Perhaps you’re about to lose a tooth or you’ve neglected your teeth over the years. You’ve decided now is the time to do something about your teeth. You’ve heard of dental implants and they seem to be the best thing since sliced bread. They can solve all your dental problems; you’ll never have to see a dentist again. To hell with those rotting, waving in the breeze teeth!
All your dental problems solved! When it sounds too good to be true, it often is. As a dentist, I am even asked to remove healthy teeth, and to replace them with implants. That’s how much excitement dental implants generate. As somebody who has placed thousands of implants, I have seen it all. I want to share my experience with you, provide you with the facts, so that you are able to make an informed decision. No fluff, no sales pitches, just facts and evidence. I’ve written other blogs on dental implants but this one is specifically dedicated to the safety of dental implants. So, are implants safe? Good question.
Dental implants are a great option for replacing missing teeth and give you a second chance. Technology has come a long way and the procedure has a high success rate, offering a great long-term prognosis without damaging adjacent teeth. Implant therapy is an effective solution for replacing decayed, loose, fractured, and failing teeth permanently. Restoring comfort, aesthetics, speech, function and psychological health. Furthermore, dental implants can minimise bone loss, thus preventing irreversible facial changes that result from missing teeth. In the past, the only fixed replacement option involved shaving down adjacent teeth and fitting a fixed bridge, often to the detriment of the supporting teeth.
I agree, implants sound very enticing. We are fortunate to live in an age of endless possibilities, and for many people dental implants are nothing short of life-changing, but we should not forget that as with any surgery, all factors need to be carefully considered before diving in. This blog is specifically dedicated to answering your questions on potential implant-related complications.
Can a dental implant be rejected?
One of the most common questions I hear from my patients, “Dr, are implants guaranteed or can they be rejected by the body”?
Titanium implants are non-toxic and are rarely rejected. Titanium’s unique ability to osseointegrate (fuse with bone) makes it perfectly compatible with human biology. I’ve heard of people claiming that their body won’t accept it (titanium), naturally implants don’t have a 100% success rate, but early or late failures are usually caused by other factors. Such as compromised general health, poor care, or poor surgery, implant rejection per se is less common. This follows onto the next question…
Can implants fail?
They sure can. In a similar way that natural teeth may not be for life, the same applies to implants. No matter how much you pay for them, implants are never as good as what nature designed in the first place. That said, they are pretty amazing and most of the time, highly successful.
Immediate implant failure could result from an implant failing to osseointegrate (fuse) with the jawbone. This is more likely in patients with compromised general health due to uncontrolled diabetes, autoimmune disease, smoking, certain types of cancer and bone turnover medications (Prolea, bisphosphonate), and in individuals with poor oral hygiene.
If you experience pain, movement of the implant, unexpected discharge (pus) or spontaneous bleeding after implant placement, please discuss it with your surgeon. He or she might be able to intervene quickly and implement measures to minimise the chance of the implant failing. However, sometimes there is nothing that a dentist can do, and the only option will be to remove it. Another attempt is possible in 3 months after the site has healed and will require a new assessment. It’s not uncommon for the jawbone to resorb with the failing implant, and sometimes the only way to regenerate it is to regrow this bone before attempting to place another (implant) in the same site. This procedure is called a bone graft.
How often do dental implants fail?
The simple answer is surprisingly not that often. Studies indicate that about 5-10% of dental implants fail. Considering that an implant is a foreign body inserted into living bone, it never ceases to amaze me that most of them do indeed integrate.
However, what we regard as failure differs from person to person. Some believe an implant falling out or becoming infected should be deemed as failure. Others find it unacceptable that their implant has a slightly different appearance to the adjacent natural teeth. So, figures quoted in the literature are relative. Understanding the pros and cons and establishing reasonable expectations from the beginning will result in a better overall outcome.
Is general health a factor?
