Dental implants are designed to last for your entire life. That doesn’t mean they cannot fail, or won’t require any maintenance, but under ideal circumstances, implants are one of the most predictable procedures in dentistry. The long term (20 year) success rate for dental implants is above 90%, with 10 year success rates generally above 95%. Although they are considered a last resort, implants are usually the most ideal option for replacing teeth.
What is a dental implant made of?
Dental implants are small screws that go into the jawbones to act as tooth roots. Implants are generally made of titanium, although there are alternative materials such as zirconia that can be used in some circumstances. After the implant is placed, a prosthetic tooth called a crown will be attached to the implant with a connector called an abutment.
What is the process of getting a dental implant?
- Extraction and Bone Grafting which takes about 30-60 minutes, then 3+ months of healing.
- Implant placement which takes about 60 minutes, then 3+ months of healing.
- Abutment and crown fabrication. The actual visit for this is about 30 minutes because the crown is pre-made
Before an implant is placed, the tooth or teeth that are going to be replaced need to be extracted. When the tooth is extracted, a procedure called bone grafting is usually done to fill in the defect left by the now missing tooth. Bone grafting material is a powdery substance that is placed in the socket, covered by a membrane, and then left to incorporate into the bone for about 3 months.
When the implant is placed, the titanium screw is placed in the bone, and then has to be allowed to heal into the bone (a process called osseointegration) for at least 3 months before it can have a crown placed on it. If force is put on the implant before it solidifies into the bone, it will not heal properly.
How long does a dental implant take?
Implants are a multi-step process with a lot of waiting in between. If you calculate all the healing time involved after the extraction, and then after the implant placement, it will take at least 6 months before a crown can be put on so you have a tooth in the space.
Do I have to leave a space for 6 months while my implant heals?
If you are having an implant placed in an area that is visible, a temporary appliance called a “flipper” can be made to fill the space while you wait for everything to heal. A flipper is essentially a plastic retainer with a tooth attached, and although it is not a great long-term solution, it is generally sufficient to get you through the implant process without others knowing you’re missing a tooth. If you are having a back tooth replaced with an implant, a flipper is probably not necessary during the implant process.
Do dental implants hurt?
The process of getting a dental implant may sound intimidating, but the placement of the titanium screw into the bone is designed to be non-traumatic so the bone can heal properly. It is a minor surgical procedure, but generally, there is only minimal soreness of the gums where the incision was made. Most patients find that the “worst” part of the implant process is having the tooth extracted, and each step from there gets easier.
How / Why Do dental implants fail?
Implants can fail soon after placement if they don’t integrate into the bone, or they can fail after having been in the mouth for years. Early implant failure happens in the first year and is more common than failure later on.
There are many elements that can affect the success of implants including:
- Oral hygiene habits
- Skill of the doctor
- Quality and quantity of bone
- Patient health
- Medications
The quantity and quality of bone that is available in the placement site is a very important factor. For example, the bone in the upper jaw is generally less dense, so implants are more likely to fail. If a tooth has been missing for years prior to implant placement, the bone may have shrunk and additional procedures like ridge augmentation or a sinus lift may be necessary to have sufficient bone to place an implant.
Before placing an implant, your doctor should take a 3D x-ray called a CBCT to determine if there is sufficient bone to place an implant, and have a surgical guide made to be sure the implant is put in at the most ideal area and proper angle.
One of the most common causes of implant failure years after placement is peri-implantitis, which is gum disease around the implant. If you have lost teeth due to gum disease, your risk of losing implants due to the same issue is significantly higher.
What health conditions affect dental implants?
It is important to talk to your dentist or oral surgeon about all of your health conditions, but especially high risk conditions include:
Smoking: Due to decreased blood flow to the oral tissues, studies have shown significant increases in implant failure in smokers.
Diabetes: Patients with diabetes, especially if it is poorly controlled, have slower wound healing and are more likely to have implants fail.
COVID -19: Extensive studies have not been completed, but it is worth noting doctors have observed increased implant failure in patients with COVID-19 infection prior to implant placement or during implant healing.
What medications affect dental implants?
Although there are many medications that can affect the success of dental implants, some of the most common are:
Proton Pump Inhibitors: Used to treat acid reflux, proton pump inhibitors have recently been shown to lower the success rate of dental implants.
SSRIs: Selective serotonin reuptake inhibitors are anti-depressants that can affect the integration of the implant into the bone.
Bisphosponates: Bone building drugs called bisphosphonates change how the jaw bone remodels and can increase the risk of implant failure. Patients with a history of cancer that have had high dose IV bisphosphonates are at the most risk.
What can I do to improve the longevity of an implant?
Brush and floss (or use a waterpik): Proper oral hygiene is critical to maintaining healthy teeth and implants. Although implants can’t get cavities, if you are not brushing and flossing daily, plaque buildup can lead to gum disease and bone loss around dental implants, which is known as peri-implantitis.
Get a night guard: Clenching and grinding places abnormal forces on your teeth that can be very damaging, but it can especially be hazardous for implants because they are fused directly to the bone, and don’t have a periodontal ligament to act as a “shock absorber”. If you are aware of clenching or grinding, wearing a nightguard to protect your implant is necessary to prevent issues.
See your dentist regularly.
What happens if an implant fails? What are the symptoms?
If caught in the early stages, failing implants usually don’t have any symptoms. Your dentist may observe bone loss on routine x-rays, or notice bleeding or pocketing during periodontal probing. This is why regular check-ups are so important.
In late-stage implant failure, patients may notice the implant moves or “wiggles”. In most cases, it is only the crown that has come loose, which is an easy fix at your dental office, but if you notice your implant is not stable, contact your dentist immediately.
How can a failing implant be treated?
If you are concerned about your dental implants, see your dentist immediately. They may be able to place an antibiotic to reduce inflammation. Sometimes the implant can be saved with a surgical procedure to clean out infection and repair defects in the bone.
Some failing implants need to be removed, but even when dental implants fail after the site has been allowed to heal, your doctor can re-attempt the implant placement. Success rates for replacing implants is about 71%.
