By Anthony Lieu, DMD
In the unfortunate situation when we see a dental implant fail and I am usually sad to see it. We take every precaution to ensure that all dental implants we place are in the best location for success.
The primary reasons I see a dental implant fail are:
- Poor Hygiene. Dental Implants are not real teeth or natural roots, so they can not get cavities. However, they can develop peri-implantitis around the implant or abutment. Peri-implantitis is just like gum disease (periodontitis). Too much buildup of plaque and tartar can result in a localized infection around the implant or abutment. The infection starts down the surface and can easily travel down the implant affecting the gum and bone it is surrounded by. Peri-implantitis can occur with dental implants in much the same way that periodontitis can occur with natural teeth. Patients have the same responsibility to care for their dental implants that they have for caring for their natural teeth. In fact, when patients ask me how long an implant will last, I tell them that in general, a dental implant can last as long as their healthy, well-cared for natural teeth. In other words, they need to brush 2–3 times per day, floss daily, and see their dentist at least three times a year (or more, if appropriate) as well as not perform any oral activities that are hazardous to teeth, such as chewing on ice.
- Failed Osseointegration. Osseointegration is the formation of a biologic connection between a person’s bone and a dental implant. This process takes place over several months after the implant is placed, typically 4-5 months. Failure of an implant is often due to the failure of the jawbone to fuse together properly with the implant. Smoking inhibits this process. Sometimes diabetics with slower healing have this problem as well. An implant is deemed a failure if it is mobile, falls out or shows signs of bone loss of more than 1 mm after the first year and more than 0.2 mm after the second year. Several factors can cause this to happen including incorrect positioning, insufficient bone density or volume, overloading, damage to surrounding tissues, external force/sudden impact, fractured implants or even a reaction to anesthesia.Before an implant can integrate properly into a jawbone, there must be a healthy volume and density of bone present. For patients who lack adequate bone height, width or length, procedures such as a sinus lift or bone graft can help add space and bone mass, but significantly add to both the total treatment time and cost.It’s interesting to note that the density of bone beneath missing teeth deteriorates over time since it is not being stimulated by the forces of chewing. Patients who have been missing teeth for months or years often require bone grafts before they can get implants.
- Overloading. In certain cases, an oral surgeon may decide to perform immediate loading during a dental implant procedure. Immediate loading is a one-stage treatment method where the crown and abutment are placed on the dental implant right after the post is surgically inserted. This all-in-one procedure can lead to complications since implant integration is incomplete. Chains such as Clear Choice Dental Implant Centers are fans of this method. The normal process consists of two stages and provides time for the implant to integrate with the bone before adding the abutment and crown that protrude above the gums.Overloading is the term given to failures caused by undue pressure or forces placed on the protruding abutment and/or crown. These forces can easily disrupt the osseointegration process. Patients who have inadequate bone mass may not be able to have immediate loading
- Foreign body rejection – Similar to organ transplants, it is possible that a patient’s body will reject the dental implant. In this case, the patient’s body see the dental implant as a foreign object that does not belong and pushes it out.
- Failure of the implant itself – Even though they are made of metal (usually titanium), it is possible for the post to bend or even break. This much less common than it was years ago thanks to advances in implant design and materials, but it is still possible. An implant can crack or fracture if it is subjected to excessive external forces. This could be a sudden impact like a blow to the face or excessive pressure over a period of time like grinding teeth or an unbalanced crown.
- Allergic reaction – Most implants today are made of a titanium alloy that contains traces of nickel. While quite rare, some patients can have an allergic or inflammatory reaction to titanium. The symptoms can range from itchiness to Chronic Fatigue Syndrome.
There are others as well, but these are the most common. Poor Hygiene is what we see often. Thankfully there are new advances with dental lasers that can be used to manage infections around dental implants. We have had great results where people with failing dental implants have been able to return to health and stability even with some bone loss, after treatment with the Biolase Waterlase MD and a regimine of Oracare Mouthwash 2x per day. If you or someone you know has dental implants that are loose or mobile, please let them know about us. We are happy to place dental implants but my Dental Hygienists and I would rather see a patient maintain what they have at a level of health with good homecare and regular cleanings.
Thank you and be well!
Blue Apple Dental Group
6230 State Farm Drive, Rohnert Park, CA 94928