Absolutely! Your oral health is largely dependant on your general health and vice versa. Many conditions should not affect dental implants. The following examples are some of the more common systemic factors, which may not work in your favour:Smoking – smoking inhibits blood circulation, and as a result, impairs your ability to heal. Your surgeon will recommend that you cease smoking before surgery to maximise success with initial healing and the long-term success of the implant. It doesn’t mean that you categorically can’t have
Smoking – smoking inhibits blood circulation, and as a result, impairs your ability to heal. Your surgeon will recommend that you cease smoking before surgery to maximise success with initial healing and the long-term success of the implant. It doesn’t mean that you categorically can’t have implants if you smoke, but to achieve the best outcome, consider quitting smoking as early as possible before surgery. The longer you don’t smoke, the more time your body has to repair, and the better the chances of success. Easier said than done, I understand. We can discuss your options, and I can sometimes prescribe certain medications which can assist in abstaining from smoking.
Uncontrolled diabetes can also interfere with healing. However, if you work with your medical practitioner to get it under control prior to surgery, you will be perfectly suitable to receive dental implants
Leukaemia, radiotherapy, chemotherapy can impede healing, and thus, it’s not advisable to have oral surgery until you’ve recovered.Medications such as bisphosphonates (Fosamax) or Denosumab (Prolia) slow down bone healing. If you are taking these medications, your surgeon will carefully consider if it’s safe to proceed with implants. How long you’ve been on these medications as well as your bone turnover rate, indicated by a simple blood test, would need to be taken into consideration.
Growing children. Some rare genetic conditions can result in children and young adults missing their natural teeth. We would need to wait until they are adults to have their teeth replaced with implants. It’s not advisable to have dental implants until full maturity, after the age of 25. If an implant is placed prematurely, while the patient is still growing, and the face is developing, it might not look in line with the rest of the teeth when the patient is fully developed.
If a dentist determines that there is not enough bone in your mouth to anchor implants, bone grafting could be considered before they are placed. Insufficient bone will often result in subsequent bone loss and implant failure.
Periodontitis is an advanced form of gum disease resulting from partly genetic predisposition, and partly from inadequate oral hygiene. Bacteria implicated in this condition results in bone loss surrounding natural teeth. The same bacteria that can compromise teeth can also compromise future implants. It is crucial to get periodontitis under control and stabilise this condition. With some help from your dentist, it’s not too difficult to get your gums healthy and ready for implant surgery.
Can an implant become infected?
When we think about dental implants being a foreign body in living tissue, infection is the first thing that comes to mind. Infection can occur immediately after surgery or it can be delayed.
To minimise the risk of post-operative infection, your surgeon will prescribe some antibiotics. These significantly reduce the risk of infection. However, with the emergence of superbugs, on a rare occasion an infection can develop regardless. Sometimes, with urgent intervention, an implant can be saved but other times an infection can result in implant loss. If you experience any of the following symptoms shortly after surgery, please contact your surgeon immediately:
pus discharge from the gums in the area of the implant
swollen, spongy, puffy gums
Although it’s the little, invisible creatures (bacteria) that are responsible for infections, you are not entirely powerless against them. Please help your dentist help you and follow their instructions. Eat soft foods, use a chlorhexidine mouth rinse after surgery, take your medications as prescribed, don’t drink alcohol or smoke and maintain good oral hygiene. A sterile surgery coupled with good homecare should minimise your risk of post-operative infection.
Delayed infections can also arise, especially if you are a smoker, have uncontrolled diabetes, or are taking bisphosphonate drugs. You could develop a condition called peri-implantitis, which is still not well understood and thus has limited treatment options; although this area of science is evolving. As a result, you might lose bony support around your implants in a similar manner as that of a natural tooth with gum disease (periodontitis). Both the skill of the surgeon as well as meticulous home care of your implants can minimise the risk of this condition. But remember, if mother nature hasn’t designed your teeth to last a lifetime, the money you spend is unlikely to alter this fine balance between nature and the magic we perform.
Can an implant cause an allergic reaction?
