Revision and Second Opinions
Your implant failed. Here is what happens next.
Implants fail for reasons that are usually identifiable and often correctable. This page explains what actually goes wrong, what can be saved, and what a revision realistically involves. Written by a board-certified prosthodontist in Hamilton Township, New Jersey.
Start here
If you are reading this, something has gone wrong: an implant is loose, painful, the crown keeps coming off, the gum around it bleeds, or a full-arch bridge is not sitting the way it should. You may have been told to just live with it, or quoted a large sum to start over from scratch.
Both of those are usually the wrong answer. Most implant problems have a specific, identifiable cause, and identifying it correctly determines whether you need a small correction or a genuine rebuild. Starting over without knowing the cause tends to reproduce the same failure.
An honest note about second opinions
A second opinion is a normal part of medical care and is not a betrayal of your original dentist. Complications happen in every practice, including good ones. What matters is whether the problem is being diagnosed accurately now.
Why implants actually fail
Failures fall into a small number of recognizable categories, and telling them apart is most of the work.
These require different responses. Peri-implantitis may be treatable with the implant left in place. A badly positioned implant that has integrated perfectly may still need to come out, because no restoration will look right on it. A repeatedly loosening screw is often a bite problem that will recur on any replacement unless the bite is addressed.
What can usually be saved
Patients arriving for a revision consultation generally expect the worst. The picture is often better than that.
- An implant with early peri-implantitis can frequently be kept, with decontamination and management of the underlying cause.
- A well-positioned implant with a failed restoration usually needs only the restoration replaced, not the implant.
- In a full-arch case where a few implants have failed, the remaining ones are often still usable, and the plan can be revised around them rather than removing everything.
- Where an implant does have to come out, the site can usually be grafted and re-implanted after healing. A failed implant is not a permanently lost site.
What we tell you honestly
Sometimes the answer is that the existing work cannot be salvaged and rebuilding is the right call. When that is the case we will say so plainly, and explain what specifically drove that conclusion, rather than presenting it as the only option from the start.
What a revision consultation involves
- A 3D scan, which shows bone levels and implant position in a way a standard X-ray cannot.
- Assessment of each implant individually rather than the case as a whole, since they frequently differ.
- A bite evaluation, because occlusion is the cause of a large share of the mechanical failures we see and is the thing most often missed.
- Identification of the implant system already in place, which determines what components can be reused.
- A written plan setting out what is being kept, what is being replaced, why, in what order, and what it costs.
Bring anything you have: previous X-rays, the name of the implant system if you know it, and any paperwork from the original treatment. It saves time and sometimes saves an unnecessary procedure.
Why a prosthodontist
Who should be handling a revision
Implant failures sit at the intersection of surgery and restoration, and a large proportion of them originate on the restorative side: bite forces, prosthetic design, implant positions chosen without a clear plan for the final teeth.
A prosthodontist is the specialist trained specifically in the restorative and reconstructive side of this work, which is a three-year residency after dental school. Board certification through the American Board of Prosthodontics adds a further examination process beyond that. In revision cases the relevant question is usually not only whether the implant can be placed, but whether a functional, natural-looking restoration can be built on it, and that is the question prosthodontic training is built around.
Common questions
Questions patients ask most often
How do I know if my implant is failing?
The signs worth acting on are: any movement of the implant itself, persistent pain or pressure, bleeding or pus around the gum margin, a crown or screw that repeatedly loosens, or gum recession that exposes metal. Any implant that moves needs to be assessed promptly. A crown that comes loose repeatedly is not a nuisance to live with, it is usually telling you something about the bite.
Can a failed implant be replaced in the same spot?
Usually, yes. The site is cleaned and typically grafted, then allowed to heal, and a new implant placed after several months. Occasionally an immediate replacement is possible where the bone is sound and the failure was not infective. The waiting period is what protects the second attempt.
Will I have to pay again for work that already failed?
That depends on where the work was done, how long ago, and what warranty was offered. We are not able to speak to another practice's terms. What we can do is tell you exactly what is wrong and what correcting it involves, which is often the information you need to have that conversation with the original provider.
My All-on-4 bridge broke. Can it be repaired?
Frequently, yes. Acrylic full-arch bridges fracture reasonably often, particularly where the bite was not balanced or the framework underneath was inadequate. Sometimes the repair is straightforward. Sometimes the fracture is a symptom of a design problem that will recur, in which case the honest answer is that the prosthesis needs redesigning rather than repeated repairs.
I was told nothing can be done and I should go back to dentures. Is that true?
Sometimes it is, but it is worth a second look before accepting it. Bone grafting, zygomatic implants and revised prosthetic designs have made many previously untreatable situations treatable. We will tell you honestly if dentures are genuinely the right answer for your case, but we will not reach that conclusion without a proper assessment.
Bring us the case someone else could not fix
Revision and complex reconstruction is a substantial part of what this practice does. If you have an implant problem, a failing full-arch case, or a result you were told could not be improved, we will give you an honest assessment of what is achievable.
Request a ConsultationDr. Akshay Parmar, BDS, DDS, MDSc, FACP, FAAMP. Board-certified prosthodontist, Hamilton Township, New Jersey.