why some dental implants fail

The estimated reading time for this post is 6 minutes

Dentadental implant failure diagraml 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.

implant failure chronic health conditionsChronic 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!).

dental implant integration with jawSometimes, 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.

Surgery for dental implants

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.

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 About Dr. Balogh

Dr. Balogh - Expert in Cosmetic Dentistry and Dental ImplantsDr. Peter Balogh (B.Sc. D.D.S. D.A.B.O.I) 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 focuses on cosmetic dentistry and implant dentistry. In the past, he was a surgical instructor at the University of Boston School of Dental Medicine.

88 thoughts on “Why Some Dental Implants Fail

  1. Avatar

    if you have osteoporosis can you still get implants or will they fail they tell me I am a minus 2 when I had bone scan done but don’t have any broken bones at least not yet I been told they will fail

    Reply
    • Dr. Peter Balogh

      Hello Kim

      Thank you for your comment.

      Generally, osteoporosis affects the hips and longer bones before it affects the jaws. Having implants will place stress on the bones and stimulate them to be maintained in volume and density.

      A bone density of -2.5 is just at the borderline of being diagnosed with osteoporosis. If your BMD score was significantly less than that, I might have some reservations or would need to be more cautious. The implants would have to be assessed individually and on a per-site basis.

      I have treated many patients with osteoporosis and have not had any issues. We sometimes have to modify our treatment and healing time takes slightly longer but it has not been a major issue.

      A potentially long-term problem for osteoporosis patients with implants and even dentures is the complications with the medications (Bisphosphonates) that are given to patients with osteoporosis.

      I hope that answered your question.

      Sincerley,

      Dr Balogh

      Reply
    • Dr. Peter Balogh

      Hello, Mitchell

      Thank you for your comment.

      Two weeks following surgery you might have some minor discomfort but it should be significantly better than the first week. You should be noticing an improvement every couple of days. Check with your dentist/surgeon to make sure there is no infection, pressure on the site or something else going on.

      I hope this helped to answer your comment.

      Sincerely,

      Dr Balogh

      Reply
  2. Avatar

    I had a implant fail 3 times. First time the bone graft was coming out after several days and the dentist removed the implant. Second time, same location, the implant fell out. Third time after being in for several weeks exray showed implant to be crooked and it was removed. So # 7 is an empty space and I am out $ 3000. 00. I do have 3 other implants that I have had for over a year or two. I also had a blade implant for 30 yrs.

    Reply
    • Dr. Peter Balogh

      Hello David,

      Thank you for your comment.

      It is difficult to determine why you had issues in this area. Anytime something does not turn out as expected I always look back at my notes and the procedure to see if there was anything that I had done that was different.

      If not then I look at the area. I ask myself, is there something going on with the adjacent teeth? Some unusual history of infection in the surgical site? Something medically that was not noted or missed?

      Sometimes implants do fail, but if we can make adjustments in technique or protocol then usually the next one works just fine. But success comes with understanding what caused the failure in the first place.

      It seems from your description that all three attempts failed for slightly different reasons. I would not give up, especially if the bone in the area is still in good condition; but if it were me I would have a discussion with my dentist.

      Be sure that your dentist thoroughly understood the reasons for the past failures and ask if he feels confident in moving forward. Or ask if alternative solutions should be looked into.

      Reply
    • Avatar

      Good morning Dr., I had three implants in a row put in three years ago. I went to a dentist for quite a few years who saw me last January and said nothing about the metal starting to show up at the gumline. I wasn’t real happy with this dentist so I went to another and she told me I should have this checked. Yesterday, I saw Periodontal Specialist in Rochester Minnesota Who did my implants. The doctor that did them has retired but another lady’s doctor Saw me. They took x-rays and saw I had a lot of bone loss that was starting to occur and possible infection around the implants. I’m a little disappointed because I was told at the time I had them put in that they would last a lifetime. And I spent $17,000. Three years later they need to come out and I have to make a decision on which way I’m going to go??? What are your feelings and is there anything that I can do For a recourse since they failed so quickly?
      Two different dental offices worked on this procedure.
      Thank you so much.
      I’m frustrated Because I don’t have the money to redo this anymore and my dental insurance that I have through MetLife said they won’t replace implants and tell their 10 years old. These were glued in place so there’s a good chance they will break when they take them apart to remove them. Thank you again,
      Can you please email me?

      Reply
      • Dr. Peter Balogh

        Hello Linda

        Sorry to say that although we do have very good success with implants, they don’t always last a lifetime. The best thing we can have in our mouth is our natural teeth and as we all know, oftentimes they are fraught with problems and/or loss.

        Nevertheless to have severe bone loss at three years is quite early. Many years ago it was considered normal to have up to 1 mm of bone loss in the first year but now we understand better some of the causes and I would not say that is necessarily normal or even typical.

        Question I have is how much bone loss is actually present. Different dentists will look at the same x-ray or clinical situation around your implants and have a quite different opinion not only on the diagnosis but also on the treatment. Secondly it is very important to understand what is causing the bone loss because if we cannot identify the cause whatever we do to treat the situation may bring us back into full circle to our starting point.

        If your bone loss is minimal, 1-3 mm, then your implants should be salvageable. If you have more than 50% bone loss after three years then it probably is best to have the implants removed. It’s the in between situations that become tricky because different dentists will have different skills tools training and experience in dealing with these situations

        Assuming that you had very good quality and quantity of bone when the implants were placed, Andy implants healed perfectly well, and there was no bone loss at the time that the T4 first placed….. Then the most common reasons for bone loss would be either food impaction or heavy function ….possibly related to the bite. These things should be checked first.

        If you have only minimal bone loss of one to 3 mm my question for you is are you flossing and brushing daily? Do you use the WaterPik? If not I would recommend using a WaterPik every day using hot saline around your implants. I have written previous blogs and responses regarding the success of using water picks to not only stop bone loss but also how it can sometimes allow for bone to regenerate. The key to growing bone is create and environment that will not impede bone growth…no bacteria, no food or plaque accumulation and the forces/stress on the bone to be within physiological limits.

        Best would be to speak to your dentists about some to these things and see if they can determine what ask causing the bone loss and also to give you a more accurate assessment of the severity of bone loss.
        Sincerely
        Dr Balogh

        Reply
  3. Avatar

    Dr. I just had implants uncovered today they had been in for three months of the four that were put in the two right beneath my nose ffailed what can I do? The surgeon Dr o Neil is a stately old gent and well thought of. He did my bottom 4 and one fell out. This was for a 4 on one procedure. He saved me a bundle by being able to spare me the grafting. As it was I spent 8k. I am 66 and on Methadone. He is willing to redo it but I don’t think I can stand the pain. As it was I only used locals and 10 Oxys for post. Will he have to tap a new hole? Won’t that create a Swiss cheese out of my jaw? He was shocked. He said one in 20 fails but sine I lost 50% I feel like I should cut my losses and see what can be done with the two good ones. The procedure was in aug 2017. It is Halloween. Did the lack of bone graft cause it? The ones behind the incisor area were fine. I go back in 2 weeks advise please

    Reply
    • Dr. Peter Balogh

      Hello Walt,

      Thank you for your comment.

      It is difficult to say why those implants failed without knowing more about the site and the surgical steps and protocol. The bone in the upper jaw is not as dense as the lower and being in the front the bone is often thinner so there may be several reasons why they failed.

      You may need more grafting if it was not done at the time the implants were removed. Just because these two failed does not mean you cannot have implants in that site, however, it would be important for your dentist to understand why they failed to avoid a repeat occurrence.

      You may choose to stay with only two implants but the type of teeth and the amount of retention will have to be modified from what was planned using four implants.

      I hope that helped to answer your question.

      Sincerely,

      Dr. Peter Balogh

      Reply
  4. Avatar

    Hi Dr Balogh,

    I have just been to my dentist to check the implant he put in a few months ago to tell me it did not take, so I have the option to revisit a few months time and he hopes the second attempt will be a success. I am reluctant and now I am thinking of a bridge, as the the 2 teeth either side I am putting crowns on them anyway. I am extremely disappointed but I want to make sure the teeth look right as its my front tooth. Any advice would be super ! thanks, Trish

    Reply
    • Dr. Peter Balogh

      Hello Trish,

      Thank you for your inquiry.

      There are times we place an implant and it does not take, however it doesn’t mean it will fail the second time or that an implant is not possible. It’s most important for your dentist to understand what likely caused the first failure so as to avoid another failure, and to ensure the bone is healthy and of adequate volume for the second attempt.

      Even if you are crowning the adjacent teeth, if it were my own teeth I would not give up as in the long term having an implant will give you fewer potential problems than a traditional bridge.

      I hope this helped to answer your question.