There is literature available that suggest some individuals can be allergic to metals including titanium. A whole scope of possible conditions has been stated as originating from metal sensitivity (chronic fatigue, chronic joint pain, contact dermatitis, and oral lichenoid reactions). In a similar way as people are exposed to nickel, aluminium and titanium in jewellery, watches and sunscreens; some people can have a reaction to long term titanium exposure. In writing this, I appreciate that there is a percentage of the public who might misuse this information and assume that this is a reason to discard implants as a good treatment option. In my whole practising career, I am yet to see a patient display an allergic response to an implant, simply because this is so rare. However, if you are concerned, and have a history of allergies to metals, I would recommend taking a simple blood test (Memory Lymphocyte Immunostimulation Assay), and check for potential sensitivity. It is possible that on a rare occasion, titanium hypersensitivity can lead to an implant being rejected but this unlikely and shouldn’t be the only reason to deter you from what is an incredibly good treatment option.
If an allergy is severe, an implant needs to be removed. However, for mild allergies oral atropine sulfate or oral corticosteroids may be sufficient. In patients with a confirmed titanium allergy, alternatives such as zirconium oxide implants are available. However, these implants are yet to reach the strength of titanium implants and are primarily suitable for replacement of front teeth, as they are prone to fracture under the chewing forces of the back teeth. A potential alternative is Polyether ether ketone (PEEK plastic), a partially crystalline polyaromatic linear thermoplastic with excellent mechanical properties, but perhaps a little futuristic at this stage.
Can my implant corrode?
Titanium is a strong, light and malleable metal, which is highly biocompatible. Upon exposure to air, it forms a titanium oxide (TiO2) layer that protects the bulk of the metal from the environment. If an implant is damaged, this layer quickly reforms. Thus, titanium implants rarely corrode. Even though titanium implants are highly stable, some microscopic corrosion during biting and chewing has been reported in the literature, the effects of which (if any) are yet to be understood.
Can an implant promote bacterial growth?
The oral environment is full of bacterial colonies. The warmth, the moisture… Bacterial heaven! Bacteria can also seed onto the surface of dental implants, and cause inflammation of the peri-implant tissues. These bacteria can be a challenge to eliminate, a sterile surgery and meticulous home maintenance are the best ways to minimise bacteria taking hold.
What are the most common complications after surgery?
Most complications experienced are minor and insignificant in terms of the continuing success of your implants. Some of these can include bruising and swelling. Some patients return saying, “Doctor, I’m bruised, what did you do?” I’ve done surgery on your mouth!! Expect some bruising and swelling, it’s normal! Some people hardly bruise, but many do, some more than others. I will prescribe you medications such as a Non-Steroidal Anti Inflammatory (NSAIDs) and corticosteroids to reduce swelling. However, if you get away without at least a bruise, count yourself lucky. All bruises and swellings subside and heal. Despite how nasty they look; they are nothing to worry about.
Another common post-operative complication is called – incision line opening. This is jargon for wound opening, if it’s attended to promptly, it doesn’t cause any serious long-term problems. Don’t worry, your implant won’t fail, but if not addressed promptly, it can result in an unexpected infection and bone loss. If you experience ‘incision line opening’, contact your surgeon as soon as possible.
What are the less common complications?
Nerve injury. In the upper jaw, unless you are having zygomatic implants, there aren’t any nerves in the vicinity so there is no risk of nerve damage).
In the lower jaw, there is a nerve, namely the “Inferior Alveolar Nerve”, responsible for supplying sensation to the lower lip, the chin and the teeth. There is one on each side of the jaw. Occasionally during a grafting or implant placement procedure, this nerve can be temporarily or permanently affected, resulting in an altered sensation in the lip and chin on the corresponding side of the face.
This could feel like minor tingling, which can sometimes improve over time, or it can result in a permanent loss of sensation (numbness). It’s worth knowing that this complication does not result in loss of function, your lip will not droop, and no one will notice the difference. You will be the only person to notice it, and of course your dentist should too. If you suspect this has happened, your surgeon will make an assessment and advise you on the best way to manage it. This is one of those rarer complications, but not to be dismissed. In fact, most people who have their wisdom teeth removed would also have been informed of this complication by their dentist.
