A loose or painful dental implant is unsettling. This is especially true after you already went through surgery once. The good news is that a failed implant is rarely the end of the road.
When a dental implant fails, a periodontist first finds out why. Then you choose together: repair it, remove and replace it, or switch to a different tooth replacement option. Most people who get a second implant keep it long term. The right choice depends on how much bone and gum tissue the first implant left behind.
Dr. Daniel J. Thomas, DDS, MS, is a board-certified periodontist with this Kansas City practice. He has placed implants here since 1994. He starts every revision case the same way he starts a first dental implant placement, with a full look at why the first attempt did not hold.
● Early failure happens before your permanent crown goes on. It usually means the implant never fully bonded to the bone.
● Late failure shows up one to three years or more after placement. It often comes from an infection around the implant called peri-implantitis.
● Replacement implants succeed in 69 percent to 91 percent of cases, according to published clinical data.
● Patients who grind their teeth at night fail at a much higher rate, close to 41 percent. That compares with about 12 percent for people who do not grind.
● Book an evaluation before you decide anything. Not every implant that feels off has actually failed.
Not every sore or loose-feeling implant has failed. Sometimes the crown on top loosens. Or the gum around the implant flares up and just needs a cleaning. True failure means the implant itself moves, sinks, or shows bone loss on an X-ray. A periodontist can usually tell the difference in one visit.
A little tenderness in the first week after placement is normal. It settles on its own. A crown that feels slightly loose often just needs a tightened screw, not a new implant. Gum swelling around an otherwise stable implant often clears up with a professional cleaning. A short course of antibiotics or an antimicrobial rinse can help too.
Real failure looks different. The implant itself moves when you press on it. Pain gets worse instead of better over days or weeks.
An X-ray shows bone pulling away from the implant body. Pus or a bad taste near the site points to active infection. A cleaning alone will not fix that. If you notice any of these signs, call your periodontist. Do not wait to see if it passes.
Early implant failure happens before you get your final crown, often within the first few months. It means the implant never bonded to the jawbone. Late failure shows up one to three years or more after placement. It is often caused by peri-implantitis or ongoing pressure from grinding. The cause decides the fix.
Early failure tends to trace back to the bone itself. If low bone density caused the failure, your periodontist may recommend bone grafting before placing a second implant. Grafting rebuilds the area so the new implant has solid bone to anchor into, instead of going back into the same weak spot.
Several other factors raise the risk of early failure too: uncontrolled diabetes, smoking, and certain medications such as bisphosphonates. A lack of initial stability when your periodontist places the implant raises the risk as well.
Late failure usually traces back to what happens around the implant after it heals. Peri-implantitis, a bacterial infection similar to gum disease, is the most common cause. Loose abutment screws, a poorly fitted crown, and heavy grinding at night also wear down an otherwise successful implant over time.
Once a periodontist confirms the implant has to come out, three paths forward typically make sense. Which one fits depends on your bone, your budget, and how soon you want a finished tooth.
A second implant is the most common choice once the site heals. If the bone is healthy, your periodontist can often place it much like the first. If bone loss caused the failure, healing from a bone graft usually takes four to six months before a new implant goes in.
If a second implant is not the right call for right now, a bridge anchored to nearby implants or teeth can restore how you chew and smile. This option skips more surgery at that exact spot.
A removable partial denture is the least invasive option. It works well as a temporary fix while you decide on a longer-term plan. It also works as a lasting choice if more surgery is not right for you.
Option
Needs more surgery?
Typical timeline
Second implant
Sometimes, if bone grafting comes first
4 to 8 months
Implant-supported bridge
No
2 to 6 weeks
Removable partial denture
No
2 to 4 weeks
Our guide on when a bone graft comes before an implant walks through how periodontists decide. The same questions apply to a second attempt.
Replacement implants succeed in 69 percent to 91 percent of cases after an initial failure. That range comes from a review published by Perio-Implant Advisory. Your own odds depend on two things: why the first implant failed, and whether your periodontist fixes that cause before the second one goes in.
That range is wide because the causes behind it vary so much. A healthy patient who lost an implant to a one-time infection has a better outlook than someone with uncontrolled diabetes or a long smoking history.
Grinding makes a real difference too. A review in the National Institutes of Health's PubMed Central library found implants fail at close to 41 percent in patients with bruxism. That compares with about 12 percent in patients without it. A night guard or a bite adjustment often protects a second implant in a way the first one never had.
If grinding played a role in your original failure, raise it at your evaluation. It changes what your periodontist recommends afterward.
A revision evaluation starts with an exam and imaging of the implant site. This lets your periodontist see exactly why the first implant failed before recommending what comes next. This matters even more if someone else placed your original implant. There is no record of exactly what happened during that first surgery.
Your periodontist checks the bone level around the site and looks for signs of infection. Your periodontist also asks about habits like grinding or smoking that affect healing. From there, you get a clear recommendation: try again, graft first and then try again, or move to a bridge or denture instead.
Dr. Thomas and the other periodontists on this team are each Diplomates of the American Board of Periodontology. You can see each doctor's training and background on our team page before you book.
Periodontal Specialists has placed dental implants in the Kansas City area since 1992, with offices in Leawood, North Kansas City, Country Club Plaza, Lee's Summit, and St. Joseph. A failed implant feels like a setback. In almost every case we see, it is a solvable one.
Call (913) 663-4867 or request an appointment to have your implant evaluated before you decide what comes next.