      Sincerely,

      Dr. Peter Balogh

      Reply
  5. Avatar

    I had 4 dental implants with overdenture on upper. After 5 years, I had a sudden onset tenderness at one of the posts. When the periodontist took off the overdenture, one of the posts fell out with a second so loose it came out easily. At that time it was found the upper ridge has deteriorated and was gone. Prior to this time I had been seeing my dentist and periodontist alternately every three months during the 5 years without any problems or concerns. A replacement temporary upper denture was made. Due to flat platete, I am unable to keep suction to keep the denture in. I am unable to eat, chew, or maintain. The dentures in my mouth with gagging after time. I am negative for osteoporosis per dexascan. I am looking for possible solution to my problem. Is rim
    augmentation a viable solution with replacement of implants.

    Reply
    • Dr. Peter Balogh

      Hello Diane,

      Thank you for your comment.

      Certainly, the bone can be rebuilt and another implant put in place. A very important point is for your dentist to try to understand why the implant failed in the first place to avoid a repeat occurrence or a similar failure on one of the other implants.

      Most commonly it is overloading of one of the implants or an inability to keep the area clean, although there are other factors/possibilities.

      I hope that helped to answer your question.

      Sincerely,

      Dr. Peter Balogh

      Reply
  6. Avatar

    Hi

    I had 7 implants done 5 months ago , 6 at the top and one at the bottom .
    The bottom one has healed and i now have a tooth in there.

    The top implants are ready except one , i had to wait another month as the one had not healed yet , i went back today and it has failed and he took it out. I am now going to have it re done in 3 weeks in the same place. Will it heal being put back in the same place ? the other 5 are ready and have healed but now i have to wait another 3 to 6 months after the failed one has been re done to have my bridge which is upsetting . Is it correct to re do it in the same place and can trying again work ?

    Reply
    • Dr. Peter Balogh

      Hello Tracey,

      Thank you for your comment.

      Yes, there is no problem in placing the implant back into the same location, just as long as there is adequate bone and no infection in the area.

      In fact, in a few cases, I have found an implant “failed” and after removing it found the bone was healthy, but soft tissue grew all around the implant (instead of bone).

      The implant was removed, the soft tissue thoroughly cleaned out and a new implant put in its place at the very same appointment. Your dentist is being cautious by letting it heal for a few weeks, but otherwise, the protocol is certainly correct and OK.

      I hope that helped to answer your question.

      Sincerely,

      Dr. Peter Balogh

      Reply
  7. Avatar

    All top teeth were extracted and I had 6 implants implanted. I was told I did not have a lot of bone and if they failed I would need a sinus lift. After one month the first implant failed, Dr said it was okay as I still had 5. I requested a bar but said I didn’t need one. After a year another implant failed and Dr gave me a sinus lift and another bone graft and inserted two. I ha e now felt another one loose on the opposite side. That’s the 3rd one to fail! We are in over $30K! My father has been paying. I clean my mouth several times a day because I have a slight pallets on my implant denture…im at a loss. I feel like I want a 2nd opinion to see why these keep failing? Should they even have been done without a sinus lift first? This has been the longest two years of my life. I was miserable with the snap in denture, just had the two on the left side and sinus lift done 3 weeks ago and now another one? I’m so depressed.

    Reply
    • Dr. Peter Balogh

      Hello Danielle,

      Thank you for your comment. I am very sorry to hear about your troubles these past 2 years.

      There are many reasons for why you could be
      having problems. It could include any of the following conditions: minimal bone, prosthetics not fitting, the
      number or size of the implants, bone quality and implant quantity.

      Certainly splinting implants is always a better option because it spreads the weight
      over all of the implants and minimizes one being overloaded which could lead
      to failure. I can’t comment as to whether or not the sinus graft was any
      compromise for the size or length of the implants.

      The bone on your upper jaw is naturally slim and more narrow than the lower jaw. This makes the area particularly susceptible to bone loss.

      I don’t know your medical history so I cannot comment as to whether there might be a systemic issue
      contributing to the bone loss or implant failure. Nevertheless, in most cases, I would say it is either a local
      issue (bone, teeth etc) or surgical/prosthetic protocol.

      Without knowing more it is really hard to say. Definitely, speak to your dentist,
      tell them your concerns and if you do not feel like you are getting a
      straightforward answer do go for a second opinion.

      I am never offended by any of my patients seeking a second opinion. In fact, if they do not feel
      100% comfortable or in agreement with what I have recommended, I
      encourage them to have a second opinion before proceeding with any
      treatment.

      Dentists each have their own approach, there are generally several different treatment options available and when it comes to your teeth, it’s best to feel confident with your decision. Sometimes you need to compare your options to make the decision.

      I hope that this was helpful for you, do get a second opinion and if money is problematic, you can also contact local dental schools. (If there are any in your area.)

      They are often in need of patients for students to work with and the procedures are often substantially discounted. They are also supervised by professionals in the field.

      Sincerely,

      Dr. Balogh

      Reply
  8. Avatar

    I am so disappointed. I think we are mislead into believing implants are the panacea and preferable to dentures.

    I suffered through the loss of teeth 18, 19, & 20 due to bone loss, a very painful bone graft, and then implant surgery.

    My implant surgery was 30 days ago and last night the one in the 20 spot fell out. I returned to the oral surgeon today only to find the one in #18 was loose and had to be removed. So today, I essentially had oral surgery for the third time.

    I am discouraged by this failure most certainly and will never encourage anyone to consider oral implant surgery. Some months ago, I just about made up my mind to get a permanent partial lower after considering the cost of implants end to end. Well-today made up my mind, I’m in the hole now 5k and will have to deal with the pain of recovery for a couple of weeks. Plus the continued embarrassment of wearing a flipper, as soon as I can again.

    Oh sure, I signed and initialed all of the documents indicating I was aware of the risk of failure but the voice over you get from dental professionals is contrary.

    Never again. Keep your money in your pocket. Too much risk associated with dental implants. Just face the facts; you lost some teeth by whatever cause and implant technology isn’t certain enough at this point to risk your bank roll. False teeth were good enough for George Washington and by golly, they’ll be good enough for me.

    Reply
    • Dr. Peter Balogh

      Hello Mike,

      I am sorry to hear about your bad experience. You are correct, implants are not perfect and some do fail.

      I would say to anyone that it is best to keep your own teeth assuming they are in fair to good condition. However, if your teeth are already gone or just not worth fixing, implants are still a much better choice over dentures, for the many reasons I have written about in the past.

      Although it may not make a difference for yourself, for all the others out there who are considering implants some questions to ask your dentist are: What are the risks, Chances of failure, How many implants have they done, How many have failed…. and most importantly: What happens if an implant does fail?

      Although I cannot speak for anyone else but myself, I have been placing implants for over 25 years and during all these years I continue to “guarantee” that the implant will be successful.

      As long as the patient follows my instructions and does not have something unusual such as a traumatic accident, the implants are successful.

      What that means in practical terms is if an implant fails to heal or integrate, I will remove it, graft the site if necessary and replace it with another one at no cost.

      Implants can be an expensive option and I try to take away any worries or risks a patient may have in choosing implants. Although this means that I lose money in some cases, it instills confidence and trust in the services we provide.

      Sincerely,

      Dr. P. Balogh

      Reply
    • Avatar

      Mike…I feel for you. I have the same story. My dentist convinced me to pull 8 natural teeth and get 4 implants and a snap in denture that turned out to be flimsy ad hell. I’ve had one implant fail, define, and fail again. Now I saw two other dentists who did a 3d scan and said the other 3 will fail eventually because my bone is gone. For the past 2 years, my dentist kept telling me that they looked good. They were healing well. He was just trying to get me out the door before but they failed. So, to sum it up, I have 4 failed implants, and no upper jaw bone to show for it. The icing on the cake is I still have 4 more years to pay for them. I am permanently disabled, so that payment is a good chunk of my income for the whole month. I met someone i would consider marrying, too. But everytime I think of that possibility, all I can think is how would any good looking guy want to marry a woman with no teeth. Why does thee American Dental Association let dentists do implants when they lack proper knowledge or equipment to do it correctly. I’m sure it’s the same answer as everything else. $$$$ . That’s what it all comes down to. My dentist stole my hope in the future. To anyone reading this…please learn from my horrible, forever life altering experience. DO NOT trust everything any dentist says. Do your own research. Get multiple opinions. Dentists are just people. They get greedy, lie, mislead, whatever just like anyone else. I don’t trust anyone anymore.

      Reply
      • Dr. Peter Balogh

        Hello Melott: (Sorry if I got your name incorrect) If I can add one comment….there are companies and dentists out there that advocate placing four implants to support an entire arch of teeth. Even if the bone is excellent this is often under engineered. If you consider our natural teeth have 24-32 roots for a full arch of teeth, and the ratio of surface area of root surface of natural teeth versus implants, you can probably understand that four implants is risky. It does not mean that it cannot be done with good success, but case selection is critical, and success is much greater on the lower than the upper.

