Implant dentistry is not perfect. The treatment is reliable, with many patients receiving a restoration that is long-lasting and functional. Unfortunately, though, success rates are not, and may never be, 100%.
There are many reasons a dental implant may fail. Patients could have a systemic health condition that puts an implant at risk, like diabetes or osteoporosis. Patients with poor levels of glycaemic control are likely at risk of postoperative surgical complications, and osteoporotic individuals that do not look after their nutritional needs or indulge in lifestyle habits such as smoking may face a similar fate.[i]
Patients without pre-existing health conditions may still experience failure, through the development of peri-implantitis following poor oral hygiene, or the occurrence of an implant fracture,i as two examples.
Luckily, for many patients, in the face of implant failure there may still be hope. With effective and timely care, they may yet have a restoration that stands the test of time.
Identifying failing implants
Every dentist should know what a failed implant looks like, from general dental practitioners to specialist oral surgeons.
Early implant failure may result in minor peri-implant bone loss, and will typically occur prior to or at the abutment connection.[ii] Extensive bone loss may be present in the case of late implant failure, which is seen after occlusal loading, and is more common than early failure.ii
Both patients and clinicians may be able to identify implant failure, and individuals should be advised to contact their dentist immediately if they suspect there is an issue. Signs of complications may include difficulty chewing, inflamed or recessed gums around the implant site, increased swelling, severe pain and discomfort, or the mobility or loosening of the implant or crown.[iii]
Early detection and intervention are essential to control the progression of bone loss around an implant, and have a chance at reversing its fate.[iv] Regular patient visits post-surgery may allow you to spot the signs of implant failure in a timely manner. This does not only mean in the immediate weeks and months following placement. In subsequent years, it is still important to regularly see patients and assess the health of an implant site.
Intervene early
If and when you spot complications with an implant, devising an effective treatment plan is essential. In many cases, the hard and soft tissue at the implant site will already be affected. Preserving its health is a fundamental first step, before it can then be treated for a potential replacement of the dental implant, should it be eventually necessary.
A patient with peri-implantitis may find the greatest chance at a full recovery with surgical treatment. The mechanical decontamination of the implant surface, perhaps with ultrasonic devices or appropriately designed curettes, or implementation of laser implant treatment have been discussed as options – even in conjunction with each other – but the literature concludes that with proper case selection, surgical intervention is most effective when resolving peri-implantitis.[v]
There are a variety of surgical interventions that may be of use, and promising results have been observed in studies that use a combination of bone graft or bone substitutes with guided bone regeneration for regenerative therapy.[vi]
Appropriate case selection is fundamental. When there is a bony defect of 3 or 4 walls, with favourable anatomy, guided bone regeneration is recommended as the treatment of choice.v Where this is not the case, it may still be of use, but the judgement of an experienced clinician will be invaluable.
The procedure typically includes the raising of a flap in order to access an infrabony defect, where decontamination of the implant surface is carried out. Supplementary antimicrobial agents may be of use here. Bone grafting material is then utilised to fill the defect with the subsequent addition of a barrier membrane – note that there is no one bone augmentation material or membrane that is agreed to facilitate superior treatment outcomes.v
Clinical judgement
Whilst surgical intervention and guided bone regeneration are recognised as effective treatments for recovery of a failing implant, clinicians must only carry out these procedures when they have the appropriate training and experience to do so. If an individual presents with a complication regarding their implant, and you cannot confidently provide effective care, you must refer the patient to an appropriately trained professional.[vii]
Consider referring them to clinicians like Dr Fazeela Khan-Osborne and Dr Nikolas Vourakis of The One to One Dental Clinic, London. Dr Khan-Osborne is the founder of the clinic and One to One Implant Education, where she is joined by Dr Vourakis in providing effective care in complex implant cases, as well as training and supporting the next generation of clinicians in implant dentistry. Both professionals are backed by years of clinical and educational experience, and actively take on referral cases to support patients and clinicians alike.
With early intervention, implant failure can be avoided. Employing effective surgical solutions, such as guided bone regeneration, may help in the recovery of an implant site, and provide a greater opportunity for successful retreatment in the future.
To learn more about referrals to The One to One Dental Clinic, visit
https://121dental.co.uk/for-dentists/referrals/ or contact 0207 486 0000
Dr Fazeela Khan-Osborne Bio:
Principal Implant and Restorative Surgeon
MSc.BDS (Lon) BSc(Hons) LDS.RCS (Eng) DRDP Dip. Imp. Dent.(RCS.Eng)Advanced Certificate, FCOI
Nikolas Bio:
Nikolas is a Senior Implant and Restorative Surgeon in private clinics in London and Edinburgh.
His special interest and main qualifications are in Oral Surgery and Oral Implantology, while he has vast experience in all areas of Aesthetic Dentistry.
He has been a practising Dental Surgeon since 2005 after graduating from the prestigious Military Academy Medical School at the University of Thessaloniki, Greece.
Nikolas started his training in the Oral and Maxillofacial Surgery Department of the 401 Military Hospital in Athens, Greece. As a military officer, he then went on to serve as a team leader in a field hospital in Kabul, Afghanistan – an experience, which shaped his commitment and dedication to his chosen field. On returning to Greece, he furthered his
training completing a Postgraduate Diploma in Oral Implantology from the University of Athens, Greece and a Master of Science Degree in Oral Surgery/Implantology from Göethe University of Frankfurt, Germany.
He recently obtained an Advanced Surgical Master Curriculum in Regenerative Implant Dentistry next to Dr Istvan Urban in Budapest, Hungary.
Nikolas is lecturing about Dental Implants and Regenerative Dentistry, and he is holding a program for introducing and mentoring dentists in Implant Dentistry.
He is a Member of the Association of Dental Implantology and the International Team for Implantology.
[i] Kochar, S. P., Reche, A., & Paul, P. (2022). The etiology and management of dental implant failure: a review. Cureus, 14(10).
[ii] Oh, S. L., Shiau, H. J., & Reynolds, M. A. (2020). Survival of dental implants at sites after implant failure: A systematic review. The Journal of prosthetic dentistry, 123(1), 54-60.
[iii] Higuera, V., Frank, C., (2018). What to Know About Dental Implant Complications and Failure. Healthline. (Online) Available at: https://www.healthline.com/health/dental-implant-problems [Accessed March 2024]
[iv] Talreja, P. S., Gayathri, G. V., & Mehta, D. S. (2013). Treatment of an early failing implant by guided bone regeneration using resorbable collagen membrane and bioactive glass. Journal of Indian Society of Periodontology, 17(1), 131-136.
[v] Kormas, I., Pedercini, C., Pedercini, A., Raptopoulos, M., Alassy, H., & Wolff, L. F. (2020). Peri-implant diseases: diagnosis, clinical, histological, microbiological characteristics and treatment strategies. A narrative review. Antibiotics, 9(11), 835.
[vi] Madi, M., Htet, M., Zakaria, O., Alagl, A., & Kasugai, S. (2018). Re-osseointegration of dental implants after periimplantitis treatments: a systematic review. Implant Dentistry, 27(1), 101-110.
[vii] General Dental Council, (2019). Standards for the Dental Team. (Online) Available at: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/standards-for-the-dental-team [Accessed March 2024]
