Is "implant rejection" a real thing?
Not as the word suggests. Implants are titanium or zirconia, a white ceramic, and both are biocompatible: the body does not attack them as it can a transplanted organ. What people call rejection is a failure of osseointegration, the process in which bone grows onto the implant and locks it in place.
- Early failure. The bond never forms, and the implant loosens during healing.
- Late failure. A working implant loses bone months or years later, usually from peri-implantitis, an infection of the gum and bone around an implant.
What is normal after implant surgery, and what is not?
- Pain. Soreness for two or three days, easing by the fourth, is normal. Pain that grows worse a week or more after surgery is not.
- Swelling. Mild swelling for two or three days is normal. Gums still swollen, red or tender after a week need to be seen.
- Temperature. A fever of 100.4 °F (38 °C) or higher after surgery needs a call the same day.
- Discharge. Pus at the implant is never normal; it means infection.
- Movement. An implant should never feel loose. If it moves, stop chewing on it and call us.
Why do dental implants fail?
These are the usual causes, often two together:
- Infection. Plaque left where the gum meets the implant causes mucositis, inflammation of the gum only, then peri-implantitis, which destroys bone.
- Too much load. A crown that sits high, a bite that is off, or heavy grinding puts repeated force on the implant.
- Poor position or too little bone. An implant in thin bone, or too close to the next tooth, leaves pockets that cannot be cleaned.
- Parts that do not fit. A gap at the abutment, the connector between implant and crown, gives bacteria a home.
- Health risk factors. Smoking, uncontrolled diabetes, past gum disease and some medications slow bone healing.
What can I do to protect a new implant?
- Follow our instructions for the first week: no heavy exercise, no hot baths, soft food on the other side. Do not smoke: smokers lose implants more often, so stop at least two weeks before surgery and stay off tobacco through healing.
- Clean around the implant daily with a soft brush and an interdental brush (a small brush for the gaps between teeth), and keep maintenance visits, often every three to six months.
- Tell us if you grind. A night guard, a thin custom appliance worn during sleep, helps protect an implant from clenching.
What do we do when an implant is failing?
First we find the cause: an examination, gum measurements and an X-ray, with a CBCT, a three-dimensional dental scan, where the bone level is in doubt.
- Mucositis is usually reversible with professional cleaning and better home care.
- Peri-implantitis with bone loss may need surgical cleaning of the implant surface and sometimes bone grafting, rebuilding lost bone with graft material.
- A loose implant cannot be saved. It is removed, the site heals or is grafted, and a new implant is planned once the cause is addressed.
Before any new implant we treat active gum disease and clean the whole mouth professionally. Where several implants carry a full row of teeth, the final teeth are designed so the bite is shared evenly.
Read more about dental implants and periodontal surgery.
When to call us
Call the same day if pain or swelling is getting worse after the first week, if you see pus, if you have a fever, or if an implant feels loose.
Sources
- Jung RE et al. Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years. Clinical Oral Implants Research, 2012.
- FDA: Dental implants, what you should know
- EFP S3 guideline: Prevention and treatment of peri-implant diseases
- American Academy of Periodontology: Dental implant procedures
About the author: Dr. Baruch Tetri, DDS, is a periodontist. He earned his DDS at NYU College of Dentistry in 2006, completed his Certificate in Periodontics in 2009, and is a Diplomate of the American Board of Periodontology.