A few weeks after an implant is placed, some people run their tongue over the site and feel something smooth and hard, or see a small grey disc where there was only gum before. If your implant was meant to heal under the gum, that is usually the top of the cover screw, the flat cap that seals the implant while the bone heals around it. It is not usually urgent, but it is worth a call to the practice so the dentist can look at it, because an opening in the gum is a place where plaque can collect.
Some implants are meant to show and some are not
Implants are placed in one of two ways. In a one-stage approach, a healing cap sits through the gum from the day of surgery, so a small metal collar at the site is expected. In a two-stage, or submerged, approach, a low cover screw is fitted and the gum is closed over the top so the implant heals out of sight. A short second procedure months later uncovers it, as described in our guide to second-stage implant surgery and healing abutments.
A Cochrane review by Esposito and colleagues (European Journal of Oral Implantology, 2009) pooled five randomised trials and found no statistically significant difference in implant or prosthesis failure between the two approaches, although the trials were small. The authors suggested the submerged approach could suit implants without optimal initial stability, sites where barrier membranes are used for bone regeneration, and cases where a removable temporary denture might press on the implant. If you are not sure which approach was used for your implant, your treatment notes or a quick call will tell you. Our article on one-stage versus two-stage implant surgery explains the choice in more detail.
In two studies, about one submerged implant in seven opened early
Researchers call this spontaneous early exposure. Tal (Journal of Periodontology, 1999) followed 372 submerged implants in 148 patients and found that 51, or 13.7%, broke through the gum before the planned second stage. Hertel and colleagues (Clinical Oral Investigations, 2017) reviewed 395 submerged implants in 165 patients and found premature cover screw exposure at 13.4% of implants, affecting 26.1% of patients.
Tal graded these openings from Class 0, where the gum is intact, through partial openings, to Class 4, where the cover screw is completely exposed. Barboza and Caúla (Implant Dentistry, 2002) noted that some openings are so small they cannot be clearly seen, so a site can be exposed before you notice anything.
Some implants are more likely to break through
In the Hertel study, exposure was more frequent in men, in implants towards the back of the mouth, with cover screws the same width as the implant platform, and when the top of the implant sat 0.5 mm or more above the bone. In a retrospective study of 103 implants in 46 patients, Cehreli and colleagues (Clinical Oral Implants Research, 2010) found more exposures when implants were placed early after an extraction than when they were placed conventionally into a healed site, and suggested that wearing a removable temporary denture may lead to more exposure and bone loss with early placement.
These are patterns across groups of patients and do not predict what will happen with any one implant.
What the studies found about the bone
The main concern with an early opening is that plaque collects at the edge of the exposed cap, the gum around it can become inflamed, and some of the bone at the top of the implant may be lost while it heals. In the studies below, the extra bone loss was usually small, and one study found no significant difference.
| Study | What was compared | Main finding |
|---|---|---|
| Tal and colleagues, International Journal of Oral and Maxillofacial Implants, 2001 | Bone level at placement and at uncovering, 206 implants in 64 patients | Significantly more bone loss with Class I to III openings than with intact gum; 10 of 115 exposed sites lost more than 2 mm |
| Hertel and colleagues, Clinical Oral Investigations, 2017 | Exposed and covered implants on X-rays at first and second surgery | Significantly more marginal bone loss at exposed implants than at covered ones |
| Soheilifar and colleagues, Journal of Long-Term Effects of Medical Implants, 2016 | Records of 48 exposed and 88 covered implants, on X-rays at first and second surgery | 0.46 mm and 0.32 mm of bone loss, not a significant difference |
| Caudill and colleagues, International Journal of Periodontics and Restorative Dentistry, 2000 | 48 implants in six baboons, exposed or still covered, examined under the microscope six months after the crowns were placed | The authors concluded that overall bone contact was similar between groups (animal study) |
Most of the human studies are retrospective, and they measured bone at the point of uncovering rather than years later. Hertel and colleagues recommended frequent reviews during healing for people at higher risk of exposure. An opening on its own does not mean the implant has failed, but it is a reason for the dentist to keep a closer eye on it.
Keeping the area clean matters most
An animal study by Jeong and colleagues (Journal of Periodontology, 2008) partly exposed implants in dogs and either kept the sites meticulously clean or allowed plaque to build up. After eight weeks, the clean sites had kept more bone height. Among the clean sites, implants fitted with a healing abutment kept slightly more bone than those left with a partly exposed cover screw, although without plaque control the result was reversed. Animal results do not transfer directly to people, but they fit with the clinical advice that plaque control is the part most within your control.
Until the dentist has seen it, and unless you have been told otherwise, these general steps may help:
- keep the area clean as advised after surgery, for example with gentle brushing using a soft brush
- avoid poking the cap with your tongue, fingers or toothpicks
- avoid chewing directly on that side where you can
- keep wearing a temporary denture only as instructed, and mention if it rubs or presses on the site
The aftercare guide for stitches after implant surgery covers cleaning in the first few weeks in more detail.