Sinus complications. Maxillary sinuses are air-filled cavities in your face, an implant can sometimes penetrate this sinus space. Rarely causing any long-term complications but can occasionally result in sinus infections. In this case a follow-up procedure may be required to alleviate the situation, or you may even be referred to an ENT (Ear, Nose, Throat) specialist.
Adjacent tooth injury. This is not very common, as careful planning and precise surgical implant placement can prevent injury to adjacent teeth. If the roots of surrounding teeth are very close, digitally prepared surgical guides can be pre-made to precisely guide the surgeon’s hand to ensure almost zero error during surgery. Another reason why it’s so important to select an experienced surgeon. If this complication does occur, it might not be of any significance. Equally, an injured tooth could require root canal treatment or even need to be removed.
What about surgical complications?
People are often worried that something will go wrong during dental surgery. Whilst it is true that surgery can be unpredictable at times, an experienced surgeon has dealt with complications in the past and can overcome any issue that might arise, ensuring a positive outcome. I stress, it is extremely important that the dental surgeon you choose is experienced, especially in tricky circumstances, for both your safety and peace of mind.
If an artery is affected during the surgery, excessive bleeding can occur. A mouth is highly vascular and contains a number of important arteries. Although major complications can be avoided with a surgeon’s care, sometimes it’s inevitable that an artery is injured. A bleeding artery can usually be ligated (sealed) to stop the bleeding, with no major long-term complications.
Blood thinning medications:
Your surgeon will make a preoperative assessment of the medications you take. If you take a blood thinner, it’s crucial you disclose this to your surgeon. Your medications will require adjusting in accordance with the advice from your medical practitioner, this is to avoid uncontrolled bleeding during your surgery. Some of the common blood thinners are:
Yes, but if your surgeon is experienced and careful, this is unlikely. Still, some roots of adjacent teeth can be within 1mm of the implant site, and as you can imagine, a millimetre or so is not a great distance. If an adjacent tooth is injured, rarely will it cause serious complications, but occasionally the effected tooth might require root canal treatment or even removal.
Extremely rare risks
I promised to be thorough, so I’ve included these risks for absolute comprehensiveness. However, most are far-fetched, so I won’t dwell on them too much, yet they still made it onto my list.
Temporomandibular joint problems (your jawbone)
Pain in the neck or face
Muscles in the jaw that become weak or tired
Most implant surgery is performed under local anaesthesia or light sedation. This is as safe as having a filling. If you are undergoing a more involved implant rehabilitation with All on 4 full mouth dental implants, or simply feeling anxious about being awake during surgery, most surgeons will offer the option of general anaesthesia.
Perhaps you’ve heard that having general anaesthesia can carry associated risks. These are very rare, as you are in the hands of highly specialised anaesthetists, who cares for you attentively while you are asleep and measure your vital signs minute by minute. Nevertheless, any history of previous complications with general anaesthesia or a family history of conditions such as malignant hyperthermia, must be disclosed to the anaesthetist to help him or her assess your safety. If you are healthy, of good weight (BMI under 30) and under the age of 80, sleep dentistry should be a safe option for you.
Allergies to medications that your dentist prescribes you
I prescribe a number of medications to my patients to control pain, reduce the risk of infection, and reduce swelling during and after the surgery. If you have any known allergies, let’s discuss and consider alternatives.
Can gum and bone recede around an implant?
Sadly, this is common. It was thought that once an implant integrates, it keeps bone, but evidence shows that bone can recede around implants. This could be due to poor home care, incorrect placement of the implant during surgery, smoking or another systemic condition, or even implant design. Sometimes, this is hardly an issue, particularly with rear implants, where the implant can still be maintained and functional. However, in the aesthetic zone, gums that don’t follow a natural contour of adjacent teeth can be unsightly, especially if you show your gums when you smile. Once bone around implants is lost, it cannot be regenerated. There are emerging techniques to counteract this, but they are still in their infancy. Thorough evaluation before implant surgery and correct treatment planning can minimise the risk of this complication. I can’t stress enough how invaluable immaculate home care is in the long-term success of your implant(s).
Is it safe to have implants if you grind your teeth?