        To put it in another perspective, I have been placing and restoring implants for 30 years now…and I have never done an “all-on-four” system.

        It is truly unfortunate and saddening to hear that you have gone through. I cannot comment if anything could have been done differently or your problems avoided. As an implant dentist, there has been push for many years to not only educate and train dentists, but to also make implant dentistry a separate specialty so that the public may have a better understanding of credentials and levels of training and experience. But as you can imagine there is a lot of politics involved and many who are opposed to the concept. Fortunately that is slowly starting to change.You may want to write the the ADA.

        ON another note, have you spoken to your dentist(s) about your disappointment in the outcome?
        Sincerely,
        Dr Balogh

        Reply
  9. Avatar

    I had four implants done in the summer of 2015. Two on the top right and one bottom left and one bottom right. All required bone grafts. All were successful and are still intact and doing great. Summer 2017 I lost a tooth to infection. Went consult for my 5th implant and scheduled procedure. Implant was placed and after 4 months of healing it failed. Surgeon was just as confused as I was since the first four did great. Wondering though why did the first 4 require bone grafts and the fifth one didn’t. I know without actually seeing x days or in person it would be hard to say but what are the chances there should have been a bone graft done since the others required it.

    Reply
    • Dr. Peter Balogh

      Hello Tony,

      Thank you for your comment.

      Every implant site is completely different, even when it’s in the same individual. If there was not a lot of bone loss from the infection then you most likely had enough bone to place the implant without further grafting. I would say that is the norm.

      Usually, if a tooth has been missing for a long time or there has been a lot of bone loss due to gum disease or infection then the chances of needing a bone graft are much greater.

      There are many alternative reasons for why the implant could have failed. It depends on factors such as where the implant was placed in your mouth, the extent of infection that occurred, whether or not the tissues fully recovered from the infection etc.

      Certainly, talk with your dentist. They can check for bone loss in the area and if that’s the case, a bone graft may be needed. If your past implants have been successful, it’s no guarantee that future implants will be as well, but I suggest you persist and consider other factors at play.

      Sincerely,

      Dr. Balogh

      Reply
  10. Avatar

    Dr. Balogh. Last summer I noticed I had an infection on my upper gum where I had an implant done. There was puss coming out of it and my dentist took the crown off and scrapped the infected area and gave me an antibiotic to take. After two rounds of antibiotics, the infection didn’t go away and an xray showed bone loss around the implant. He sent me to a periodontists and implant specialist and they removed the implant. They told me it would slide out but it didn’t. It was a battle getting it out. She said the hole was big and gave me bone graph but the membrane started coming out so she removed the membrane and put seven stitches in but there is still fluid coming out which i think is part of the infection doesn’t seem to want to go away. I am on my second round of cephalexin 500 mg. I just want the infection to go away. Why doesn’t the antibiotic work? Does this happen sometimes? I am worried the infection may spread to other teeth.

    Reply
    • Dr. Peter Balogh

      Hello Danny,

      Yes sometimes an area can get infected and depending on the situation antibiotics may not work very well. Essentially the graft material is sterile when it is placed, however, if some bacteria gets into the site then they proliferate and the blood supply/immune system to the area may still be less than ideal. If caught early antibiotics will get rid of the infection. However, if too much of the graft has been infected/affected, then sometimes the best solution is to literally remove everything, let it heal (could be anywhere from 2 weeks to 2 months and then graft +/- place the implant). Make sure to place some heat as opposed to cold in the area…warm salt water rinsing is good. IF the fluid is white it is probably an infection, however, if it is a clear yellowish fluid there is a reasonably good chance the area will heal, although there may be some loss of the graft volume.

      Sincerely,

      Dr. Balogh

      Reply
  11. Avatar

    I had a dental implant in March 2017. There was some numbness in lower jaw that lasted for about 6 weeks. Otherwise everything appeared to be fine, but when site was opened for attaching abutement, the bone had grown over the implant and had to be drilled away. Even with anesthetics, it was very uncomfortable. The dentist then could not get the abutement to attach and tried two or three different abutements. It was necessary for me to take an antibiotic as the site appeared to be infected. I fear that the abutements were not cleaned each time before reinserting, but I can’t be sure as it was done behind me. All this time, the pressure on the jaw was very uncomfortable. After a few days, the abutement fell out and had to be reattached, which again was very uncomfortable for me. Finally, the dentist said he would need to order a taller abutement because the gums were growing over the abutement and required cutting away. Inserting the new abutement again required a lengthy procedure with enormous pressure on the jaw. After several weeks, the swelling and soreness finally abated and the form for the new tooth was made. I thought the procedure for attaching the new tooth would be quite simple, but once again I was subjected to a great deal of discomfort in the form of pressure on my jaw and pain to the gums that required several shots to numb. This part of the procedure took about 1 hour. It has now been almost 2 weeks, and although the area looks good, there is a pulsating on the back side of the gums beneath the tooth. I don’t feel I can trust the dentist to find the problem without causing me another very painful visit. What should I do? I am considering seeing an oral surgeon for advice.

    Reply
    • Dr. Peter Balogh

      Hello Joan:
      Firstly, it is not unusual for bone to grow over top of an implant, and it is not such a bad thing. However along as you are well anesthetized with local numbing you should not feel aching other than some vibration. I cannot say for sure, but I’m guessing the problem your dentist had with the abutments was a either too short of an abutment for the thickness of tissue and/or not removing enough bone to allow the abutment to fit securely and tight againts the implant. Sometimes we think the abutment is screwed on tight, but it is really binding on the bone or tissue…then as the tissue or bone remodels the abutment gets loose and falls out. You could see your oral surgeon, however oral surgeons rarely deal with the prosthetic end of things so they might not be aware of what is going on. I don’t think any of the issues are serious and hopefully your dentist has already sorted things out.

      Reply
  12. Avatar

    I started the implant process a year ago. 6 months prior to my visit my dentist noticed an inflammation with a tooth he was concerned about but we put it off “too keep an eye” on it. On the next 6 month visit he said it was worse and sent me to an oral surgeon who ended up pulling it, and started the bone-graft, implant procedure. Do they always hammer like that? I had the bone graft but the first implant didn’t take and the 2nd one he said was wobbly and after giving it more time it was taken out or came out and he said the bone failed to grow around it and that the bone was spongy. I have osteoporosis, I’m not willing to go for the sinus lift. I do want to know if I need more bone graft or how to follow up to zero in on what is going on with the bone. Am I legally entitled to my records and x-rays. Not looking to sue or complain, just want to do more homework and address the bone problem. The dentist was very confident but I’m always skeptical when it’s that easy to say it failed. Could he have done anything more or preventive before the fact. Is there any chance he damaged it when he hammered? What would you suggest?

    Reply
    • Dr. Peter Balogh

      Hello Ester: My understanding is you are entitled to your dental records. You may have to sign a release form but no one can withhold them from you arbitrarily. Regarding your procedure, some implants and some procedures do require some tapping…although as one who has gone through the procedure it literally does feel and sound like hammering! I cannot comment as to why the implants did not integrate and heal properly….it could be that there is minimal bone and the dentist is trying to work with what is available. With your osteoporosis have you ever taken any medications for it? If so, some of these medications may be affecting your bone healing and that could be one possibly, even if these medications were taken years ago.
      Sincerely, Dr Balogh

      Reply
  13. Avatar

    I went to a dentist in my area, who advertised that they do implants. I wanted implants for my bottom dentures. After looking at my xrays, the dentist said i was a candidate for implants and he could put four mini implants in my lower jaw. I have been without back teeth (and teeth on my right side) for several years, (probably since the late 80’s). I’m 56 years old and got full dentures 2 years ago. I had 5 teeth pulled from my lower jaw, and 4 teeth in my upper jaw in the front.

    When i went to my appointment to get my implants (and new dentures), he started cutting and drilled one hole and tried to place an implant in. After about 30 minutes, he stopped and told me that it would not work! He said my bone was too thin to hold an implant (he had already made a comment about how my “ridge” was very thin).

    My question is this, shouldn’t he have known that BEFORE he proceeded with the surgery? Shouldn’t he have been able to know that by looking at the panoramic xray and told me i would not be a candidate (even after looking and feeling my “thin ridge”?

    I just hate that i got my hopes up and missed a day of work (2 days now, because my bottom jaw is swollen and i can’t even wear my regular denture because of the pain and swelling of the one hole he drilled in my mouth)

    I just want to know if he followed correct proceedure or not.

