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Why Implants Fail: Understanding the Causes and How to Prevent Them

joseelaradds

Updated: Oct 21, 2024


Reduce Implant Failure Rates in Your Practice

Dental implants are widely regarded as the gold standard for replacing missing teeth, with consistently high success rates. However, as with any procedure, complications can arise that may lead to implant failure, which can be demoralizing for both patients and doctors. By understanding the reasons behind implant failure, dentists can learn valuable lessons—whether it’s something that was initially overlooked in the pre-op case overview or an unexpected issue, such as retrieving an implant that migrated into the sinus of a heavy snorer. Let’s explore some of the most common causes of dental implant failure and how we can prevent them.


  1. Poor Osseointegration

One of the primary reasons dental implants fail is poor osseointegration, which occurs when the implant does not properly bond with the surrounding bone. This fusion process is essential for providing the implant with a stable foundation. Without successful osseointegration, the implant can become loose or even fall out, compromising the entire restoration.


Causes of Poor Osseointegration:

  • Inadequate Bone Density: If the patient's jawbone lacks sufficient strength or density, it may not provide the support needed for successful implant integration. Bone density is typically classified from D1 (the densest) to D4 (the least dense). As the bone density decreases, the likelihood of successful integration diminishes.

  • Immediate Loading: Placing too much pressure on the implant too early—such as attaching a crown before the bone has fully healed—can interfere with the osseointegration process, leading to potential failure.

Preventing Poor Osseointegration:

  • Bone Grafting and Proper Healing Time: For patients with insufficient bone density, bone grafting or other augmentation procedures can create a stronger foundation for the implant. After allowing adequate healing time, usually several weeks, the implant can be placed successfully, significantly improving long-term success rates.

  • Under-Drilling Technique: When dealing with lower bone density, using the under-drilling technique can enhance osseointegration. Instead of drilling to the exact width of the implant fixture, a slightly smaller drill size is used. This creates a tighter fit, allowing the implant to better integrate with the bone, preventing it from loosening or spinning during placement.


All-on-4 dental implants case study
  1. Infection or Peri-Implantitis


Another common reason for implant failure is infection, specifically peri-implantitis. This condition occurs when bacteria build up around the implant site, leading to inflammation of the surrounding gums and bone. If left untreated, peri-implantitis can result in bone loss and implant failure.


Causes of Infection:

  • Poor Oral Hygiene or Smoking: Failure to maintain proper oral hygiene after the implant is placed can result in the accumulation of bacteria forming around the implant. One huge factor in this would be smoking. Smoking impairs healing and increases the risk of infection. 

  • Existing Gum Disease: Patients with untreated gum disease are at a higher risk of developing peri-implantitis.


Prevention Strategies from Infection:

  • Meticulous Oral Care: Patients must commit to regular brushing, flossing, and professional cleanings to keep the area around the implant free from harmful bacteria.

  • Quit Smoking: Pretty obvious but yes, stopping smoking can significantly improve the chances of a successful implant and overall oral health.

  • Gum Disease Treatment: Any pre-existing periodontal issues should be addressed and resolved before implant surgery to reduce the risk of infection. 




Bonus Question: Can an implant still be placed even though there is an infection in the area of the surgery?

  • Yes

  • No



  1. Medical Conditions & Medication


An often overlooked but significant factor in implant failure is the impact of certain medical conditions and medications. These can interfere with the body’s healing process, increasing the risk of complications. Conditions such as diabetes, osteoporosis, and autoimmune disorders can slow healing, reduce bone density, and raise the likelihood of infection, all of which can compromise the success of dental implants.


Prevention Strategy

  • Medical Consultation/Pre-Screening: As with anything it is important for patients to discuss their full medical history with their dentist, including any medications they’re taking. In some cases, a collaborative approach with the patient’s doctor may be necessary to manage their condition during the implant process. For example, properly controlling conditions like diabetes can greatly improve the chances of a successful implant outcome.



  1. Implant Mispositioning


Implant failure can sometimes occur due to improper placement, often resulting from poor planning, inaccurate positioning, or misjudgment of the patient’s bone structure and bite. A common mistake with newer practitioners is the lack of attention to the emergence profile, which can lead to food trapping, infection, and eventual bone loss. I firmly believe that taking a 'restoration-first' approach is crucial when placing implants. By prioritizing the final restoration from the beginning, many of the issues that lead to implant failure can be avoided, ensuring a more predictable and successful outcome.


Prevention Strategies

  • Comprehensive Pre-Surgical Planning: Using advanced technology like CBCT scan can help ensure precise implant placement. This level of planning reduces the likelihood of misalignment or placement in areas with insufficient bone support. 

  • Surgical Guides: More advancements in technology have made the use of surgical guides incredibly straightforward and efficient. With precise 3D imaging of the patient's mouth, an experienced technician can accurately plan and calculate the exact placement of each implant, ensuring optimal positioning and improved surgical outcomes.

  • Experienced Implant Professional: Choosing a skilled and experienced dental professional who has extensive knowledge in implant placement is critical for achieving a successful outcome.




  1. Bruxism (Teeth Grinding)

Bruxism, or teeth grinding, places excessive pressure on dental implants and can lead to failure. The constant grinding can cause the implants to loosen or even fracture over time.

Causes of Bruxism:

  • Stress and anxiety: Emotional stress is one of the most common triggers.

  • Sleep disorders: Conditions like sleep apnea can contribute to bruxism.

  • Abnormal bite or misaligned teeth: Dental issues like malocclusion can lead to grinding.

  • Lifestyle factors: Smoking, caffeine, alcohol, and recreational drugs may increase the risk.

  • Medications: Certain antidepressants and antipsychotic drugs have been linked to bruxism.

  • Genetics: Some individuals may have a genetic predisposition to grind their teeth.

Prevention:

  • Night Guards: Patients who grind their teeth should be fitted with a custom night guard to protect their implants and natural teeth from excessive wear and tear.


Continuing Education in Dental Implants



Although dental implant failure is relatively uncommon, it’s crucial to understand the factors that can contribute to it. By recognizing the causes and taking the necessary preventive measures, both patients and dental professionals can work together to maximize the long-term success of implants. In the case of the heavy snorer I mentioned earlier, despite taking all the right precautions for low-quality bone and utilizing the under-drilling technique, complications still arose. Sometimes, unforeseen issues happen. However, these experiences serve as valuable learning opportunities, just as they will for many of you.

Successful implant outcomes rely on thorough planning, meticulous attention to oral hygiene, and proper management of medical conditions. With the right approach, dental implants can remain a durable and effective solution for tooth replacement.


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