After getting a dental implant placed, it’s normal to expect it to last for many years without any issues. However, in some cases, patients start to notice bone loss around the implant over time. This can be concerning, as it may indicate a problem with the integration of the implant. Some bone loss is to be expected, but significant or progressive loss can lead to failure of the implant. In this article, we’ll explore the potential causes of bone loss around dental implants and what can be done about it.
What is normal bone loss after a dental implant?
Some degree of bone loss is expected after a dental implant is placed. When the implant is first inserted, it stimulates bone growth to fuse with it in a process called osseointegration. As the bone remodels over the first year, a small amount of bone loss occurs as the bone adapts to the presence of the implant. This is usually less than 0.2 millimeters on average. After this initial integration, the bone should remain stable if the implant is healthy.
Why is bone loss around an implant a concern?
If more significant bone loss occurs after the first year, it can lead to problems. The implant depends on solid bone integration to stay firmly in place. As bone is lost around the implant, it loses this support. Too much bone loss can make the implant loose or unstable. It also exposes more of the implant to oral bacteria, increasing the risk of infections and peri-implantitis (severe gum inflammation around the implant). That’s why progressive bone loss needs to be addressed to prevent implant failure.
Potential causes of bone loss around dental implants
There are several potential reasons why bone loss may occur around a dental implant:
Infection around the implant
Bacterial infections can develop around implants, just like around natural teeth. Poor oral hygiene is often a contributing cause. If plaque and tartar buildup leads to gingivitis or periodontitis around an implant, the inflammation can damage surrounding bone. Peri-implantitis specifically involves inflammation of the soft and hard tissues around the implant. Getting proper professional cleanings and maintaining vigilant daily oral hygiene is key to preventing infectious bone loss.
Implant placement issues
Sometimes bone loss occurs because there were problems with the initial placement of the implant. If the implant was placed incorrectly and doesn’t integrate well with the bone, the lack of stability can cause gradually worsening bone loss. Bone grafts around the implant may also not take as hoped. Additionally, if there is excessive pressure on the implant, such as due to a poor fit with the crown restoration, this constant pressure can cause bone to break down.
Mechanical damage to the implant
If an implant restoration doesn’t fit properly or becomes damaged, the constant mechanical irritation against the implant can cause bone loss. Clenching and grinding can also potentially damage the implant and surrounding bone. Poor implant materials or craftsmanship can lead to fractures or wear that damages the integration.
Medical conditions affecting bone density
Some medical conditions can accelerate bone loss around implants (as well as natural teeth). Osteoporosis and medications like steroids that thin bone can make implants more prone to bone loss. Other conditions that affect healing and bone health also increase risks.
Heavy smoking
Smoking is well-established to increase risks for implant failure and peri-implant bone loss. The toxins in smoke can interfere with blood flow and healing. Heavy smokers are more likely to lose bone support around implants. Quitting smoking can significantly improve the prognosis.
Signs of bone loss
Some signs that may indicate concerning bone loss around a dental implant include:
- Gum recession around the implant, exposing more of the crown/metal post
- Loosening or discomfort of the implanted crown
- Chronic bad breath or gum infections around the implant
- Changes in the fit of the implant crown
- Swelling, redness, or pain around the implant
- Pus discharge around the implant
- A change in the way the implant crown meets other teeth
- Visible bone loss on x-rays around the implant
Diagnosing bone loss
Dental x-rays are needed to evaluate bone levels around implants over time. Specialized cone beam CT scans may also be used. The dentist can look for signs of bone loss between the time the implant was placed and follow-up visits. They may also probe around the implant to check for pockets, which indicate bone loss. If concerning bone loss is found, additional tests may check for infection or examine the fit and stability of the implant.
Can bone loss be repaired around implants?
If bone loss is diagnosed early, it’s often possible to stop it and regrow some lost bone. This may help rescue a failing implant.
Some approaches include:
Surgical bone grafting
Your dentist may place bone graft material around the implant to stimulate bone regrowth and reverse bone loss. Materials like human donor bone, bovine bone, or synthetic options are used. Sometimes membranes are also placed to hold the graft in place.
Guided tissue regeneration
This regenerative technique uses a small barrier membrane around the bone defect next to the implant. This guides your body to regrow bone and periodontal ligaments in the area blocked off by the membrane.
Emdogain
This material derived from developing teeth contains growth factors that stimulate bone formation. When placed around the implant, it can help regenerate lost bone.
PRP (Platelet-rich plasma)
A concentrated mix of your blood’s growth factors is injected into around the implant to spur localized bone regrowth. A “PRP facelift” around the implant can improve bone density.
Treatment of inflammation and infection
If peri-implantitis is causing the bone loss, treating the infection and inflammation is critical. This can involve antibiotics, deep cleanings to remove bacteria, and surgery to clean infected tissue. Quitting smoking and improving oral hygiene are also essential.
Preventing bone loss around implants
While bone grafts can help restore lost bone, prevention is key. Steps to help prevent bone loss problems include:
- Quitting smoking before the implant procedure
- Maintaining excellent oral hygiene with daily brushing, flossing, and mouthwash
- Getting regular professional teeth cleanings and exams (at least twice a year)
- Treating any periodontal disease before getting an implant
- Using an occlusal guard if you grind your teeth
- Getting improperly fitting implant restorations adjusted or replaced
Careful implant placement by an experienced dentist and following up with diligent home care helps ensure successful long-term implant results.
When is bone loss severe enough to require implant removal?
As a general guideline, bone loss over 2 millimeters beyond the first year post-placement is a concern. If more than half the bone around the implant is lost, it likely needs to be removed. However, every case is unique, so have an honest discussion with your dentist.
Factors like the implant location, amount of bone at placement, and rate of progression matter. If bone grafting and regeneration fail to resolve the bone loss, the implant may be deemed unsalvageable. But removing an integrated implant also involves risks like jawbone defects. You and your dentist should decide together if removal is the best option.
What happens if an implant fails due to bone loss?
When an implant fails, it needs to be removed through minor oral surgery. If there is minimal bone left, bone grafting may be done during implant removal to prepare the area for possible future re-implantation. After adequate healing, getting a new dental implant placed is usually possible if enough bone remains. But if there is advanced bone loss, you may need a bone graft before placing another implant.
An alternative like a dental bridge may be recommended if bone loss is very severe and placing a new implant isn’t possible. But regular dental implants are still the best permanent replacements for lost teeth when bone conditions allow it. Partner closely with your dentist if an implant fails to find the best solution to restore your smile.
Takeaways
Some key takeaways about why you may be losing bone around a dental implant:
- A small amount of bone loss is expected following implant placement as the bone remodels and attaches to the implant. But ongoing, progressive loss is not normal.
- Potential causes include infections like peri-implantitis, issues with the implant placement or fit, mechanical damage, medical conditions affecting bone density, and smoking.
- Signs like gum recession, looseness, or changes in fit warrant an exam and x-rays to check for concerning bone loss.
- If diagnosed early, bone loss may be repaired with grafts, regeneration techniques, and infection treatment.
- Preventive care through good oral hygiene, dental visits, occlusal protection, and implant maintenance is key.
- If an implant fails due to bone loss, it can often be replaced with a new implant once healing allows.
Consult your dentist right away if you have any concerns about bone loss around your dental implant. Catching problems early makes successful treatment much more likely. With proper care after placement and good preventive maintenance, dental implants can last for decades and preserve your smile for life.