The Implant Never Integrated, and We Had to Say So

Quick answer: A small proportion of implants fail to integrate with the bone in the first months. It is usually detected before any crown is made, the implant is removed, the site heals, and a replacement succeeds in most cases. Saying so plainly is the only workable response.

The call

He came in for the routine check before crown-making, expecting a formality.

Natan, 58, from Migdal HaMayim, had had an implant placed to replace a lower molar eleven weeks earlier. It had been comfortable throughout. He had noticed nothing.

What we found

The implant moved.

Not much — a fraction of a millimetre, detectable with instruments on either side rather than with fingers — and any detectable mobility in an implant means the same thing. An integrated implant is fused to bone and does not move at all. Mobility is not a degree of success; it is failure.

Percussion gave a dull note rather than the sharp ring of an integrated implant. The x-ray showed a thin radiolucent line around part of the fixture.

No pain, no swelling, no pus, no infection. He had had no symptoms whatsoever, which is typical of early failure and the reason these are found at a routine check rather than reported by the patient.

Why early failures happen — meaning failures before the implant is ever loaded, in the first weeks to months:

• Overheating of the bone during preparation. Bone is damaged above about 47 degrees. Sharp drills, correct speed and copious irrigation prevent it.
• Inadequate primary stability. If the implant is not firm at placement, micromovement during healing prevents bone forming against it.
• Poor bone quality, particularly soft bone at the back of the upper jaw.
• Contamination or infection at placement.
• Smoking, which is the largest patient-side factor.
• Loading too early, before integration.
• Poorly controlled diabetes.

His case had no obvious single cause. He did not smoke, was not diabetic, had good bone on the scan and adequate stability recorded at placement. Some proportion of implants fail without an identifiable reason, and reported early failure rates in the literature generally sit in the low single-digit percentages.

Late failure is a different thing entirely — peri-implantitis, years later, driven by bacteria and bone loss around a previously integrated implant. That is a maintenance problem. This was not.

What we did

Told him straight, at that appointment. The implant had not integrated, it had to come out, and it would be replaced at no charge for the implant itself.

That last point matters and is worth stating: a failed implant in the integration phase, where nothing the patient did caused it, is not something to charge for a second time. Practices vary in how they handle this, and it is a fair question to ask before treatment starts.

Removal, which was straightforward precisely because it had not integrated — it was unscrewed under local anaesthetic in a few minutes.

Debridement of the site and a bone graft to fill the defect left behind, covered with a membrane.

Four months of healing.

A second implant placed at four months, in a slightly different position where the bone was denser, with a wider diameter for better initial stability, and a longer integration period of four months rather than three.

Reviewed at four weeks and eight weeks rather than only at the end — earlier detection would not have changed the outcome, and it does shorten the period of uncertainty.

The outcome

The second implant integrated. Crown fitted at eight months from the original surgery.

Stable at three years.

The cost to him was time — eight months rather than four — and two additional surgical procedures. Reported success rates for a replacement implant at a previously failed site are good, though somewhat lower than for a first attempt, and he was told that before agreeing.

What to do if this happens to you

1. Ask what the practice's policy is on failure, before treatment starts, in writing.
2. Attend the integration checks. Early failure is silent and found by examination.
3. Ask why it failed, and accept that sometimes there is no identifiable reason.
4. Ask about the odds for a replacement at the same site.
5. Stop smoking. It is the largest modifiable risk factor.
6. Do not read failure as incompetence automatically, and do expect it to be explained clearly and handled fairly.

Concerned about an implant? Ramat Beit Shemesh Urgent Dental Care gives straight answers about what is happening. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh

This is a composite clinical story. It reflects a presentation we see regularly in Beit Shemesh and Ramat Beit Shemesh; the name and details are illustrative and are not those of a real patient.