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Why Do Dental Implants Fail?

About 30% of my practice is treating failing implants, removing them, rescuing them. Let’s talk about why, and why did your implant fail or why do they hurt? 

There is no one reason why dental implants fail. Reasons can range from anatomical – not enough bone or gums – to problems with the bite and mechanical issues and the type of bone you have.

Other reasons for failure may be related to the care and maintenance of implants. They need to be brushed, flossed and cleaned just like any other tooth.

For more details watch the video below and if you have questions or comments, please post them below and subscribe to my channel to get more information about dental implants.

Why did my dental implants fail?

Video transcript lightly edited for easier readability.

Why do implants fail? About 30% of my practice is treating failing implants, removing them, rescuing them. Let’s talk about why, and why did your implant fail or why do they hurt? Sometimes that’s the path that went to failure first. First off, there’s no one reason. But oftentimes the anatomical reasons are you didn’t have enough bone, you didn’t have enough gum, one or both of those. Those are the primary factors. Just having enough space for the implant to hold into. Other things I’ll talk about is your bite, and the mechanics and the type of bone that you have.

Let’s just jump right into it. So, with regards to the bite, having a bite that’s too strong, or a bite that’s poorly designed with the crown, or let’s say an all on full-mouth restoration. If the bite is too heavy, it will completely damage and destroy the implant. You’ll lose bone around it. We call that peri-implantitis, where the tissue can become really red around it. That’s the first sign. They call that mucositis.

So the bite is a big factor. Maybe you don’t have enough implants, too many teeth are attached to the bridge. Maybe an all on four should have had six implants instead, or maybe some zygomatic support or sinus grafting. Maybe you just don’t have enough implant so there’s just more load than the implants can hold. And the bone itself, there’s poor quality bone and there’s good quality bone. Poor quality bone is really soft, and I’ve written many articles on this. A soft bone has a higher failure rate. Typically, you need more implants longer, different ways, densifying the bone to put it in. And on the opposite side, very hard. It doesn’t have enough blood. It’s somewhere in the middle where the bone is medium hardness with regards to the design of your teeth. So that can make or break everything. The skill of the restorative dentist, the experience of the lab, the whole experience of the team. Let’s say you have an all on four, or just a crown that has really bad contours, it snags floss, it’s got a big ledge, stuff gets stuck underneath it, and you just can’t clean it out.

Maybe it’s failing because you don’t clean it enough. Dental implants need to be brushed, and flossed, cleaned, maintained, and have x-ray checks and everything else. It requires proper hygiene. There are some people who thought they did not have to brush implants at all, and have let them go and never gone back to the dentist after they were put in. The design of the bridge is really important. The design of the tooth. It really takes an expert lab technician.

I work with an expert team, and they’re my partner on the other side. Every single case I do is very particular in its design process. Like I said, the experience of the whole team, that includes the lab as well. Switching labs, trying to find the lowest cost materials and the people that work with, those just end up in disaster. And again, about 30% of what I’m doing is removing implants. In fact, last week I took out more implants than I put in. It was really just a bad week. There was some treatment done from out of the country, some right here in Southern California as well.

Maybe it was the actual surgery itself. The procedure wasn’t done with a high degree of sterility. It was just a dental bib and no antibiotics for something major. Antibiotics are not necessary for all cases, but most cases that require grafting, or big cases require some sort of antibiotics for you to be able to prevent and fight infection. Because it’s a large opening for a long time. Materials wise, there is a hybrid, there are plastics, acrylics, the dentures are made of different materials. Zirconia versus metal, how this is designed, and how the bite is supported so that when you grind your teeth it protects itself. We call that a mutually protected bite. When you grind from one side to the other, the right side protects the left side and vice versa when you bite up and down. All of these things, the inclination of the implants, the slant or the abutments fitting properly, or are they the right screws? Are they aftermarket parts? There are original parts with really good implant systems, and some very good complimentary parts as well. And then there are some knockoffs.

There are parts sold on Amazon and eBay, believe it or not, it’s crazy. I can’t even believe it. Other things that I talk about with patients are the quality of your gum. So the gum should have a certain thickness to it. It should have certain durability to it. As the skin of your hand is very durable. It has something called keratin in it to make it tough. You can bang it and it doesn’t get cut or beat up, while the skin of your eyelid is very delicate. So we have a similar relationship in our mouth where we have eyelid skin, and skin around our palm of our hand. And if you have more like eyelid movable skin, we call that mucosa, around the implant, it’ll be really sensitive when you brush. It’ll all be red, and that’s not durable over time. So you start to lose bone, it begins to hurt, and this is part of the failure process. Most failures don’t happen instantly. Some failures, most of them happen very slowly.

Some failures happen right after the surgery, a month out the implant becomes a loose, some of them are are a year, three to five years out, gradual bone loss, gradual redness, plaque accumulation, and then you’re losing bone. There’s an abscess, there’s an infection, recurrent antibiotic treatment over and over only to then lose the implants. My best advice is get it done right the first time. Maintain it with a practice that’s all they do is implant dentistry, and that they care about you like they would their own family. But this is just one of the many reasons why dental implants fail, and just something to know about. Dental implants are not permanent.

Your comments are welcome. To see more videos like this, please subscribe to my YouTube channel.

4 thoughts on “Why Do Dental Implants Fail?

  1. Dr. Amin, I had a titanium dental implant placed on 2/11/2020, and it has been painful since it was placed. The periodontist who placed the implant said that there is nothing wrong with the gums or x rays. Two weeks after placement he had to remove the healing cap because the upper tooth was touching it. I felt a horrible pain when he tried to place a shorter cap, so he just placed a screw cover and let the gum above to close on its own. I have been keeping it cleaned with Peridex mouth wash 3 times a day. The pain fluctuates, and it is throbbing sometimes, and dull another times. Last night it woke me up from sleep. I also feel tingling on the side of my tongue. The periodontist wants to keep watching it, but i wonder if it is causing some nerve damage. What is your opinion? What could have caused this, other than infection? Should he remove the implant right away? I appreciate any help you can give me. Thanks.

    1. It sounds like his of in a month already. It is very likely the implant may be failing. Dental implants typically do not have pain this far out. Take an x-ray. Hopefully by week 6 all pain is gone if not is likely going to fail. Please keep me posted on what happens with this tooth so that a can benefit others as well. Prayers sent!

  2. Dr. Amin ,
    I pray my implants aren’t failing I go to the original dentist that put my implants in . I have all on 4 I just had a X-ray it showed a tremendous amount of bone loss . But what I don’t understand is if I just had a sinus lift with bone , just 2 yrs ago . How could I have lost the bone? I’m so hopeful you will be able to help me ….

    1. I saw your x-ray! You are losing bone on your right side at a rapid rate. The bone that you are losing is not inside of the sinus but rather at the edges where the teeth used to be. Unfortunately this will likely be progressive. Are you a smoker? That will certainly cause the bone to dissolve.

      Sorry 😐

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About Ramsey A. Amin, DDS

Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.