    Reply
    • Dr. Peter Balogh

      Hello Jan: Most xrays are only two dimensional so one cannot tell from a traditional xray how wide your bone is, although there are other methods (ie ct scans etc) that can give more details. I’m guessing is your bone was already very thin, otherwise they may have considered standard sized as opposed to mini implants. Treating very deficient bone does take advanced methods and in some cases bone grafting is required. You may still be able to have implants but your dentist may need to revise his treatment plan accordingly. Unfortunately I cannot comment on the procedure your dentist followed without truly knowing more about the diagnosis, treatment plan and surgery etc. and this is really not the correct forum for that.

      Reply
  14. Avatar

    How painful is the initial bone graph? I’m scheduled to have an upper second from back (#14) molar pulled (its fractured), area cleaned and bone graph done. I’m concerned that even with local numbing shots, this will be painful? or no?

    Reply
    • Dr. Peter Balogh

      Hi Mike: Sorry for the late response. It sounds like you are having what we call a socket graft done. It should not be painful in the least….if it is tell your dentist and they should be able to put in enough freezing to numb the area fully. Afterwards it may be a bit sore but not more than a 3 out of ten.
      Sincerely,
      Dr Balogh

      Reply
  15. Avatar

    I had an implant put in when I was 15 now 11 years later I’m starting to have issues with my implant. The tooth that has the implant would be on my top jaw right in front of my canine. I’m having a lot of gum issues. I’ve been flossing the implant to keep it clean, but it’s still swollen around the implant. I’ve gone to my dentist a couple of times about the issues, but they can’t seem to find any issues. My next visit we will be taking the cap off my front tooth and putting a new one on. The cap isn’t all the way to my gum line and has been like this for 11 years also. So we believe that the cap is creating a shelf for bacteria. My main concern is that this implant is going to fail. I don’t understand why all of a sudden after 11 years I’m having all these issues with it. It’s swollen all the way around the implant and bleeds when I brush.
    Also, I had a plate and three screws in my ankle. Two years ago I had to have that hardware taken out because it had started bothering me a lot and causing issues. I had that plate and screws in my ankle for about 10 years. The thought that keeps running through my mind is that this implant is going to be the same way.
    Any thoughts?

    Reply
    • Dr. Peter Balogh

      Hello Abigail: I cant say for sure but the plates you had in you ankle were probably stainless steel and these can and do cause problems as they do not fuse with the surrounding bone. So I feel the issues with your implant are likely different than the problems with your plates. Im guessing the problem may be bite related, but it could be there has been some bone loss and pocketing around the implant. If the cap does not go all the way to the gum then I don’t feel like the cap would be causing a problem…they are more likely a problem when the cap extneds under the gum as the margin of the cap is the area where plaque/bacteria tends to collect. Best to have the area probed for pocket depth, identify the exact areas of bleeding, identify if there is infection/pus fro=m any sites, and then a ct scan of the implant. It will show jsut how much bone there is around the implant and if there has been any bone loss.
      Sincerely
      Dr Balogh

      Reply
  16. Avatar

    I had an implant on lower left jaw after dentist was unable to stabilize a root canal crown he had replaced.
    2013, he removed the root canal material ,finished the implant. I continued to have minor soreness in the area. 2014,per x-ray, he said part of root canal material was still present. He referred me to surgeon but I was moving and their was no infection. Chewing was fine. New dentist 2016 referred me to surgeon. He drilled out 1/4 inch pebble of bone. No infection. 2018, x-ray shows tunneling in area and movement. Chewing fine and no pain, no infection They want to remove the implant and start over. I’m 74 and tired of this tooth. Since there’s no pain, infection and chewing is fine. Why do anything but keep an eye on it.

    Reply
    • Dr. Peter Balogh

      Hello Ann; If there is no pain, no signs of infection other than a shadow on an xray (which is staying the same), it is not getting worse etc….I would say leave it alone and just have it checked periodically both clinically and with an xray.
      Sincerely
      Dr Balogh

      Reply
  17. Avatar

    Had a tooth extraction and dental implant procedure nearly two weeks ago (13 days). The tooth was infected when extracted and I also needed a bone graft for the implant. How long should I expect to experience pain.

    Reply
    • Dr. Peter Balogh

      Hello Thelma: Sorry for the late reply. The majority of the pain shoudl be gone in 2-3 days, although there may be mild tenderness for up to two weeks
      sincerely
      Dr Balogh

      Reply
  18. Avatar

    Dental trainees conducted my first implant at a dental college. A bone graft was necessary, but the implant and crown was later successfully placed. My dentist did my second implant 6-8 years ago. It did not require bone graft, but with a haphazardly discovered infection, I’m wondering if this implant has failed. Two weeks after having my teeth cleaned, I began having a mouth ache. When I looked at the painful area, I noticed a white pus spot on my gum. Since it was a weekend, I soaked for two days with warm salt water to help with the discomfort. On Monday, I called my dentist and he scheduled me a same day appointment. After looking at the x-ray and hearing my explanation of the spot in my mouth, he assessed the situation. To my extreme discomfort, he began by trying to remove the crown from the implant. When he could not remove it, he gave me an anesthesia and immediately went to scrapping the area of the gum around the implant (initially without providing sufficient anesthesia). It was as if it was an “experimental” procedure. After giving me additional anesthesia, he continued. After a long, uncomfortable session of working in my mouth, he ordered the dental aid to go get some grafting and membrane material. That was placed and then he completed the procedure with sutures. I was horrified! He explained that food or something got trapped in or around the implant, which may have caused the problem. He prescribed me an antibiotic and prescription mouthwash and scheduled me to return in 2 weeks. I was in excruciating pain all night. The next morning, my face was swollen and I felt awful. I called the dentist office to see why the Dentist failed to make his “normal same day follow-up call,” and the receptionist’s explanation was that since it was such a late appointment, he planned to follow-up later. I received a phone call that evening. When I described my pain and questioned why a pain prescription wasn’t prescribed, he opted to write me one. I told him I managed to get through the night and would continue taking the OTC pill for now. The pain continued.
    I returned for the suture removal. Another x-ray was taken. I was given anesthesia and the sutures were removed. He then said that the gum looked better, but had not properly healed. He said more sutures were needed. He sutured me and instructed me to return in 2 weeks. He left the room. Before I could leave, he returned asked to look at my mouth again. He apparently had an epiphany, and decided to do more work. He explained that he wanted to put a different suture in. He did. He released me with instructions to apply the mouthwash directly to the gum line each time I ate because food was still getting trapped in that area. I have followed those instructions, but after 1 week, I am in constant pain and it looks like I have a hole in my gum near the implant. After reading your blog, I would feel more comfortable being referred to an oral surgeon with experience in diagnosing failed implants. What is your suggestion?

    Reply
    • Dr. Peter Balogh

      Hello Robin: Sorry to hear you are having such problems…if you are going to see someone else, I would recommend either a periodontist (gum specialist) who has experience with implants or another implant dentist who has experience/training in gum surgery and treating failing implants.
      sincerley
      Dr Balogh

      Reply
  19. Avatar

    Hi I had molers #18 #19#20 extraction and implant screws placed in one procedure the 8 days ago I have pain in my jaw that runs up to the jaw joint dull heavy ache not getting better Advil knocks it down but after 3 hours it comes back your opinion thanks Steve Rovella

    Reply
    • Dr. Peter Balogh

      Hello Steve:
      the fact that the pain started 8 days after the procedure makes one suspicious of infection. The first 2-3 days of pain and discomfort is due to inflammation which is normal. However whenever pain begins to increase after 3-4 days something is not healing normally. Best to have your surgeon check the site to diagnose nd identify the exact problem of the pain.
      Sincerely,
      Dr Balogh

      Reply
  20. Avatar

    Dear Dr. Balogh,
    I had a dental implant placed about 27 years ago in a lower molar, About 7 years ago the abutment became loose and it and the crown had to be replaced. i noticed that the crown was getting loose again about 2 weeks ago. My dentist said that I would need to have the abutment replaced. Today I went in to have it removed and replaced. When my dentist tried to remove the abutment, the implant itself broke off and came out with it. The lower end of the implant is still in my jaw. He said he had never seen anything like that happen before. Have you? Because I took bisphosphonates for 5 years, I elected to have my dentist put in a bridge, rather than try to remove the rest of the implant and try again. I left today with a temporary bridge. My dentist said that it will be okay to leave the rest of the implant where it is. Is there anything I should be concerned about related to all of this? I would hate for the bridge to be placed and then to have some sort of problem.

    BTW I have a bridge on the other side and I believe in both cases the problem with the abutment/implant occurred when there was relatively more pressure on the implant than on the molars on the other side. All in all, the implant was very helpful for 27 years, so I’m glad to have had it. Thank you for all of the information and feedback that you provide here.

