What are some common dental implant problems?
Dental implant problems vary from surgical to prosthetic issues and from easy to very difficult. Below is a list of various issues we have seen over the years.
This one is a fairly easy fix unless in the front of the mouth and access to the screw is not straight forward. The hard part is figuring out why the screw is loose. Most often it is a lateral excessive contact. The screw should be replaced with a new screw if this occurs. This occurs somewhere around 0-6% Pjetursson 2014
Fractured dental implant abutment screw
Much more complicated issue. Can sometimes be removed with a piezo. If cold welded then that is a problem. Here are the steps and options to fix a dental implant screw fracture.
Fracture of dental implant abutment
Implant abutments can fracture. This is more common with the ceramic zirconia abutments or hybrid implant abutments. Certain design types are prone to this such as 3i with their abutment fingers. If there is a loose screw for awhile the fingers can easily break. However, even the normal titanium abutments will fracture occasionally.
Tissue level implant breaking at the head.
Similar to the abutment breaking, a tissue implant can break at the same spot. We often consider these less prone to fracture but it can happen as seen in this DT thread.
Fracture or chipping of dental implant crown
Fairly common and we treated the same as we treat a crown fracture on a regular tooth. This is more common on dental implants due to lack of proprioceptive feedback. Pjetursson 2014 found this in 3-35% @ 5 years.
Implants can break and “flowering” is the most common type of implant breakage.
We have a page on flowered dental implants and on broken implants and how to remove them. When we see a broken implant it is usually a mini implant or a break in an implant system with a very thin metal rim on the top.
Implant abutment breakage or implant breakage?
Some cases both are broken and you are not sure which came first. Abutments can certainly break and implants can can flower, when both occur, no way to know which came first. This case has a broken MUA and a broken implant. The root cause was an all on 4 with too much cantilever.
The implant may be showing and cause biological or esthetic issues.
We have a page on implants that are showing and how to treat.
Major issue because it can cause loss of implant and is very common. Again, this is a problem that many of “solved” through better techniques. Not using resin cement and using custom abutments along with a duplicate of the abutment to aid in cementing should solve this problem.
Open contacts between dental implant crowns and natural teeth
A dental implant doesn’t change position in the bone but teeth do. Thus as time goes on some people will develop an open space in-between a dental implant crown and a adjacent tooth. It usually occurs on the mesial (front side) of the dental implant crown (Wei 2008 IJPros and Varthis JOMI 2016) and is thought to be due to mesial drift. These changes can happen in the first year and you can expect about half of patients to experience this issue. Shi JOMI 2019 Oddly enough it is more common in the mandible, which has denser bone and one would think would be less likely to happen there. French JPD 2019 Meta-analysis shows mesial and mandible are most likely spots as well. Bento JPD 2023 Bompolaki JPD 2022 shows it is more common in molars vs premolars. Our thought is more common, the father back you go, therefore second molar being the most common.
It is an annoying problem but not necessarily detrimental. We fix these problems by either intraoral repair, which is often not terribly predictable, or removing and sending it to the lab to add porcelain. Research is showing 1/3 to 2/3 of single unit dental implant crowns develop an open interproximal contact. Greenstein 2016 JADA full article supplies reference to other articles showing the percentages. Oh JOMI 2020 If a patient has it happen they are likley to have it happen again in the same spot. Liang JOMI 22
There is a really nice thread on DT that discusses this issue in depth.
Post implant placement patient growth
Placing a dental implant in an individual that is too young will definitely cause a problem as the dental implant will stay in the same place as the bone and teeth move around. You can see some of the esthetic issues in our too young for dental implant page.
One solution to fix this is orthodontic reposition of a dental implant. The only way to move a dental implant is to move all the bone that is healed to the implant. We can accomplish via a block corticotomy, well not us but some super-specialists. Not an easy thing to accomplish. This case on dentaltown shows a great result.
Where does bone growth occur?
This is one of those things that is easier to show than tell.
While there is certainly other dental implant problems, especially surgical dental implant problems, these are the most common.