The dental hygienist is key in assisting dentists to monitor and provide comprehensive maintenance for an implant. The collaboration between the clinicians and keeping detailed records as too soft tissue inconsistencies, bleeding and exudate, bone loss, and mobility are critical all while keeping an eye on patients’ medical histories for health changes which could compromise success. Ill-fitting prosthesis causing tissue overgrowth leading to mucosal hyperplasia must also be. Failing implants can become failed implants without the proper monitoring and care.  Implant failure is caused by many things including bacterial infections (mucositis, or peri-implantitis), a poorly designed prosthesis, poor placement, occlusal overload, poor homecare, drilling speeds, and changes in the patient’s overall health. “The scientific literature regarding the risk factors for implant failure is limited . . . the treatment of biologic complications and failing implants lack systematic scientific validation and is based mainly on empirical experience and inference from in vitro findings on a trial and error basis.”¹ Implant failure has multifactorial etiologies but can be put into two categories-early and late failures.  Here is a look at potential avenues leading to failures that even the best clinician must be aware of.

Early implant failure-within three or four months after the implant procedure but during the process the implant is integrating into bone. Some causes include: 

• Autoimmune diseases such as rheumatoid arthritis, lupus, multiple sclerosis, Type 1 diabetes and even celiac disease can cause the immune system to fight against itself and damage body tissues and increases the possibility of rejection of the implant.
• Poor blood supply due to effects of medications, smoking or a blood disease.
• Medications such as bisphosphonate may affect the growth of bone support after placement.
• Overloading should be paid particular attention to beginning in the treatment planning phase and can be more common with patients who have poor bone density. Implants are held in by bone and don’t have the benefit of a periodontal ligament that would give it flexibility to occlusal trauma. Overloading can cause many issues for the implant such as broken screws, fracture of the implants or restorations.
• Allergic reactions happen very rarely but implants made of titanium alloy can sometimes have small traces of nickel and for those with a nickel allergy there may be an allergic inflammatory reaction.

Late implant failure-anywhere from one to 10 years after the procedure.

• The term “under-engineered” means too few implants to support the replacement teeth. As mentioned above unlike natural teeth implants react biomechanically in a different way to occlusal force.
• Bruxism puts extra pressure on not only an integrated implant but during the process of osteointegration.
• Smokers are at a higher risk for failed implants. From recent studies the percentage is between 6.5 to 20%.
• Poor oral hygiene is one of the biggest risk factors and one of the easiest to modify. Bacteria leads to infections which leads to failure.
• Head and neck radiation can contribute to failed implants
• The amount of keratinized tissue is important to long term implant success. There are disagreements as to how much but nonetheless significant. In order to achieve what the clinician deems proper dentists often have to do a grafting procedure. The beautiful part of minimally invasive implant techniques is the implant has the opportunity to have a better implant/tissue interface and be less prone to soft tissue problems.

No matter your choice of implants whether it is minimally invasive or not, diligently monitoring the health of the surrounding tissues and bone is critical to improve the success of the implant. New treatment methods are opening up the possibility of reversing peri-implantitis but prevention is always the best choice.  

1. Shieh J. Biomechanical implant failures management of an implant failure: A case report. Oral Health Group website. 

Please see our blog Clinical Steps to Assess Peri-Implant Health