Problems with an Existing Dental Implant
Implants can develop the same kind of inflammation and bone loss that teeth do, called peri-implantitis. Caught early it can usually be treated and the implant kept. Caught late it may mean removing the implant, rebuilding the bone, and starting over. Either way, the sooner it is seen the better the options.
“Several doctors told me a new implant was out of the question because the bone loss was too severe to be grafted. … He performed masterful bone/tissue graft and now my new implant is firmed anchored. Dr Verrett is awesome! I highly recommend him!!”
“The staff at Austin Periodontal Associates are thorough and careful. I have an implant and they are very good with regular cleaning, alternating with my dentist. I have had good experiences with their doctors and professional staff.”
Peri-Implantitis, Briefly
The gum and bone around an implant respond to bacteria the way they do around a tooth, with one difference: an implant has no periodontal ligament and a poorer blood supply, so inflammation is less well contained and bone loss can progress faster. Peri-implant mucositis is inflammation of the gum only and is fully reversible. Peri-implantitis is inflammation with bone loss and needs treatment. The American Academy of Periodontology draws the same line, describing mucositis as inflammation found only in the soft tissue with no sign of bone loss, and peri-implantitis as inflammation with deterioration of the bone supporting the implant.
Peri-implantitis treatment sets out each step in detail. Neither condition is rare. A meta-analysis by Derks and Tomasi in the Journal of Clinical Periodontology found mucositis in roughly 43 percent of patients with implants and peri-implantitis in roughly 22 percent. The review of peri-implantitis prepared for the 2017 World Workshop found the strongest evidence for a history of periodontitis, poor plaque control, and no regular maintenance care after implant therapy.
What We Do
- Exam and cone-beam CT (a 3D X-ray). We measure pocket depths, bleeding, and bone levels around the implant in three dimensions, and check the crown and the way it seats.
- Non-surgical treatment. For mucositis and early peri-implantitis: thorough cleaning of the implant surface with instruments designed not to scratch it, and adjustment of the crown if it is trapping plaque.
- Surgical treatment. When bone loss is established: the gum is opened, the implant surface is cleaned and decontaminated, and depending on the shape of the defect, bone is regenerated with a graft or the area is reshaped to make it cleanable.
- Removal and replacement. When the implant cannot be saved. The site is grafted and a new implant placed after healing.
- Maintenance. Every treated implant is checked every three to six months, alternating with your dentist. In a five-year follow-up by Costa and colleagues of patients who already had inflammation around an implant, peri-implantitis developed in 18 percent of those who kept preventive maintenance and 43.9 percent of those who did not.
If an Implant We Placed Fails
An implant placed by Dr. Verrett that fails early, meaning it does not integrate or is lost within the first year, is removed and replaced at no surgical cost, after the site has healed and, if needed, been grafted. Grafting associated with that replacement is included. After the crown is on, we look for the cause with you and your dentist first, because late problems usually trace to something specific: the bite, the crown or cement, cleaning, or a change in health. We say what we found and what it will take to fix it.
Second Opinions
If you have been told an implant is failing, or that you need a full-arch replacement, and you would like an independent assessment, we offer that. A second-opinion consult includes an exam, a scan, and a written summary that goes to you and, with your permission, to your treating dentist. We don’t solicit second opinions and we don’t take over another dentist’s plan. Request a consult.
For Referring Dentists
Send us peri-implant cases early. Bleeding on probing around an implant with any radiographic bone change is enough. Referral information.
Considering another opinion before committing to a plan? Getting a second opinion covers what to bring and what the visit involves.
Frequently Asked Questions
What are the warning signs?
Bleeding when you brush around the implant, redness or swelling of the gum, a bad taste, pus, the gum pulling back to expose threads, or the implant feeling loose. Pain is often absent until late, which is why routine checks matter.
Can an implant be saved?
Often, when bone loss is limited. Treatment removes the bacterial film from the implant surface, treats the inflamed tissue, and in selected cases regenerates lost bone with a graft. In this practice, when more than about half the supporting bone is gone or the implant is mobile, removal and replacement is the more predictable path.
I had my implant placed somewhere else. Will you see me?
Yes. We regularly see patients for second opinions and for treatment of implants placed elsewhere, including at implant centers. Bring any records you have; we will obtain the rest with your permission.
Why did this happen?
The factors with the strongest evidence behind them are plaque around the implant that daily cleaning and professional maintenance did not remove, a history of gum disease, and going without regular maintenance after the implant was placed. Cement left under the crown and an implant placed in too little bone or at an angle that traps plaque are linked to it on more limited evidence, and the evidence on smoking and diabetes is mixed rather than settled. We will tell you which apply and what to change.
What happens if the implant has to come out?
Removal ranges from simple to involved, depending on how much bone still holds the implant. The site is grafted, allowed to heal for three to six months, and a new implant is placed in sound bone. Replacement implants succeed slightly less often than first implants; we'll go through what that means for your site.