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Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 14-16

Dental implant failure causes, treatment, and diagnosis: A literature review

1 Consultant Implantologist, Faridabad, Haryana, India
2 Senior Resident, Department of Periodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
3 Assistant Professor, Department of Oral Medicine, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India

Date of Submission18-Apr-2021
Date of Acceptance28-Apr-2021
Date of Web Publication03-Jun-2021

Correspondence Address:
Dr. Kamal Sagar
Consultant Implantologist, MDS, Maulana Azad Institute of Dental Sciences, New Delhi - 110 002
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmo.ijmo_4_21

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Despite the high success rates and stability of dental implants, failures do occur. The most important etiological factors for early implant failure are surgical trauma together with bone volume and quality, while etiology of late failures is more controversial. Occlusal overload and peri-implantitis could be associated with late failures. Suboptimal implant design and improper prosthetics also play an important role in implant complications and failure. Early detection and treatment of initial progressive bone loss around dental implants by mechanical debridement with plastic/titanium/gold-plated instruments, antimicrobial therapy, and regenerative therapy are the keys for the revival of early failing implants. The aim of this paper is to describe different causes of failure in detail and treatment modalities to deal with dental implant failure.

Keywords: Dental implants, implant failure, implant prosthesis, risk factors, survival rate

How to cite this article:
Sagar K, Bhagavatheeswaran S, Singh C, Gumber B. Dental implant failure causes, treatment, and diagnosis: A literature review. Int J Med Oral Res 2021;6:14-6

How to cite this URL:
Sagar K, Bhagavatheeswaran S, Singh C, Gumber B. Dental implant failure causes, treatment, and diagnosis: A literature review. Int J Med Oral Res [serial online] 2021 [cited 2022 Sep 26];6:14-6. Available from: http://www.ijmorweb.com/text.asp?2021/6/1/14/319418

  Introduction Top

According to Dr. Branemark, “Osseo-integration” is a direct anchorage of the implant to the surrounding host bone. It is apparently the most important feature to affirm long-term clinical success of dental implants. An implant-supported restoration offers a predictable treatment for missing tooth replacement.[1],[2],[3] Reported success rates for dental implants are high; however, there is still a paucity of data in the literature regarding follow-up of implants in function for at least 5 years or more.

According to Esposito et al.,[4] implant failure can be divided into four categories.

Biological failures

  1. Early failure, which is failure to achieve osseointegration between implant and bone that might indicate an interference with the initial bone healing process.

  2. Causes of early biological failure may be uncontrolled diabetes mellitus, osteoporosis, patients on corticosteroids, bisphosphonates therapy, chronic smokers, infections, postinsertion pain, lack of primary stability, inadequate surgery, and prosthodontics.

  3. Late failures, which is failure to preserve the achieved osseointegration.

This may be due to weak osseointegration, which is lost when the implant is subjected to masticatory forces postloading. The various causes of late failures may be due to inadequate prosthetic component, excessive occlusal load, and peri-implantitis.

Mechanical failures

Refers to fracture of implants and related suprastructures. Greater forces increase the incidence of implant body fracture. Cantilevers, off-axis, and parafunction increase the risk for implant fracture. The risk for fracture also increases over time. Typical mechanical failures are due to either static loads or fatigue loads. Static load (i.e. one load cycle) failures cause the stress in the material to exceed its ultimate strength after one load application. Fatigue load failures occur if the material is subjected to lower loads but repeated cycles of that load.

Iatrogenic failures

  • Position of the implant

  • Improper positioning of the implant can lead to failure of implant due to inability to achieve osseointegration. Improper implant position can either out of the bony cortex, beyond the inferior border of the mandible, into vital structures such as maxillary sinus, inferior alveolar canal, or perforating natural teeth. Implant placement into neurovascular bundles can lead to neurological symptoms along with soft tissue encapsulation of the implant.

  • Removal of implants due to violation of the neighboring anatomical structures such as the inferior alveolar nerve (IAN), mental nerve, nasal fossa, and maxillary sinus.

The occurrence rates of various types of implant failures are summarized in [Table 1].
Table 1: Occurrence rate of various types of implant failures

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Although there is no evidence which states that diabetes is a contraindication to dental implant therapy, the increased glycated state might be correlated with postoperative complications. Due to the known adverse effects of hyperglycemic state on healing and osseointegration, medical advice and strict glycemic control before and after implant therapy is recommended.

Tobacco smoke decreases polymorphonuclear leukocyte activity, resulting in lower motility, a lower rate of chemotactic migration, and reduced phagocytic activity. These conditions contribute to a decreased resistance to inflammation and infection.[5]

In 1978, the National Institute of Health (NIH) recommended the following criteria for the removal of a dental implant: (1) chronic pain, (2) significant movement, (3) infection, (4) significant progressive loss of supportive bone, (5) intolerable dysesthesia (anesthesia or paresthesia), (6) oroantral or oronasal fistulae, (7) bone fracture, (8) psychological or other significant medical problems, (9) uncorrectable implant breakdown, (10) possible irreversible damage to adjacent teeth, and (11) cosmetic problems [Figure 1].
Figure 1: Flowchart depicting types of implant failures

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In spite of the high success rate, implant failure has been vastly reported in the literature.[6],[7]

Hence, it is mandatory for every clinician to know, how and why the failures occur and how best we can prevent them to give the upcoming branch of dentistry a new horizon.