    Reply
    • Dr. Peter Balogh

      Hello Sue: I have seen an implant break, but only twice in 30 years. Leaving the remainder of the implant in the bone should not cause a problem, assuming that there was no infection in the site. The fracture of the implant may have been due to some bone loss over many years, possibly coupled with changes in bite pressure on the tooth. The loss of bone meant the implant was being overly stressed/ flexed in an area where the diameter is much narrower, and hence not as strong, and therefore over time the implant broke. Cant say for sure if this is correct, but in my opinion it is a good guess as to why and how this occurred.
      Sincerely
      dr balogh

      Reply
  21. Avatar

    Hello Dr Balogh,I’m having implants put in by southern NH oral surgeons.my Dr seems to be having issues with my implants.he put 6 in the top and only 2 in the bottom.even though other doctors have said there is plenty of room in the bottom. For more,so now for the bottoms I’m gonna have to have an oversensitive.but that’s not the real problem I’m having.i already had two screws come out.one just now.the other a couple weeks ago .the Dr couldn’t fix it .and did another implant next to it. Apparently it’s failing or maybe I’m extremely lucky and it just fell out .yeah rite .he was saying while putting in that I have a lot of bone density and was having problems getting in a fail safe implant in my bottoms in case down the road one fails.im afraid that hes in over his head and is destroying my foundation in the process.and at this rate it’s gonna take a couple years for him to finish the tops.i have workers comp helping me with my implants.the Dr is extremely nice and I like him.but he butchered my mouth a couple weeks ago.tryiing to fix the one implant .he put another one in .failed at putting one in.i wanted to know if you see red flags here?it’s been 10 months so far.and I just keep going back for implants failing.your input would. Be appreciated.thank you dr

    Reply
    • Dr. Peter Balogh

      Hello John:
      Sorry, but it is truly hard to know what to say. For sure, any dentist who says they have never had an implant failure has not placed enough implants. There are so many issues and possible things that can cause an implant to fail, and without more information it is difficult to say if it was “just one of those things that could not be anticipated” or is your dentist in “over his head”. Having dense bone can be a good thing, but if the bone is excessively dense then the risk of failure and the difficulty of placing an implant actually increases…(it has to do with heat generation and blood supply for healing among other things). The first thing would be to ask your dentist if he/she understood why the implants failed and if they have a plan to avoid future issues….if he has a relatively good answer then that should give you confidence to continue on. However if all of your implants continue to fail then it truly begs the question of why. Sometimes there are local factors, medical and health factors and of course there could be technique or procedural factors. Once again your dentist will need to evaluate the success or lack thereof and make changes to ensure that success achieved.
      Sincerely,Dr Balogh

      Reply
  22. Avatar

    I have a zirconia implant on my front tooth 22. It was put in by a dental surgeon practicing holistic dentistry. At the time of the extraction the tooth was infected under the root canal that was done many years ago. The zirconia implant was put in immediately after the extraction with the use of PRF (Platelet Rich Fibrin) and a temporary crown was put on it the same day. Following the surgery, I had an infection that was treated with a course of antibiotics. The pain subsided after 1 week of antibiotics but sensitivity to the touch remains after 3 months and the implant even if not loose still has the range of motion slightly greater than that of a normal tooth. Even though the dentist took a precaution to isolate the tooth from the pressure of chewing by reducing the size of the crown and giving me a plastic protector guard still the implant has been the subject to the touch by the tung and the lips. The dentist is waiting for the tooth to heal before placing permanent crown. He admits that healing takes unusually long. The gum line does not appear to be inflamed. I am concerned that the sensitivity of the tooth is not improving and would like to know if there is a way to verify if there may be an infection in the bone? If the implant is still a bit loos and sensitive could it be the case of the “soft tissue ingrowth”? If yes is there a chance that the soft tissue will turn into calcified bone? Would it be recommended to remove the implant at this point or continue waiting? Any ideas/recommendations would be highly appreciated. Thank you so much for your help!

    Reply
    • Dr. Peter Balogh

      Hello Tatiana:
      It sounds as if your dentist did everything correctly, however sometimes despite our best efforts things don’t always heal the way we hope and expect. I don’t think there is infection per se as you would probably have other symptoms, however, if there is soft tissue between the implant and the bone, it will not calcify. The fact that the implant is more mobile than your natural tooth and also sensitive to the touch tells me something is not normal. I understand your dentist’s desire to give the implant more time to integrate but at some point (usually four to six months) if the implant is still mobile and sensitive I would say the chances of getting improvement with more time are very slim. IN that case the implant may need to b removed, the socket curreted of any soft tissue etc and then a new implant put into place.
      Sincerely,
      Dr Balogh

      Reply
  23. Avatar

    Is there a greater chance of failure with a canine implant than other types of implants? I have a baby tooth that needs to be replaced and am considering a implant. The orthodontist who is advising on options including seeking to bring down a wayward adult tooth (and also making space for a potential implant) is saying the implant comes with failure risks due to the importance of the canine tooth. Appreciate your thoughts on this topic.

    Canines defintely do have a greater amount of force placed on them than the other anterior teeth. However that does not mean an implant cannot survive or do well in this area. Whether to bring the natural tooth into place or place an implant has to be an individual decision…sometimes moving the natural tooth means the tooth remains loose and is never 100%. WRT the implant, the size, length, available bone volume, your bite and how the crown is designed can implant the longevity in either a positive or negative way. I have patients with single implants in the canine region, going back as far as 24 years and with no issues….so it can be done. But your dentists apprehension is not totally unfounded…your dentists just need tone aware of how to overcome the forces in the area. sincerely, Dr Balogh

    Reply
    • Dr. Peter Balogh

      Canines defintely do have a greater amount of force placed on them than the other anterior teeth. However that does not mean an implant cannot survive or do well in this area. Whether to bring the natural tooth into place or place an implant has to be an individual decision…sometimes moving the natural tooth means the tooth remains loose and is never 100%. WRT the implant, the size, length, available bone volume, your bite and how the crown is designed can implant the longevity in either a positive or negative way. I have patients with single implants in the canine region, going back as far as 24 years and with no issues….so it can be done. But your dentists apprehension is not totally unfounded…your dentists just need tone aware of how to overcome the forces in the area. sincerely, Dr Balogh

      Reply
  24. Avatar

    Hi I had dental implant surgery nearly 2 weeks ago and in the last few days my chin and lips have become numb on the right side, could this be a sign of failure due to gum disease. I went yesterday and he removed one of the implants close to the one tooth I have left on the right side but the numbness is still there. I am going to see him in 3 days time should I ask to see a gum specialist for an opinion as he said he had spoken to some periodontists he knew.
    Thanks
    Janette

    Reply
    • Dr. Peter Balogh

      Hell Janette: M first thought is the numbness is not due to your gum disease. It is possible there has been some inflammation in the nerve that supplies the chin area. This can happen especially in situations where there is minimal bone volume (often with patients who have had a history of gum disease and bone loss). Nerves can and do heal although they can take weeks to months as opposed to soft tissue which take ~3-6 weeks. It sounds like your dentist did the right step by getting some opinions on how to reduce the affects. Depending on how quickly the area is recovering, whether or not there is some feeling or totally numb…these are things your dentist will likely take into consideration whether to simply monitor your healing or refer you to someone for evaluation/treatment.
      Sincerely,
      Dr Balogh

      Reply
  25. Avatar

    Hello Dr. Peter Balogh,
    Firstly I want to say thank you for patiently responding to all of our issues.
    I had an implant in one of my incisors due to being knocked off my bicycle in 2011 when i was 23. Everything was fine with it until the beginning of this year when it started to feel a little bit loose. An x-ray in April showed that the bone around the implant had fractured. So they said i had to have a bone graft, wait until it healed and then have a new implant.
    So in April this year i had the bone graft, and it was given until October to heal.
    3 weeks ago, i had the implant surgery. Unfortunately today I have just come back from the dentist who has had to remove my new implant as he said it has not ‘taken’ due to the fake tooth being knocked by my teeth below and my bite.
    I had only had the implant in for 2 weeks before the fake tooth became wobbly so I called the dentist to see if it was ok. I was also very concerned because it seemed that the fake tooth had cracked the edge/corner of my other, real incisor. It really didn’t seem like the right shape tooth; i think he said he had had to drill the fake tooth down to size by hand which seemed strange. I asked for a night guard last week and they were surprised they hadn’t given me one already. So I received the night guard, to protect my lower jaw teeth from knocking the implant, but seemingly it was too late. And now I’m told they have added another bone graft and i will have to wait until April before the second implant.
    This will mean over a year without a front tooth. It’s quite distressing and I just would like a second opinion on why this implant didn’t work, and why the tooth shape meant my bite caused knocking on the implant that led to the failure of the implant, but the dentist was implying my body is rejecting it. It seems like the tooth he made for me was completely the wrong size. I’d appreciate your thoughts.
    Many thanks and kind regards,
    David

    Reply
    • Dr. Peter Balogh

      Hello David: I don’t understand why your first implant failed…at least the explanation given to you does not seem to make sense. Why did the bone fracture? If this was related to the initial accident in 2011 then your initial implant would have had issues from the beginning.

