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Dental implants are anchors to your jaw that support your bridges, dentures, or crowns, helping them function just like natural teeth. After healing, dental implants can maintain the integrity/bone volume of your jaw and restore your bite.
Though they come with many benefits, sometimes dental implants fail. It is important to note that dental implant failure is not due to the body rejecting it. They do not create antibody-antigen type responses like organ transplants.
Failure occurs for reasons that either stem from local or systemic (general health) factors, the surgery itself or your post-op care.
What Are the Overall Reasons for Dental Implant Failure?
Implant failure can be divided into two categories. Early failure describes the situation when an implant is placed but fails to integrate (become solidly embedded into the bone). Late or long-term failure describes the situation where an implant has integrated solidly, but after many months or years, there is bone loss around the implant.
The causes of both of these failures are very different. In both cases, if we follow certain protocols in diagnosis, treatment planning, surgical protocol, and prosthetics the risk of these failures is still extremely low. Ten-year survival rates of integrated implants are still over 95%.
Nevertheless, that means very little if you happen to fall into the unfortunate 5%. So if that happens to be you, I have written this to try to help explain some of the things that may have contributed to your current problem.
Sometimes the patient may not have taken care of the implants well, allowing bacteria to grow and cause infections. Bruxism or improper bites cause undue strain and pressure on the implants, triggering failure. There are also chances of the surgery being done improperly, resulting in infections.
Chronic health conditions like autoimmune disorders, diabetes, or osteoporosis also play roles in implant failure. Certain medications can also put patients more at risk for losing their implants.
Although there are many factors that contribute to dental implant failure, the good news is that a majority of failures can be salvaged with early intervention and proper medical attention. There are two types of failure: early failure and late failure.
Early Dental Implant Failure
Early failure is any dental implant failure that occurs within the first 3-4 months after the procedure.
Surgical protocol is important for any type of surgery. I am an instructor for a 10-month introductory course on dental implants and a large percentage of that teaching is about surgical protocol, from diagnosis to treatment planning to surgical execution.
So it is impractical to write and describe all the aspects of surgical protocol in this blog. Nevertheless, these are a few basic principles:
- Make sure everything is sterile during surgery. This will avoid any chance of infections that can lead to implant failure. Though infection is a rare cause of failure in early failure, it still should be considered a factor and something to be avoided at all costs.
- Ensure the patient’s bone is not overheated. Too much heat will cause cell and tissue death (necrosis), resulting in lesions and pain.
- Use the correct surgical flap design based on the nature of the tissue surrounding the dental implants.
- Make sure the implant is stable initially. This basic precaution during the surgery is the foundation of the procedure’s success. If there is movement of the implant during the healing phase, it will not properly integrate.
- Place the implant on a site with adequate bone volume. Some patients may not have enough bone to support a dental implant, so if an implant is inserted anyway, the bone will not be able to integrate with it, resulting in early failure.
I would expect that any dentist placing implants would be well aware of the above protocols as well as much more.
Nevertheless, even the most experienced dentist/surgeon will have some implants that fail to heal properly. Just because this has happened, do not immediately assume they have done something incorrectly. (I would say that any dentist who says they have never had an implant fail to integrate has not placed many implants!).
Sometimes, there are implants that won’t integrate with your jaw in spite of everything being done correctly.
This can be due to a few factors:
- There is a poor blood supply to the dental implant area, resulting in insufficient healing.
- Certain medications like bisphosphonates (used to treat osteoporosis) can increase the risk of early implant failure (as well as late implant failure).
- Poor health. An unhealthy body will be less likely to integrate with a dental implant as it is not functioning as well as a healthy body.
- If there are existing infections adjacent to the implant site (sometimes these can be hidden as in a previous root canal).
- Sometimes the implant moves or shifts during the healing phase.
- The implants are not given enough time to integrate, attaching the teeth too soon before they are able to bear the burden.
Having a qualified and experienced implant dentist eliminates many of these factors. Simply having the surgery done correctly decreases the risk of early failure from an incorrect procedure.
Patients also have the responsibility of being completely transparent with their doctor about all medications they take and their current health condition. With both doctor and patient being well-informed and working together, the chances of success are high.
Characteristics of Late Dental Implant Failure
Late failure happens long after the dental implants have been established and functioning. This failure occurs between 1-10 years after your new teeth are placed.
There are a few common reasons why implants can fail at this stage:
- The procedure was “under-engineered”. There are too few implants supporting the teeth, which caused excessive stress to the implants.
- Clenching and grinding teeth. If the patient has bruxism and they do not proactively control this issue with behavioral modifications and a night guard, the dental implants can also endure too much pressure and fail.
- Poor oral hygiene. This leads to gum disease and other infections.
- Lack of gum tissue. This particularly pertains to the thick attached gum tissue that provides the seal around the implants.
Chronic metabolic diseases like diabetes can make one at a higher risk of late failure.
- Head and neck radiation. Irradiated patients have been reported in studies to have an increased risk of dental implant failure.
- Lack of bone to support the implant. When excessive bone is lost, bacteria can invade and settle on the implant’s rough surface, becoming a petri dish for bacteria. The location of bacteria is difficult for your body to purge and often this kind of infection will result in the removal of the implant if left unchecked or untreated.
- Food impaction around the implant. This can break down the seal around the implant, causing discomfort, pain, and infection.
- Bacterial infections. If bacteria is getting under the gum and causing an infection, you will need to insert a tiny ligament in the gum tissue to seal this area around your teeth and implants can help prevent this problem from persisting. There are especially fewer ligaments around implants compared to natural teeth, so this procedure can help prevent future infections.
If you have more questions about why dental implants can fail, contact us.
About Dr. Balogh
Dr. Peter Balogh (B Sc., DDS) is a cosmetic dentist at the Vancouver Centre for Cosmetic Implant Dentistry in Burnaby, BC. He is a Fellow at the American Academy of Implant Dentistry and International Congress of Oral Implantologists. Dr. Balogh has been a practicing family dentist for over 25 years and has a special focus in cosmetic dentistry and implant dentistry. In the past, he was a surgical instructor at the University of Boston School of Dental Medicine.