Can Dental Implants Fall Out? Signs, Causes and What Can Be Done

How often implants are lost

Most implants stay in place, but not all. The 46-study review looked at implants carrying a single crown. Of every 100, about 97 were still in the mouth after five years and about 95 after ten¹; the rest were lost. The crown on the implant is a separate part. In the same review, about 96 in 100 crowns were still in use after five years and about 89 after ten.

Staying in place is not the same as being trouble-free. Over five years the same review reported screw loosening in 8.8 per cent and soft-tissue problems in 7.1 per cent¹. The crown came loose in 4.1 per cent. Bone loss of more than 2 millimetres was 5.2 per cent and chipped porcelain 3.5 per cent. We could not confirm whether these rates are counted per implant or per crown.

These figures are averages pooled from studies in different countries and groups of patients. They are not the result of one clinic, dentist or implant brand, and they are not your personal risk. The ten-year values were modelled from studies whose follow-up averaged about five years¹; they were not observed directly over ten. The reviews used here give no pooled figures beyond ten years. An offer that promises an implant for life is not based on evidence.

Why implants fail: early and late

Early: the implant does not fuse with the bone

After placement, an implant has to fuse with the jawbone to carry a tooth over the long term. The tooth is fitted after healing or, in selected patients, as a temporary straight away. Either way, the bond with the bone still has to form. Sometimes it does not: the implant stays mobile or comes out in the first weeks or months. Smoking is one of the factors linked to early loss. A review of 32 observational studies gave an odds ratio of about 2.6 per implant² for early loss in smokers. An odds ratio is not the same as a risk that is 2.6 times higher.

Later: inflammation and bone loss around the implant

Plaque collects on an implant as it does on a tooth. Peri-implant mucositis is inflammation of the gum around the implant. Peri-implantitis is that inflammation together with loss of the bone that supports the implant. A 57-study review found peri-implantitis in about 20 in 100 patients and about 12 in 100 implants³; the rate depends on the definition used. If it is not controlled, the bone loss continues and the implant can be lost.

Later: force and the parts on top

A screw can loosen, a crown can come off and porcelain can chip, as the figures above show. These are problems with the parts on top of the implant, not with its bond to the bone. Clenching or grinding adds force. The 27 studies in one review compared people judged likely to clench or grind their teeth with people who do not. The odds of implant failure were about 2.2 times higher⁴ in the first group (an odds ratio).

What raises the risk

The figures below come from observational studies. They show an association, not proven cause and effect.

• Smoking. In people smoking more than 20 cigarettes a day, implant loss was about 2.5 times as likely per implant⁵ as in non-smokers. Per patient it was about 4 times as likely. No safe number of cigarettes has been shown.
• A history of gum disease. The studies concern periodontitis, gum disease that has damaged the bone around the teeth. Across 14 prospective studies, implants were lost at about 1.75 times the rate⁶ seen in people without that history. Peri-implantitis was about 3 times more common. These were treated patients; implants are not placed while gum disease is active.
• Diabetes. The findings are mixed. Two of three reviews found no significant difference in implant loss (2021 review⁷; 2016 review⁸), and the third reported a higher odds ratio⁹. All three found more bone loss around implants in people with diabetes, so blood-sugar control and regular reviews matter.
• Bone-strengthening medicines (bisphosphonates, denosumab). The risk depends on why, at what dose and for how long the medicine is taken. Doses used for osteoporosis are assessed separately from those used in cancer treatment. A 21-study review found that in people taking bisphosphonates, implant loss was about 1.7 times more likely per implant¹⁰. Jaw osteonecrosis, the death of jaw bone linked to the medicine, was about 3.5 times more likely per patient. The per-patient analysis of implant loss found no significant difference. These figures are for bisphosphonates and cannot be applied to denosumab; the certainty of the evidence is very low. Tell your dentist about every medicine you take, and do not stop one without asking the doctor who prescribed it.

You may read that a certain type of gum around an implant decides whether it lasts. The 2017 consensus report looked at the firm, attached gum around implants (keratinised mucosa). It found the evidence equivocal for long-term health¹¹. Possible advantages were only for comfort and ease of cleaning.

Signs that an implant is in trouble

• The implant, or the tooth on it, moves or feels loose
• A screw feels loose, or the crown comes off, cracks or chips
• Bleeding around the implant when you brush, swelling, pus, or a bad smell or taste
• The gum around the implant recedes, or the metal edge of the implant starts to show
• Pain on biting, or a bite that feels high
• After surgery, pain or swelling that increases after the third day, or bleeding that does not stop
• Numbness of the lip, tongue or chin that lasts beyond the expected duration of the anaesthetic

What can be done

What can be done depends on which part is affected and how far the problem has gone. Only an examination, usually with an X-ray, can show that.

• A loose screw or crown. A loose screw can be tightened and a damaged crown repaired or replaced. If the crown has come off, keep it and bring it with you.
• Inflammation of the gum only (mucositis). The aim is to control it before bone is lost: cleaning around the implant at the clinic, and better cleaning at home.
• Peri-implantitis. Treatment depends on what the examination finds, and it may need surgery. Afterwards the implant needs regular supportive care. If the disease progresses, the implant can be lost.
• An implant that moves in the bone. It has lost its bond with the bone and cannot be tightened back into place; it is usually removed. It is not always possible to place a new implant where one was lost. The bone may need time to heal or a graft, or a different restoration may suit you better.

Before any new implant, ask what caused the loss and what will change next time. Smoking, gum health, clenching, daily cleaning and the design of the tooth on top all count.

Keeping an implant healthy

• Daily cleaning. Brush twice a day with a soft brush and fluoride toothpaste, paying attention to the line where the implant meets the gum. Clean between the teeth every day with interdental brushes, floss or a water flosser; your dentist shows you which works in your mouth.
• A baseline record. The 2017 consensus report recommends that an X-ray and probing measurements be taken as a baseline¹¹ when the crown or bridge is complete. Later changes around the implant are judged against that record.
• Regular reviews. The European Federation of Periodontology guideline calls for a structured supportive care programme¹² once implants are in use. The NICE guideline on dental recall recommends that the interval between reviews be set for each patient¹³ on the basis of their risk. There is no ready-made 'once a year' that suits everyone.
• Clenching. A night guard may be advised to protect the crown or bridge. It has not been shown to prevent implant loss.
• Smoking and health. Tell your dentist that you smoke, and about diabetes, gum disease and your medicines, at every review.

How implant treatment runs, stage by stage, is explained on the dental implants page.

When to see a dentist

Contact your dentist if you notice any of the signs above. Do not wait for your next planned review. An implant that moves, bleeding and pus around it, or bleeding after surgery that does not stop needs an examination soon. So does numbness that lasts after the anaesthetic should have worn off.

Emergencies. Difficulty breathing or swallowing, rapidly spreading swelling of the face or neck, high fever or swelling around the eye are serious signs. Do not wait for the clinic's reply: go to the nearest emergency department or call 112.

Frequently asked questions