      Any implant that is placed has to be protected from movement. It is no different from breaking your leg…if the bones are not put into a cast the micromovement of the bones will prevent the bones from healing and the feature will fill-in with soft tissue instead. therefore if an implant is placed and anything is connected to it (ie a healing collar or a temporary tooth) the collar or tooth needs to be adjusted so that it does not make contact with any of your teeth as you eat, chew, speak etc. In some cases it may not even be possible to stabilize the implant well enough int he bone such that the implant must remain buried in the bone. Only you and your dentist can truly discern if the implant tooth was making contact with your other teeth an if this contributed to tis failure. On the positive side, it sounds like your dentist is taking steps to remedy the situation. And although another 8 months seems like a very long wait at this point in time, if it works well the time will soon be forgotten and you should =get many years of good service out of the tooth and implant.
      Sincerely
      Dr Balogh

      Reply
  26. Avatar

    Since July of 2018, I have had two implants, the first in July and second in September. I had both done by a resident student at a University Dental School because they offer what I can afford, in addition, I’ve had good general dentistry there as well. My confidence level was high. Teeth 20 and 29. I both have failed before capping. #20 cause immediate pain, especially when it was ratcheted in and I nearly came out of the chair, which is rare for me, I’m great patient and can tolerate a good bit of messing with my mouth in general. The attending said she would back it out a bit. I spent 2 months in agonizing pain and on opioids, not my thing, multiple antibiotics and finally my jaw just gave me the implant one morning as i was brushing my teeth, oddly, the pain had just subsided and i though i was in the clear, however, there was definitely an infection. I had a regraft #29 gave me no pain the first 5 days and then all creation broke loose for about 4 days and then stopped by the time I had my sutures removed. #20 had been treated with a bone graft at time of original tooth extraction and it was about 3 months before the implant was placed. Today, I returned to the chair to have my sutures removed and healing is coming along on #20, again but #29 which was 6 months down the road and was to be crowned in Jan of 2019 showed infection around the implant and out it came and bone graft. My questions:
    1. could the infection that caused 20 to fail have influenced the failure of 29?
    2. can an implant be over torqued and if so would it have “stripped” out the pilot hole much like a wood screw might do to a piece of wood if you overtightened it? My resident is at a loss as to why this happened and i have not discussed it in those terms because I don’t want her to lose her confidence at this point. She has 6 months to go and practiced general dentistry for 6 years prior so I’m not looking to blame, just educating myself. There has just been a lot of trauma to my jaw, I’m a little gun shy. Sorry for the ramble, it’s the pain meds.

    Reply
    • Dr. Peter Balogh

      Hello Johnnie: I believe you are close to your answer. If an implant is put in with too much torque(ie #20), the resulting compression on the bone will cause necrosis(cell death). Unfortunately I know this also from personal experience as I had #19 placed two years ago with too much torque…so much so that the dentist could not back it out. I suspected it at the time but because it could not be reversed out we decided to leave it and hope for the best…wrong choice. It caused terrible pain, necrosis and eventually the implant fell out. If this happens the site truly needs to be cleaned out really well, grafted and then allowed to heal for a longer period of time than normal. However I would not say that the infraction in #20 affected #29. Hard to say what happened with #29…however it sounds as though some bacteria got into the site for it to begin hurting after four days and this no doubt contributed to its demise. As pessimistic as you might be considering these failures, it can still be possible to have successful implants…it would be more comforting if the dentist continuing on had some thoughts as to why you had these failures so as to avoid a repeat occurrence.
      Hope this helps.
      Sincerely, Dr Balogh

      Reply
  27. Avatar

    Hello Dr. Balogh,

    First, thank you for this commentary, it is very helpful.
    As some one who has had upper dentures for 17years (no complications) and lowers for 13 (same), I now find myself with substantial bone loss in lower mandible, being edentulous. Two implants placed 9/2015, integrated well, although post surgery pain was long in going away. Have worn implant denture for nearly 3 years. Went, today, for impressions for new denture but “hygenist” said the dr told her my xray showed implants beginning to fail as there was slight darkening around metal/bone boundary. I could see it, barely. Also said “all denture wearers have sleep apnea and periodontitis.” Am wondering if failure is impending or this is a crock of S&*%. I have never had periodontal/gingevital disease nor do I believe I have apnea. I am 63, have osteopenia, take organic calcium, exercise daily, and am in generally good health. What gives?
    Thank you,
    Barbara L. Neuby Ph.D.

    Reply
    • Dr. Peter Balogh

      Hello Barbara: That is the first time I have heard that all denture wearers have sleep apnea…although I can understand why that comment may have been made. People who have dentures should ideally not wear them at night, and so doing the lower jaw will tend to overclose and fall backwards….this can close the airway making one more prone to sleep apnea. But I do not feel that everyone with dentures will be apnic. Regarding the bone loss, it is possible there has been some bone loss but that does not necessarily mean that you implants will fail. It depends on how much bone has been lost, is there currently inflammation or infection and howe quickly or slowly is the bone being lost. have your dentist evaluate the X-rays as well and give his/her opinion, and if they are not sure or confident in their decision ask for a referral to an implant dentist. Worst case scenario if you have lost a significant amount of bone there are steps that can be done to stop or at least slow down the process…Lanap procedures, water pick using salt water around the implants, and asa last resort…surgical intervention to smooth the implant surface and reduce the bacteria in the sulcus( gum area).
      Hope this helps.
      Sincerely,
      Dr Balogh

      Reply
  28. Avatar

    Hi Dr. Thanks for posting all the informative info on implants! I had an implant placed approximately 5 -6 weeks ago, on a canine tooth on the front left side of my mouth. The tooth fell out 6 months ago, and my dentist glued in back in place. All was fine, until late October when it fell out again!, He re-glued it ,but it kept falling out. I also had pain in the area , and needed a root canal, which he did for me. I should also add that I hadn’t been to the dentist in about 8 years ( due to a rare pelvic pain condition which makes it very painful to sit down or even lie on some surfaces). Prior to this pain condition which started in around 2009, I saw my dentist at normal intervals.. Getting back to my current situation.. after the root canal, my dentist said an implant was needed as my own tooth would not stay in place any longer.. He did the implant about 6 weeks ago. This week I first noted a little blood in the area, when I woke up in the AM. Then the implant became a bit wobbly. i have been careful all along to avoid chewing in the area., but its seems like it’s about to fall out. My question why is this happening? My dentist does all types of work but is also considered a ‘cosmetic dentist’. He has glowing 5 star reviews on the internet, and has been very accommodating . He gave me an anti-biotic after the implant. Some medicines cause bad side effects for my pelvic pain issue ( long story) .I called the dentist and asked if must take it? They said as long as I took good care of the implant (brushing regularly and using a salt water rinse,) I could skip the anti-biotic (as it was only a pre-caution). .So I followed that advice. Is my implant loose because I didn’t take the anti-biotic? Also… a former dentist of mine once noted that I was probably a tooth grinder and that my bite was different each time he saw me..( that was around 2005)..Im wondering if Im putting pressure on the implant while Im sleeping? The dentist who placed the implant is brand new to me. I chose him as he is located close to my home and because of his great online reviews. Can you offer any insight as to why this implant is loose? Also I noticed your discussion of osteoporosis. I suspect I may have it, as my elderly mom has had it for years. Could that also be why my implant is loose?. I filled out all the necessary paperwork when I went to my new dentist, but don’t remember any mention of osteoporosis.I have had about 6 visits to this dentist. It is painful for my pelvic area to lie in the chair, and I dread having to do so again.. Thanks for any thoughts or suggestions!

    Reply
    • Dr. Peter Balogh

      Hello Kathy:
      If the implant is loose and bleeding at 6 weeks…it is not a good sign and quite possible the implant is failing.

      Was there a temporary crown placed on the implant when the surgery was done? You said “Im wondering if Im putting pressure on the implant while Im sleeping?”…this makes men think there was a temporary crown.

      IF so then there may have been some pressure either at night or during the day that caused the implant to fail. Implants need bone to fuse/grow against the implant to become “integrated”…much like a broken leg if the bone is not immobilized with a. cast the bones will not heal. Same with an implant if there is movement beyond what is physiologically acceptable for bone growth.

