Dawood & Tanner Dental Implant treatments are very successful and rarely fail. However, many patients are referred to us with implant problems for advice, treatment, or re-treatment. Implant treatments are a lifelong commitment, it is important to also consider the potential for short-term failure or longer-term problems. 

For an implant to be used to support a dental restoration it needs to osseointegrate; this means that living bone must actually grow on to the surface of the implant. Ideally, the implant needs to be well anchored in good quality healthy bone, in a healthy patient and without heavy biting forces.

Using high quality implants, implant components, and laboratory work, as well as highly biocompatible materials and precisely engineered implant parts will make a great difference to the long-term outcome of implant treatment. For many of the patients who are referred to us with implant problems, the main reason for failure has been the use of inadequate low cost implants or implant components!

Implant Failure

Failure is a little more common at the back of the mouth, where the jawbone tends to be ‘softer’ and there may be less bone available. Implants that fail outright usually do so before impressions have been taken for definitive crown and bridgework - that is before treatment has been completed.

Peri-implantitis

A patient who is not in the best state of health or has dental or gum problems near the implant, can be more prone to having problems with their implants. Failure is definitely associated with smoking; someone who smokes may have poor bone quality and a poor healing capacity, and that an implant simply does not ‘take’. Peri-implantitis is an issue which is becoming more common, simply because we see more and more patients who have been treated with dental implants over the years. In many respects there are similarities with periodontal (gum) disease around teeth. The first sign of a problem may be soreness or bleeding from the gum – ‘mucositis’. Treatment at this stage may prevent progression to peri-implantitis, when progressive bone loss starts to become an issue, and can ultimately lead to catastrophic loss of the supporting bone as well as the implant or implants.

Image 1: The gum is inflamed and bleeds easily. A probe sinks into a pocket between the gum and the implant restoration. Image 2: Gum inflammation caused by the use of non-implant grade materials

In our practice we only use of titanium or zirconium abutment connectors to connect the implant tooth to the implant 'screw'. These are exceptionally biocompatible materials, which tend to maximise gum health. Unfortunately we see many patients every year who have been provided with low-cost treatments that have used low-cost implant components and laboratory work.

Peri-implantitis can take years to develop, progresses slowly, sometimes in fits and starts, and the fact that inappropriate materials or techniques have been used may only become evident later on. It can develop in patients who have a history of gum disease, those who have not had any gum disease. On the other had, there are patients with very severe gum disease who have had no problems at all with their implants.

A high biting force from clenching or grinding teeth (‘bruxism’) also seems to cause bone loss around implants. People who are smokers or diabetic are more at risk of peri-implant problems. When there is substantial bone loss, this will usually lead to complete failure of the implants and restoration, making re-treatment more complicated. We treat many patients every year who have been referred with bone loss caused by implant treatments who have not been able to find treatment elsewhere. Treating peri-implantitis can be extremely challenging. We know that meticulous hygiene will improve comfort and slow down the progression of the condition. Treatment consists of cleaning under the gum of the implant meticulously using ultrasonics and jet-polishing and grafting with bone scaffold materials in order to replace the missing bone tissue or thicken the surrounding gum. This sort of treatment can make the area more comfortable and the peri-implant condition more quiescent, allowing for survival of the implant crown or bridgework.

Where the problem is persistent or there has been advanced bone loss, there is sometimes little alternative but to remove and replace an ailing implant, which may also mean loss of the implant restoration. In these circumstances, loss of the implant may be accompanied by a great deal of bone loss although we will generally find a solution which may involve the use of grafting, special custom implants such as Zygomatic implants, or specially made short implants.

Failed implant; a poor quality, inappropriate crown has been provided using non-implant grade materials.
Failed implant; a poor quality, inappropriate crown has been provided using non-implant grade materials.