Only if you promise to wear a protective night guard (occlusal splint)! Many people suffer from a condition called Nocturnal Bruxism. Left unattended, it can damage your tooth or teeth. I often see excessive wear and cracks in the teeth of grinders. In fact, one of the most common reasons we have to replace a tooth with an implant is due to an unrestorable crack as a result of grinding. Your implants aren’t immune either, if you refuse to wear a splint, your implants can get overloaded and fail, and porcelain crowns can break. However, if you wear an occlusal splint every night, your implants are safe.
Can implants fracture?
Yes, but rarely. Modern implants are made of grade 4 titanium, which is incredibly strong. Able to easily withstand chewing forces, but as with anything, if it’s pushed to it’s limits, something has to give. If a zirconia implant is used inappropriately, for instance, it’s used to replace back teeth, or if you grind your teeth and don’t wear an occlusal splint at night, your implant is not safe. Providing you take all the appropriate precautions and recommendations from your dentist; you’ll likely enjoy many years of service from your implants.
Can an implant crown fracture?
There is a slightly higher chance of a crown fracturing when placed over a dental implant. Natural teeth offer cushioning in the form of the periodontal ligament attaching a tooth to the surrounding bone. This ligament is missing with dental implants, so the shock of biting is transferred directly to the crown.
I can’t clean my teeth well at home, is it still OK to have dental implants?
Poor oral hygiene is one of the most common causes of implant failure. You’ve heard me harp on about implant infections/peri-implantitis earlier. Just as your natural teeth can succumb to periodontitis (gum disease) due to poor oral hygiene, your implants can too, no matter how much you’ve paid for them. I’ve said it before, and I’ll say it again; if you are not able to care for your “new teeth”, all effort will be undone through poor homecare. There are no ifs and buts.
How can I minimise risk factors?
While there are no certainties, there are ways to mitigate the majority of complications. Avoid smoking and follow your dentist’s recommendations when caring for implants, eat soft foods during healing and ensure you take your medications as directed. Choosing an experienced dentist should also be a big part of your decision-making process. With a well-considered treatment plan, any additional risk factors will be taken into account before surgery.
How should you choose a surgeon for full mouth implants?
It’s really important to find a skilled, experienced dentist, but it’s equally as important that he or she is kind, compassionate and cares about the outcome. Because what better joy is there for a surgeon than to see new life injected into their patient? You want your surgeon to hold their breath when they are performing surgery, they need to be as invested in the success of your treatment as you are. No matter how experienced, they need to be transparent, honest and absolutely devoted to you. A recommendation from a friend is worth gold but if you don’t know anyone who’s undergone a similar procedure, perhaps meet a few surgeons to see how comfortable you feel with them. Your gut feeling will tell you who to go with.
Surgery is not a walk in the park. When you undergo surgery, please remember this. Hopefully, you will be one of the 9 in 10 patients for whom it all goes really well, rather than the 1 in 10 who develop complications. The success of implant surgery comes down to many factors, not just down to the surgeon.
You are ready and can’t wait! You’ve done your research and you’re convinced that dental implants are the right teeth replacement solution for you. You’ve read all the reviews online and have chosen the best dentist for you. Now is the time to meet with your dentist, so they can evaluate your health and suitability for dental implants. Pre-treatment evaluation, x-rays and scans will help them determine the best treatment for you. The more information your dentist has, the fewer the risks.
If it happens that the dentist tells you that he/she can save your teeth, please don’t try to convince them otherwise. If we are recommending a quicker, cheaper and more effective treatment option for you, it’s in your own best interest. There is nothing better than your natural teeth. I understand that you might’ve lost all faith in your teeth because they’ve given you nothing but trouble over the years. However, if there is a good chance you can save them, take that chance. I am happy to educate you and show you how to look after your teeth and maintain them at home. Replacing your teeth is the next best thing after keeping your own. But if you must, well, you must.
If you were to ask me, what would I replace my teeth with if I lost them, I would tell you confidently and without hesitation, “with dental implants!” No doubt, no question and no hesitation.