      A little “dental implant 101”: The other thing to be aware of is when implants are fist put into place the reason they are solid is because they are essentially “wedged” into the bone. During the healing the bone then remodels and wherever the pressure is too great bone is removed/resorbed and replaced with new bone the eventually crowns against the implant at a more “passive, physiologic pressure”. what that means in real life is the healing of an implant is not a straight line integration of the implant. It is solid when first placed, but then become more “fragile” after 4-6 weeks as the bone begins to remodel, and then becomes more solid until it finally is considered fully integrated as the bone crowns against the implant.

      At this point I don’t feel antibiotics will help although I can only go by what you have been able to share with me. I don’t feel this is an osteoporosis issue, however even if this implant does indeed fail do not give up…it can be replaced and it may simply be that a slightly different approach will be necessary.
      Sincerely,
      Dr Balogh

      Reply
  29. Avatar

    3 weeks ago I had my second upper molar removed due to a severe infection I’m devastated. I constantly feel the loss and it’s a constant reminder of my worst fear. I’m 50 no other issues nor ever a cavity until this. I asked about an implant and was told I would need a sinus lift due to bone loss. It would be extremely painful and expensive this was told to me by my dentist. I’m also fearful of the sinus lift and the fact I have a mthfr defect and not sure how that would play into things. I’m terrified of losing more teeth because of the molar that’s gone yet terrified of the lift and implant

    Reply
    • Dr. Peter Balogh

      Hello “Scared”: I disagree with your dentist…sinus lifts are not at all painful…not during the procedure nor afterwards. Sure, it is a surgical procedure so there is some minor discomfort afterwards, however it is typically about a 3 out of ten (or less)….essentially you may need a regular Tylenol or Advil or possibly Tylenol #3 (or equivalent) for the first 24 hours but usually by the second day the pain is often manageable with minimal too painkillers.Costs will vary depending on the procedure, amount of material as well the fees charged by the dentist which can also be variable. On a personal note, I had an implant placed with a sinus lift 20 years ago and do not recall having any significant discomfort. Secondly I just lost a molar one week ago and will need another implant, probably with a sinus lift, and I can’t wait to get my molar back…so I truly feel your sense of loss over this tooth!
      sincerely
      Dr Balogh

      Reply
  30. Avatar

    I am 80 years old. An implant was placed (Tooth #4) six years ago. Two years after implant was placed, slight movement was noted. The screw was tightened.

    For past few months, I am feeling unusual about this tooth. Recent x-ray of the tooth indicates bone loss around this implant. What does it mean? Will the implant fail? What should I do?

    Please reply to my email. I will be happy to send the x-ray of the tooth.

    Reply
    • Dr. Peter Balogh

      If the bone loss is minimal, more thorough flossing, brushing and ideally water picking daily will help to maintain the bone. some things should be checked to make sure they are not contributing….the bite for any excessive forces, the contacts with the adjacent teeth to eliminate any food impaction. Your dentist should check and follow this by checking for any blending, pus or changes in bone loss with follow up x rays. You said you felt “unusual” about this tooth…is that something physical you are noticing or an intuition? If something physical definitely try to explain that to your dentists.
      Sincerely
      Dr Balogh

      Reply
  31. Avatar

    Dr Balogh, Thank you so much for this forum and all of your answers. I have an implant that seems to be failing on #3. My regular dentist noticed it was loose when he was putting a crown on a tooth that just had a root canal #2 next to it. (I don’t have a #1). The surgeon who did the implant asked my regular dentist to remove the prosthesis to make sure it was actually the implant and not the hardware in the prosthesis that was moving. My regular dentist started to remove the Prosthesis and stopped because he was certain the whole implant is moving. He did not want to go any further because he was afraid the implant would come out and I would have a gaping hole. My question is, will the surgeon need to start from scratch (New socket prep. New implant. About 8 month before normal again)? Or is there any way he might be able to sure the implant up? Also is the infection and the root canal in #2 most likely the cause of the implant failure? I also do interval exercise pushing my heart rate over 150 8 to 9 times in a workout (I am 60 yrs old). Is it possible that I started my exercise routine back up too soon after the implant was place. Thanks again for all you do.

    Reply
    • Dr. Peter Balogh

      Hello Rich:
      As long as you took it easy from exercise for the fist 5-10 days I don’t think your routine did anything to harm the implant. It is possible the infection form the adjacent tooth might have affected the implant, but then there are so many other possibilities without seeing all the clinical information it sis really hard to say for sure. Most likely the implant will need to be removed, the site cleaned and then grafted before another implant is put into place.
      Sincerely
      dr balogh

      Reply
  32. Avatar

    I have had an implant on #28 fail twice now. I have consulted a major dental school, hoping for reasons why this keeps happening. Three other implants have not failed. I wear an appliance at night because I am arthritic and deal with tmj and jaw wear issues on my right side. I have been a grinder.

    Those I consulted want to do a bone graft with a composite stronger than natural bone and try another implant. I am 74 years old and really weary of implants, but I don’t see what other choice I have. Also, the cost is a shocker (around $5,000 for what I fear may not be a sure thing. Is there research on folks like myself who have repeated failures? If so, what have they learned? And what would you advise me to do?

    Reply
    • Dr. Peter Balogh

      Hello Sylvia:
      With every failure, we need to to try to discern what occurred and why otherwise we are bound to have repeated failures. I would ask your dentists if they have determined why the first two have failed and if current steps will avoid another failure. I personally have had failures and each time try to go through this exercise. I have also had some where there first two did fail, only to ascertain there was a problem with the tooth next to the site. Thereafter the third one was successful. You may also want to see if a traditional bridge is na option instead of an implant..if so it wild be easier, faster and less expensive.
      Sincerely,
      Dr Balogh

      Reply
  33. Avatar

    Hello, I had an implant for almost a year and it broke and eventually came out. When I went back to the oral surgeon, he said he would replace it “at his cost”, which about $1000. Shouldn’t he replace it at no cost?

    Reply
    • Dr. Peter Balogh

      Hello Lyndse:
      I understand your concern…unfortunately how one deals with an implant or dental service that failed varies from dentist to dentist….some may replace it at no cost but it is not up to me nor the licensing bodies to dictate what each dentist does in their practice. This is one question I have suggested for patients to ask before accepting treatment…what is the likely outcome, what if additional work is required, and what if something fails within a certain period of time. If you are not happy with what has been offered be up front and direct and explain your concerns to your dentist…I’m sure you will be Abel to reach a mutually agreeable solution
      Sincerely
      Dr Balogh

      Reply
  34. Avatar

    Hi Doctor! I had an implant placed 15 years ago, and it failed 10 months ago. It served me well, but I could feel a strange sensation when I would press on it through my skin. Four years ago, it became painful and a little swollen, but my dentist found that the crown or screw had become loose and so they tightened the connection. All was good after that, until 10 months ago, when within one week, the implant became loose and dislodged itself completely. There was no pain or swelling. I am wondering why it would fail after 15 years. I have had other recent issues with needing apicoectomies and endodontic retreatments in other teeth, but the x-rays are not showing bone loss. What would you think after 15 years? Thank you for your time!

    Reply
    • Dr. Peter Balogh

      Hello Kathy:
      For the implant to fail there must have some bone loss and chronic infection….since implants rarely cause pain this can go on unnoticed by the patient and in the early stages may be difficult to identify by the dentist. As far as what caused it…many possibilities …food impaction, the bite being off due to changes in your bite, dental work, wear and tear of the other teeth, clenching or grinding, lack of what we call “attached tissue” around the periphery of the implant.
      Sincerely,
      Dr Balogh

      Reply
  35. Avatar

    I have chronic Lyme disease. I was told that should not stop me from having implants. I tried to get 2 implants on my left rear 6 years ago and they failed, he split the gum and built the bone up while putting in the implants. Much pain in first 3 weeks and then they popped up with lots of pus behind it. Dentist grafted area with bone and said come back in 3 months to try again. We did and the same problem happened again. So the dentist said the area has a problem and he would not try again. Anyway now my right side bridge came out due to broken tooth at one end and a tooth that was soft and was bad at other end of 3 tooth bridge (my molars). I was told to try an implant again. My dentist referred me to another dentist for this. This dentist started me on Clindimycin 3 days before and to continue 7 days after. I just had them put in April 12th he also needed to split the gum and put in bone while putting in implant. The pain was horrible after just a few days and the dentist gave me Methyl prednisone to stop the pain as my head was about to blow off and the swelling was bad. Finished Clindimycin, started the Predisone and it helped but within a few days after the end of the Pred.the pain started again and the swelling started again. He has now gave me Flagyl antibiotics to take for 7 days and told me to come back next Wednesday so he can re-evaluate or remove one or both. Why won’t my moth accept them. Is it the titanium rejecting? I was told to try Zirconia implants to see if they will be less rejection. Any ideas?

