen, and that can be due to a variety of factors. 

Managing External Forces and Dietary Habits

What you want from your implant team is someone who’s going to take their time and do their proper planning to make sure that it’s a healthy mouth, the right location, healthy bone, and everything is set up for success. Another reason that implants can fail is once they’re integrated, the bone is on there, they’re doing great, they’re awesome. Now comes a part of putting a tooth on there, and unfortunately, if that tooth isn’t put on there and the correct orientation, the correct load kind of matching with the rest of the mouth, you can provide forces that are too much for that implant to take. 

Sometimes, we see implants fail from too much force or biting pressure on those implants. 

Treating Your Implants Like Natural Teeth

Whether that’s from the tooth itself being too tall, too bulky,  in the way, or the patient has some bad dietary habits that we haven’t instructed them on properly, that can cause occlusal overload as well. One of my favorite stories is in the army. We had a soldier who had a bunch of implants, and he kept breaking them. In order to break an implant, you have to really put a lot of force on it. It turns out we asked him what he was doing, and he said he felt like he had bionic teeth, so he was breaking chicken bones. So, as a rule of thumb, implants are a great replacement for your teeth, but as long as you treat them like your regular teeth, they can last you a lifetime. 

So, speaking of diets and not chewing on chicken bones, one of the questions we get is, how do I treat my implant grounds? Do I treat them differently than my natural teeth? And that’s the great thing about implants: once they’re integrated, if they’re loaded correctly and designed correctly, you can treat them just the same as your other teeth. 

So, they have the same brushing, the same flossing, and the same chewing habits. I wouldn’t recommend anything that you wouldn’t do on your natural teeth. So we don’t like people to chew ice. We don’t like people to try and chew bones and overwhelm the strength of their teeth. Implants are probably stronger than your natural teeth, but I wouldn’t push it. You can still chew and function and eat like your regular teeth with the implant, just like your existing teeth. So treat it like your other teeth, and you’ll be great. Thank you so much for spending time with us, discussing dental implants and their failures, why they might fail, and how to treat them. 

Contact Dr. Brett Langston Today!

If you have an implant that you think might be failing or a history of failing implants, or if you have any questions about your existing implants, please feel free to reach out to us, like, subscribe, comment, or call our office. We’d love to have you come in and talk about your specific case. I’m Brett Langston. I’m here to help you watch your mouth.