If an implant suddenly feels different, the first step is to work out what has actually changed. A crown that clicks, a gum that bleeds and an implant that moves in the bone are three very different problems, and only the last one means the implant itself is failing. All three are worth a prompt visit, and most implant problems are easier to manage the earlier they are seen.
Implant failure is not common. A 2019 review of long-term studies in the Journal of Dentistry (Howe and colleagues) put 10-year implant survival at about 96%, or about 93% when patients lost to follow-up were allowed for. The rest of this article covers the minority of cases where something goes wrong.
The crown, the screw or the implant
An implant tooth has three parts: the implant in the bone, a connector called an abutment, and the crown on top. A small screw usually holds them together. When patients say their implant feels loose, it is quite often the crown or that screw that has worked loose rather than the implant. That is normally a repair job: the crown is taken off, the screw is replaced or tightened and the crown goes back on.
If the implant itself moves in the bone, the situation is more serious, because it means the bond between bone and implant has been lost. You cannot reliably tell the difference by feel, so avoid wiggling it and let a dentist check it.
Failure in the first weeks and months
After placement, bone grows tightly against the implant surface over several months. Our guide to how dental implants work explains that stage. An early failure is one where this bonding does not happen properly. It may show up as pain that worsens instead of easing, ongoing swelling, an implant that feels mobile, or a sense that the area never quite settled.
Known contributors include infection at the site, smoking, too little bone to hold the implant firmly at the start, and too much force on the implant before it has integrated. Early failures often become apparent before the final crown is fitted.
Failure years later
Late problems usually come from the gum and bone around an implant that has been working well. Plaque builds up, the gum becomes inflamed, and in some people the inflammation spreads into the bone. This is peri-implantitis. The 2017 World Workshop on periodontal and peri-implant diseases (Berglundh and colleagues, Journal of Clinical Periodontology, 2018) described it as a plaque-associated condition with progressive loss of supporting bone.
Signs to look out for include:
- bleeding when you clean around the implant
- red, swollen or tender gum
- pus or a persistent bad taste from the area
- the gum shrinking back so that metal shows at the gumline
- discomfort when chewing on the implant crown
Heavy grinding or clenching can also overload an implant, crown or screw over time. Risk is generally higher in people who smoke, have a history of gum disease or find it hard to clean around the implant, and poorly controlled diabetes may add to it, as explained further in our article on who is a good implant candidate.
What to do if you notice something
- Book an appointment soon. Pus, swelling or a moving implant warrant a prompt visit rather than waiting for the next check-up.
- Leave the implant alone. Avoid testing it with your tongue or fingers, and chew on the other side for now.
- Keep cleaning gently. Stopping cleaning because the gum bleeds tends to make inflammation worse.
- Note what you have seen. When it started, whether it hurts, and any change in your health or medicines all help.
- Bring any records you have. If the implant was placed elsewhere, the implant details or old X-rays help identify parts and compare bone levels.
What the dentist will check
The examination usually includes looking at the gum, gently measuring the pocket around the implant, checking for bleeding or pus, testing whether the crown or the implant moves, and checking your bite. An X-ray shows the bone level around the implant and, compared with earlier images, whether bone has been lost.
Treatment depends on the stage
When only the gum is inflamed, professional cleaning around the implant and better home care can often settle it. If bone has been lost, treatment may involve a deeper clean of the implant surface, sometimes with surgery to reach it, and in some cases bone regeneration. Our guide to peri-implantitis treatment goes through these options. A loose crown or screw is repaired, and a bite that is overloading the implant can be adjusted, often alongside a night splint for grinding.
If an implant has lost its bond with the bone, it usually has to be removed. After the site heals, and sometimes after a bone graft, another implant can often be placed. Bone that has been lost around an implant does not regrow by itself, which is the strongest argument for acting early.
Questions we are often asked
Can a failing implant be saved?
Often, if the problem is found before much bone has been lost. Once an implant moves in the bone, removal and later replacement is usually the more predictable path.
My implant was placed at another practice. Can it still be checked?
Yes. Any dentist can examine the implant and take an X-ray. Knowing the implant system helps when parts need replacing, so bring any paperwork you have.
Will a replacement implant work if the first one failed?
Many replacement implants do well, especially once the reason for the first failure has been dealt with. Your dentist will look at the bone, your gum health and any risk factors before suggesting a plan.
How can I lower the risk of problems?
Clean carefully around the implant every day, keep up regular reviews, avoid smoking and manage grinding. Our article on how long implants last covers the habits that make the biggest difference.
Getting an implant looked at
If an implant has started to feel loose, bleed, ache or taste unpleasant, an examination and X-ray will usually show what is going on. Lumi Dental offers free implant consults, and we can check implants placed here or elsewhere. Visit our dental implants page or see current offers to book. This article is general information and not a substitute for personal dental advice.