  Discussion Top

Apart from the early and late failure causes described above, one of the causes for osseointegration to develop a progressive marginal bone loss (MBL) is the shortcoming of the implant-to-bone connection. Here, the contact surfaces comprise dissimilar tissues: titanium and the jaw bone. The implant surface coatings comprise titanium oxide coating, ceramic coating, or diamond coating.[8],[9] Biodegradable ceramic coating may have the best future prospects. Most dental implant materials presently used in clinics are quite biocompatible in human tissues in their specific dental application. They are usually made of titanium, titanium–aluminum vanadium (Ti-6Al-4V), cobalt–chromium–molybdenum, and more rarely of other alloys.[10],[11] Under normal environment, this metal-to-bone contact is stable, well established, and resists bone resorption. Under an unfavorable chronic environment, often of a microbial or traumatic nature in addition to the weakening in the systemic health, the tissue interface can become distressed. Albrektsson et al. in 1986 suggested success criteria for MBL, among other parameters.[12] During the 1st year after abutment connection, 1 mm of MBL is allowed followed by 0.2 mm per year. Today, these criteria are still frequently referred to as the “gold standard” for implant success. There are various criteria to decide success of an implant.

According to the American Academy of Periodontology 2000:

  • Absence of persistent signs/symptoms, such as pain, infection, neuropathies, paresthesias, and violation of vital structures
  • Implant immobility
  • No continuous peri-implant radiolucency
  • Negligible progressive bone loss (<0.2 mm annually) after physiologic remodeling during the 1st year of function
  • Patient/dentist satisfaction with the implant supported restoration.

Parameters used for evaluating failing/failed implants

Clinical signs of infection, hyperplastic soft tissues, suppuration (spontaneous, on probing or under pressure), swelling, fistula, change in color, changes of the marginal peri-implant tissues, probing depth ≥6 mm or suppuration, bone loss and microbiota consisting primarily of Gram-negative anaerobic rods [Figure 2], mobility is the cardinal sign of implant failure, radiolucency on X-ray.
Figure 2: X-ray showing marginal bone loss in implant in molar region

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In the absence of mobility and radiographic changes, these signs indicate more a complication (amenable to treatment) than a failure. These conditions can be treated by thorough curettage with titanium or gold-plated instruments along with regenerative procedures such as bone graft and membrane. Laser is also very useful in restoring proper health of an infected implant.

Some failure causes and their contribution in implant failure are listed as follows.

Treatment alternatives following removal of failed implants

A mobile implant may easily be removed by rotating it anticlockwise using an implant-driver, countertorque ratchet technique, or tooth forceps. Rotating with minimum luxation allows reduced trauma and damage to the surrounding bone and soft tissue. Methods of immobile implant removal include use of countertorque ratchets, screw removal devices, piezo tips, high-speed burs, elevators, forceps, and trephine burs. After removal, we can do regenerative procedures and explain other alternative treatment options available to patient.

  Conclusion Top

Implant therapy has become a common practice and will probably gain in popularity during the next several years. This implies that dental professionals will have to deal more with implant failure and related complications. Hence, a thorough knowledge regarding the various aspects of failure is deemed necessary to know and implement in the future.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Levin L, Schwartz-Arad D. The effect of cigarette smoking on dental implants and related surgery. Implant Dent 2005;14:357-61.  Back to cited text no. 1
Levin L, Laviv A, Schwartz-Arad D. Long-term success of implants replacing a single molar. J Periodontol 2006;77:1528-32.  Back to cited text no. 2
Levin L, Pathael S, Dolev E, Schwartz-Arad D. Aesthetic versus surgical success of single dental implants: 1- to 9-year follow-up. Pract Proced Aesthet Dent 2005;17:533-8.  Back to cited text no. 3
Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (I). Success criteria and epidemiology. Eur J Oral Sci 1998;106:527-51.  Back to cited text no. 4
Jones JK, Triplett RG. The relationship of cigarette smoking to impaired intra-oral wound healing. J Oral Maxillofac Surg 1992;50:237-9.  Back to cited text no. 5
Ekfeldt A, Christiansson U, Eriksson T, Lindén U, Lundqvist S, Rundcrantz T, et al. A retrospective analysis of factors associated with multiple implant failures in maxillae. Clin Oral Implants Res 2001;12:462-7.  Back to cited text no. 6
Schwartz-Arad D, Laviv A, Levin L. Failure causes, timing, and cluster behavior: An 8-year study of dental implants. Implant Dent 2008;17:200-7.  Back to cited text no. 7
Santavirta S, Nordström D, Ylinen P, Konttinen YT, Silvennoinen T, Rokkanen P. Biocompatibility of hydroxyapatite-coated hip prostheses. Arch Orthop Trauma Surg 1991;110:288-92.  Back to cited text no. 8
Aspenberg P, Anttila A, Konttinen YT, Lappalainen R, Goodman SB, Nordsletten L, et al. Benign response to particles of diamond and SiC: Bone chamber studies of new joint replacement coating materials in rabbits. Biomaterials 1996;17:807-12.  Back to cited text no. 9
Lacefield WR. Hydroxyapatite coatings. Ann N Y Acad Sci 1988;523:72-80.  Back to cited text no. 10
Lumbikanonda N, Sammons R. Bone cell attachment to dental implants of different surface characteristics. Int J Oral Maxillofac Implants 2001;16:627-36.  Back to cited text no. 11
Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: A review and proposed criteria of success. Int J Oral Maxillofac Implants 1986;1:11-25.  Back to cited text no. 12


  [Figure 1], [Figure 2]

  [Table 1]

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