Failing Dental Implants

An implant that is loose, sore or bleeding needs looking at within days, not months. Pearl32 Dentistry and Wellness in Laguna Hills assesses failing implants with a 3D cone beam scan and careful probing around the implant. Some problems are mechanical: a loose screw or a fractured crown, both fixable. Some are biological: infection and bone loss around the implant, which is harder. We see second opinions on implants placed at other offices. The earlier we look, the more we can save.

What are the signs of a failing implant?

Five things bring people in. The crown or the whole implant moves when you touch it. There is a dull ache or tenderness when you chew on it. The gum around it bleeds, looks red or gives off a bad taste. Food packs into the space next to it at every meal. Or an x-ray at a checkup shows bone loss around the implant that was not there before. An implant that is truly mobile has already lost its bond to the bone. Come in quickly, because what we can save depends on how much bone is left.

Peri-implantitis or a mechanical problem?

These are different problems and the fix differs. Mechanical problems involve the parts: an abutment screw that has loosened, a fractured crown, a worn attachment on an implant denture, or a crown that was never seated fully. The implant itself is sound, and the repair often takes one or two visits.

Peri-implantitis is biological: bacteria under the gum causing inflammation and bone loss around the implant. It starts as peri-implant mucositis, which is bleeding without bone loss, and that stage is reversible. Once bone is lost, it does not grow back on its own. Our periodontics page covers the gum side in more detail.

How is it assessed?

With a probe, an x-ray and a 3D cone beam scan. We measure the depth around the implant at six points and note where it bleeds. We compare today’s bone level with the x-ray taken when the implant was placed, if we can get it. The cone beam scan shows bone on the cheek side and the tongue side, which a flat x-ray cannot. We also unscrew the crown where the design allows, which tells us in minutes whether the problem is the screw or the bone. The examination takes about an hour.

What can be done about it?

It depends on what we find. A loose screw is retightened to the manufacturer’s torque and the access is resealed. A fractured crown is remade, often milled here in one visit. Peri-implant mucositis is treated by cleaning the implant surface and correcting whatever traps plaque, then reviewing at three months.

Peri-implantitis with bone loss needs the surface cleaned surgically under the gum, sometimes with a graft, and a periodontist visits our office for the harder cases. When too much bone is gone, the honest answer is removal. We take the implant out, graft the site, and place a new implant three to six months later when the bone allows.

Will you look at an implant placed somewhere else?

Yes, and a good number of our second opinions are exactly that. Bring whatever you have: the implant brand and size, the surgical report, old x-rays and the name of the office. Implant parts are not interchangeable between brands, and matching the right abutment screw or attachment saves time. If the records do not name the system, the cone beam scan and the shape of the implant on the image usually narrow it down. Three general dentists work here, all DDS graduates of Loma Linda University, and we will tell you plainly whether the implant is worth keeping, including when the answer is that nothing needs doing yet. See our implant dentistry page.

What does treating a failing implant cost?

We do not publish prices for implant repairs. Retightening a screw, remaking a crown, treating peri-implantitis surgically, and removing and regrafting an implant are four different levels of work. Your cost is quoted in writing, itemized, after an examination and a scan, and the assessment visit always comes before any treatment number.

We are in network with most major PPO plans and Delta Dental HMO. Third party financing is available and the practice is not the creditor, through CareCredit, Cherry, Sunbit and Happen Bank (formerly LendingClub). Call (949) 830-0074 or contact the office to be seen.

Questions people ask about failing Dental Implants

Can a failing implant be saved?

Often, if it is caught while the bone loss is small. Bleeding gum without bone loss is reversible with cleaning and a change in home care. Bone loss of two or three millimeters can usually be stopped, and sometimes partly rebuilt, with surgical cleaning and a graft. Once more than half the implant has lost its bone support, removal is the sensible course.

Why did my implant fail?

Usually one of four reasons: bacteria under the gum, too much force from grinding or a heavy bite, a crown shape that traps plaque where no brush reaches, or smoking. Uncontrolled diabetes and some medications slow healing and add risk. We look for the cause, because replacing an implant without fixing the reason tends to produce the same result twice.

Does treating peri-implantitis hurt?

The surgical cleaning is done under local anesthetic, with sedation available if you want it. Afterward, expect soreness and swelling for two to three days, similar to gum surgery. The gum often sits lower once the inflammation settles, which can leave the crown looking longer than before. We tell you that in advance so the result is not a surprise.

How soon can a new implant go in?

If the implant is removed and the site is grafted, plan on three to six months of healing before a new implant is placed, then another three to six months while bone bonds to it. When the bone is intact after removal, a new implant can sometimes go in at the same visit. The cone beam scan is what decides that.

What can I do at home to protect my implants?

Clean under and around them every day, because plaque is the one factor you control. Use floss or a thin brush under the crown, and a water flosser along the gum line. Come for maintenance every three to six months so the implant can be probed and x-rayed. If you grind at night, wear the guard. Stop smoking if you can.

This page is general information, not a diagnosis. What is right for you can only be decided after an examination.