What the dentist may do
The right step depends on how much of the cap is showing, how the gum looks and how long the implant has been healing. Options the dentist may consider include:
- watching a small, clean opening at more frequent reviews, with cleaning advice and antibacterial treatment if needed
- uncovering the implant fully, often with a healing abutment; Tal and colleagues (2001) recommended exposing a partly exposed implant as soon as possible after the opening is seen
- adjusting or relieving a temporary denture so it no longer presses on the site
- taking an X-ray to check the bone level
Implants are placed at Lumi, and our implant treatment steps page sets out how each stage is planned. The implant questions page answers other common concerns about healing.
Signs that need a sooner appointment
A grey disc with healthy-looking gum and no pain is not usually an emergency, but it is still worth letting the practice know. Call the practice promptly if you notice pain or swelling that is getting worse rather than settling, pus or a bad taste from the site, or a fever. healthdirect advises seeing a dentist for gum swelling with a fever over 38°C, trouble swallowing or swelling in the cheek or jaw, and getting emergency medical care if swelling causes problems with breathing or speaking, or swelling around the eye or neck.
If the implant itself feels loose or moves, contact the practice the same day. Our article on signs an implant may be failing explains what those symptoms can mean.
Common questions
Will I need the second surgery if the cover screw is already showing?
Not always. Depending on how much is exposed and the condition of the gum, the dentist may be able to work through the existing opening when fitting a healing abutment, or a small uncovering procedure may still be needed. The dentist will explain what suits your implant.
Does an exposed cover screw mean the implant has failed?
Not by itself. In the studies above, exposed implants tended to lose somewhat more bone at the top of the implant than covered ones, although one study found no significant difference. The dentist will check the implant's stability and take an X-ray if needed.
Can the gum be stitched back over it?
Closing the gum again is not the approach described in the studies above. Tal and colleagues (2001) recommended fully exposing a partly exposed implant as soon as possible, and Soheilifar and colleagues pointed to professional follow-up and antibacterial treatment. The dentist will explain which approach suits your site.
Concerned about a healing implant?
If something has appeared at your implant site and you are not sure whether it is expected, it is better to check than to wait. You can book an appointment or contact us at our practice in Melrose Park, and a dentist can look at it and explain the next step.
Sources
- Tal H. Spontaneous early exposure of submerged implants: I. Classification and clinical observations. J Periodontol. 1999;70(2):213-219. PubMed 10102561
- Tal H, Artzi Z, Moses O, Nemcovsky CE, Kozlovsky A. Spontaneous early exposure of submerged endosseous implants resulting in crestal bone loss: a clinical evaluation between stage I and stage II surgery. Int J Oral Maxillofac Implants. 2001;16(4):514-521. PubMed 11515998
- Barboza EP, Caúla AL. Diagnoses, clinical classification, and proposed treatment of spontaneous early exposure of submerged implants. Implant Dent. 2002;11(4):331-337. PubMed 12518699
- Hertel M, Roh YC, Neumann K, Strietzel FP. Premature exposure of dental implant cover screws. A retrospective evaluation of risk factors and influence on marginal peri-implant bone level changes. Clin Oral Investig. 2017;21(6):2109-2122. PubMed 27838845
- Cehreli MC, Kökat AM, Uysal S, Akca K. Spontaneous early exposure and marginal bone loss around conventionally and early-placed submerged implants: a double-blind study. Clin Oral Implants Res. 2010;21(12):1327-1333. PubMed 20626422
- Soheilifar S, Bidgoli M, Abbasi Atibeh E, Faradmal J. Radiographic evaluation of bone-level implants with wound dehiscence between the first- and second-stage surgeries. J Long Term Eff Med Implants. 2016;26(3):245-251. PubMed 28134607
- Caudill R, Vernino AR, Holt R, Severson S, Church C. Effect of unintentional exposure of 2-stage implants upon subsequent osseointegration: histologic findings 6 months postloading. Int J Periodontics Restorative Dent. 2000;20(3):307-314. PubMed 11203572
- Jeong SM, Choi BH, Li J, et al. Influence of abutment connections and plaque control on the initial healing of prematurely exposed implants: an experimental study in dogs. J Periodontol. 2008;79(6):1070-1074. PubMed 18533785
- Esposito M, Grusovin MG, Chew YS, Coulthard P, Worthington HV. One-stage versus two-stage implant placement. A Cochrane systematic review of randomised controlled clinical trials. Eur J Oral Implantol. 2009;2(2):91-99. PubMed 20467608
- healthdirect. Toothache and gum swelling. Last reviewed February 2026. healthdirect.gov.au
This article is general information only and is not a substitute for advice about your own situation from a dentist.
