Can dental implants fail, and what causes failure?

How often implants fail

The honest answer is: uncommon, but not negligible.

A systematic review of long-term studies with at least 10 years of follow-up reported a pooled implant survival rate of about 94.6% at 10 years (Moraschini et al., 2015).¹ Translating that: of every 100 properly-placed implants in patients in research-grade follow-up, roughly 5 are no longer in place at the 10-year mark. The same review reported a pooled success rate of about 89.7%, because some implants survive but are no longer free of disease.

That said, survival (the implant is still in place) and success (the implant is in place, functioning, and free of peri-implant disease) are different metrics. Peri-implantitis — inflammatory bone loss around an implant — is common. A large Swedish population study by Derks and colleagues found that, nine years after implant therapy, 45% of patients had peri-implantitis (bleeding on probing or suppuration together with bone loss greater than 0.5 mm), and 14.5% had moderate-to-severe peri-implantitis (bone loss greater than 2 mm) (Derks et al., 2016).³ Peri-implantitis does not always cause the implant to be lost — but it does mean the implant is no longer fully healthy and requires intervention.

Early failure (within the first year)

Causes of early failure are typically related to the osseointegration process not completing:

• Surgical contamination at placement.
• Excessive surgical heat during the bone preparation (rare with modern equipment and proper irrigation).
• Loading too soon — putting force on the implant before integration is complete.
• Poor primary stability at placement (the implant did not "lock in" tightly enough during surgery).
• Patient systemic factors — uncontrolled diabetes, certain medications, smoking.

Early failure presents as the implant becoming mobile in the months after placement, often with discomfort. The implant is usually removed, the site is allowed to heal, and a replacement implant can usually be placed three to four months later. Re-implantation success rates after early failure are good when the cause has been identified and addressed.

Late failure (after the first year)

The dominant cause of late failure is peri-implantitis, the inflammatory destruction of the bone supporting the implant. The 2023 EFP S3 clinical practice guideline summarises the prevention and treatment of peri-implant diseases in detail.²

Peri-implantitis is the implant equivalent of periodontitis: a chronic inflammatory response to bacterial biofilm on the implant surface, leading to progressive bone loss. The presentation includes:

• Bleeding when the implant area is brushed or probed.
• Visible swelling or redness of the gum around the implant.
• Sometimes pus.
• On x-ray, progressive bone loss around the implant.
• Eventually, mobility — which usually indicates that the implant is unsalvageable.

Risk factors for peri-implantitis:

• Smoking. Smokers are substantially more likely to develop peri-implantitis.
• History of periodontitis. Patients who lost teeth to periodontitis carry forward the susceptibility to inflammation around implants.
• Poor home care of the implant area.
• No structured maintenance programme (no recall visits).
• Excess cement left during the original restoration (a technical failure that traps bacteria).
• Implant position — implants placed too close to a neighbouring tooth or too superficially are harder to keep clean.

What can be done if peri-implantitis develops

The 2023 EFP S3 guideline distinguishes:

1. Non-surgical phase. Cleaning the implant surface mechanically, with adjunctive antimicrobial agents in some cases. Modest effectiveness; rarely sufficient on its own for established peri-implantitis.
2. Surgical phase. Reflecting the gum to access the implant surface, decontaminating it, and either reshaping the bone (resective) or attempting bone regeneration (reconstructive) depending on the defect geometry.

Outcomes from peri-implantitis treatment are less predictable than outcomes from periodontitis treatment of natural teeth — which is part of the reason prevention through proper maintenance is critical. Every implant we place is enrolled in a follow-up programme; we do not place implants for patients who will not commit to maintenance.

What you can do to reduce your risk

Three categories of action:

Before placement:

• Stop smoking (or, if that is not possible, reduce significantly and discuss with the specialist whether implants are still the right choice).
• Get any active periodontal disease under control first.
• Confirm general health factors are addressed (diabetic patients should be in reasonable control).

At placement:

• Choose a specialist or substantively-trained dentist for surgery, particularly for any non-routine case.
• Choose an established implant system with documented long-term performance.
• Insist on CBCT planning for anything beyond the simplest case.

After placement, indefinitely:

• Clean around the implant with the techniques you were taught — usually an interdental brush at minimum, sometimes a water flosser, always a thorough toothbrush.
• Attend recall visits at the cadence recommended for your specific case (typically every six months, sometimes every three to four months for higher-risk patients).
• Mention any bleeding, discomfort, or change around the implant to the practice promptly; early peri-implantitis is more treatable than established peri-implantitis.

What this means when you are deciding whether to have an implant

Implant placement is a procedure with very good outcomes in carefully selected patients with appropriate planning, surgical skill, and ongoing maintenance. It is not a procedure with guaranteed outcomes, and the published evidence is honest about that. A specialist consultation provides an individualised risk assessment for your specific case.

This article is general educational content. The risk profile for your specific case depends on your medical history, smoking status, periodontal history, site, bone quality, and the specifics of the planned procedure — assessed at consultation.