    Reply
    • Dr. Peter Balogh

      Hello Angela:
      Without seeing the clinical condition or knowing more detail on exactly what was done for you it is difficult to comment. There are many possibilities…any previous infection, even years earlier from a previous root canal, the need to graft bone or soft tissue….all these things increase complexity, difficulty and risk. Sorry to tell you but based on your symptoms your dentist will likely have to remove the implants. Lastly placing zirconia instead of titanium will not necessarily prevent the problems you have had…in fact it could be worse as zirconia implants tend to be wider diameter (for strength) and hence need an even greater volume of bone.
      Sincerely,
      Dr Balogh

      Reply
  36. Avatar

    Hello Dr.Balogh
    I had 3 implants done a little more than 3 months ago on tooth 12, 21 , 23. I had 5 teeth removed , being 11, 12,21,22&23. ( I had gum disease before but it’s all treated and the dr. Its find to proceed with the implants). The treatment plan is to do a 5 teeth bridge with the support of 3 implants. However, I went in this week for preparation for Provisional implant crown, and the dentist said that implant 12 did not heal properly and had to be extracted and redo. The other two are fine. I am extremely disappointed as I am wearing a flipper right now and is not comfortable and inconvenient. Now I am worry about the risk of failure of having a Five tooth bridge. If anything happens to one of my implant, I will have to remove the entire bridge and start the process all over again. Cost is one issue but the pain and inconvenience is another big concern!
    I am wondering whether it is a better idea to do a Three teeth bridge on the 2 implants that are healthy ( 21&23), and maybe do a crown on implant 12 once it’s healed. In this case, do I have to have another implant on tooth no.11 since I probably can’t do a bridge with only two teeth.
    I would appreciate your suggestions and comment on this matter.
    Thank you very very much.

    Reply
    • Dr. Peter Balogh

      Hello Emmie:
      Yes you could do a there tooth bridge from 21 to 23. However then you need to consider what is to be done for the two other missing teeth, 12 and 11. Despite the failure of the 12 and your displeasure with the flipper, overall it is more more predictable to replace the 12 implant, from the point of view of esthetics, long term success and possibly even initial success of a single implant in the area. Depending on your bite, passing a single implant to support both the 12 and 11 may over stress the implant and lead to long term failure.
      Sincerely
      dr balogh

      Reply
      • Avatar

        Thanks for your prompt reply, Dr. Balogh. I am thinking since I have to redo the implant on 12, I can add another implant on No. 11. But at the same time, I worried if implant 11 would also fail since it’s just next to No.11. Does that make any sense at all?
        Tks for your comment.

        Reply
        • Dr. Peter Balogh

          Hello Emmie: I don’t feel it will necessarily fail just because you had issues with the implant beside it. Nevertheless the areas should allowed to heal fully before proceeding
          Sincerely
          dr balogh

          Reply
  37. Avatar

    Because of my financial situation, I am going to Mexico soon to get 2 implants in the front, a 4 unit bridge and 2 crowns, one on each of the canines.I still have some tooth matter in my gums, so ive been told I would probably require grafting. I was also told that they would have to do a ct scan in order to properly check bone density. I am very nervous and scared. Can u give me any advice or information on what to ask before I agree. ?

    Reply
    • Dr. Peter Balogh

      Hello Mike;
      Essentially what you described sounds correct, however the best is to ask to see some of their dental work and or to speak to some of the previous patients that have had similar work done may them. You can certainly ask about their training and experience, as well as prognosis and expected outcome of the procedure, both functionally, aesthetically and long term.
      hope this helps…bottom line the answers they give should give you peace…go with what your heart tells you…every country has excellent dentists and possibly some that are not as excellent…even for myself…although I always strive to do my absolute best for many reasons…some totally out of our control…we can end up with a less than ideal result. But for all of us we try to minimize those events as well as learn from then… so due diligence and discernment is definitely important.
      Sincerely
      dr balogh

      Reply
  38. Avatar

    I had 2 dental implants (bridged with 3 crowns on my lower jaw) done 2 years ago. This was done overseas by my dentist. Last week I experienced excruciating pain and went to a local dentist. My gums are swollen and I thought it is probably an infection. The dentist took an x-ray and confirmed the infection but said that I must remove the implant ( which now means cutting the bridge). This is the first time there is an infection. Only 3 months ago I had a full mouth xray by my overseas dentist and he said that the implants are sitting well. I am shocked by the local dentist treatment suggestions. I thought that pulling out an implant is really the last option when no other treatment can be done. I would love to have your opinion in this matter. Does a first time infection means implant failure, which results in implant removal?

    Reply
    • Dr. Peter Balogh

      Hello Laura:
      There are several questions and possibilities that come to mind. Usually a first time infection would not be so severe as to need implant removal, however you may have had some low grade chronic infection that could have gone relatively unnoticed…in other words very little pain, swelling etc.

      Why one dentist said the implant was fine and the other said it must be removed raises several questions…it is possible that the first dentist did not see any bone loss clinically or by x ray, yet the second did if the X-rays were “different”. I had a patient with an implant showing 50% bone loss….it did not look bad clinically and the traditional 2D films did not show any bone loss whatsoever. However a 3D ct scan showed ~50% bone loss where the bone height was still fine, but it was “saucered” all around it. The patient had no pain or symptoms.

      At the same time there is a wide variation of opinions as to when an implant has to be removed or can be saved. If you have bone loss at the very least it needs to be determined what is causing the bone loss and take steps to correct it. The bone loss could be due to food impaction, a heavy bite, bite interferences, or even that the bone was too thin to begin with at the time of implant placement etc. there are many possibilities and without more information I really cannot make assumptions. Nevertheless if there is greater than 50% bone loss then the best may be to remove the implant, however if less than 50% it may be possible to clean and graft the site, either surgically or with a periodontal laser (lapip procedure).

      Definitely get more information on the amount of bone loss and ask you dentist if he/she can determine the cause of the bone loss, and water there are any other options besides removal.
      Hope this helps,
      Sincerely,
      Dr Balogh

      Reply
  39. Avatar

    Hello Dr. Balogh,
    I have had an implant at #30 (lower right molar in front of last molar, no wisdom teeth) for 13 years. About six years ago I mentioned to my dentist (he is not the dentist that put in the implant; that was done when I lived in Georgia) my gum at the implant site was slightly tender. He said everything looked good. I repeated my concern each cleaning and he referred me to an oral surgeon in 2017. Each appointment the oral surgeon took X-rays and the last one (July 23) compared to 2017 showed 1 mm bone loss. The prediction was the implant would fail within five years due to bacteria accumulation causing more bone loss. The oral surgeon suggested a procedure where an incision is made in the gum and a detergent is used to clean the area. This would not prevent the implant failure but may postpone it. Is this a recommended procedure? Can the bacteria be removed? The oral surgeon also recommended that the dentist reduce the height of the implant to reduce stress on it. Can this be done without causing additional stress on the implant? It sounds like a reasonable thing to do. Especially because the molar above implant has become sensitive.
    I would appreciate any information or comments you have.
    I want to mention that when the implant was done there was no mention of the possibility of implant failure. After the implant was in place and everything had gone well I believed it would be there forever.

    Reply
    • Dr. Peter Balogh

      Hello Carol:
      My first comment is that if you have had an implant in place for 13 years and only now is showing 1mm bone loss….you are doing very well. More importantly is to determine if this is truly just happening now or if this bone loss has been present for a longer period of time. 1mm is very difficult to ascertain unless one has 2D x rays taken at the exact same angle (or alternatively good quality 3D films). Secondly is to know why this is happening. Everything happens for a reason. The bone loss could be food impaction (are your teeth contacts tight), food collecting (are there gaps around the gums and do you clean the area well) or is it a bite issue.

      I would recommend a bite adjustment of the crown, especially if there are any contacts where they should not be. The oral surgeon may not be the best person to determine this as their expertise is in surgery….ideally someone who truly understands occlusion…could be a general dentist, implant dentists, periodontist or prosthodontist. Ideally the only contacts should be in the centre of the tooth, the cusp tips and no contact on the slopes of the teeth either in your centric bite or as you move from side to side. That is the best I can describe it in simple terms. I mention this because there may be dentists out there who do not fully appreciate the negative impact of some of the contact points.

      One thing you may consider before doing surgery, especially if the bone loss is minimal is to use a water pick. I have mentioned this in previous posts. Use hot salt water in your water pick…you need some type of antibacterial solution and saline is a good start. Do this once a day before you go to sleep and you should find the gum inflammation/tenderness will decrease and can potentially stop the bone loss. Depending on whether the underlying problem was identified and corrected and how much bone loss you truly have…this may or may not negate having to go for further treatment.
      Sincerely
      Dr Balogh

      Reply

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