The Implant Had Lasted Nine Years. Then the Bone Around It Gave Way.

Quick answer: Late implant failure is a bacterial disease, not a surgical one. It develops silently over years, and by the time an implant becomes loose most of its bone support has gone. Replacing it is possible; the more important question is why the first one failed.

The call

He was expecting to be told it needed tightening, which is what had happened the previous two times something felt loose.

Aharon, 66, from RBS Daled, had an implant replacing a lower molar, placed nine years earlier and trouble-free for most of that time. Over the previous four months the gum around it had bled when brushing and there had been an intermittent bad taste.

Now the crown moved, and so did the implant.

What we found

Movement of the implant itself, not the crown — the two are distinguished by removing the crown and testing separately, which is a two-minute procedure and the difference between a screw problem and a lost implant.

Deep pockets of 9 to 11mm all round, with pus on probing. The x-ray showed bone loss extending down two-thirds of the implant's length in a crater around it.

Late failure is a different disease from early failure. Early failure is a healing problem in the first months — the implant never integrates, and it is usually detected before any crown is fitted. Late failure is peri-implantitis: bacterial inflammation around an implant that had integrated perfectly well, destroying the bone over years.

Why it goes unnoticed. Implants have no periodontal ligament and no nerve supply of their own. A natural tooth becomes tender, feels high, aches. An implant gives none of those signals. It stays entirely comfortable until enough bone has gone that it moves — at which point nothing can be saved.

Bleeding on brushing and a bad taste are the early signs, and they are exactly the signs people dismiss.

Why his failed, which is the more important question than how to replace it:

• A history of periodontitis, treated before the implant was placed. This is one of the strongest predictors of peri-implantitis, and it needed lifelong maintenance rather than a course of treatment.
• No maintenance programme. He had been discharged to six-monthly check-ups with no implant-specific review, no probing and no x-rays. His implant had not been probed in nine years.
• A crown contour he could not clean under. The crown was slightly over-contoured at the gum, creating a ledge that trapped plaque and that no brush reached.
• Excess cement, visible on the x-ray as a small radiopaque fleck at the shoulder — a well-recognised cause of peri-implantitis with cement-retained crowns, and one of the reasons screw-retained crowns are often preferred now.

Four contributing factors, and every one of them was preventable or detectable.

What we did

Removed the implant. With that degree of bone loss it came out with a reverse-torque device rather than surgically, which is straightforward and considerably less traumatic than cutting bone away.

Debrided the site thoroughly and grafted the defect, covered with a membrane. Six months of healing.

Then the real conversation, at six months: should it be replaced at all?

That question deserves asking honestly. He was 66, the site was a lower first molar, and he had the tooth in front and the tooth behind. Options were a second implant, a three-unit bridge, or accepting the gap.

The argument against a second implant: he had already demonstrated susceptibility. A patient who has lost one implant to peri-implantitis is at elevated risk of losing another, and nothing about his history had changed except awareness.

The argument for: the underlying causes were identifiable and modifiable — maintenance, crown design, and cement. Fix those and the risk profile is different.

He chose to proceed, having been told the odds honestly rather than reassured.

A second implant at six months, restored with a screw-retained crown — no cement anywhere — and a deliberately flatter emergence profile with clear access for an interdental brush underneath.

A three-monthly maintenance programme, with probing and annual x-rays, written into his notes as an ongoing requirement rather than an option.

The outcome

Three years in, stable, with normal bone levels and no bleeding on probing.

Whether it lasts nine years or thirty depends more on the maintenance than on the surgery, and he understands that.

What to do if this happens to you

1. Report bleeding around an implant immediately. It is the only early warning you get.
2. Insist on probing and x-rays at least yearly. Implants that are only looked at are not being monitored.
3. Ask for screw-retained crowns where the position allows. It removes the cement risk entirely.
4. Ask whether you can clean under the crown, and get shown how.
5. Commit to three- or four-monthly maintenance if you have a history of gum disease.
6. Ask honestly whether replacement is wise if you have already lost one. Sometimes a bridge or a gap is the better answer.

Bleeding or a bad taste around an implant? Ramat Beit Shemesh Urgent Dental Care probes and x-rays implants, not just looks at them. 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.