Dental implants have an excellent long-term success rate — around 95% over 10 years in healthy non-smoking patients. But like natural teeth, they are not invincible, and a small percentage do fail. At Dentist Pymble, we treat peri-implantitis and failing implants for patients across the Ku-ring-gai region, and the right outcome depends almost entirely on catching the problem early. This page covers the warning signs, the most common causes, and the treatment options — including what happens if the implant has to come out.

How do I know if my dental implant is failing?

The warning signs are similar to those around a natural tooth with advanced gum disease:

• Red, swollen, or bleeding gum around the implant
• Persistent bad taste or bad breath that won’t go away
• Pain or tenderness around the implant, particularly on biting
• The implant feeling loose or wobbly (a late sign — call straight away if this happens)
• A pus discharge or small pimple on the gum beside the implant
• Receding gum that exposes the metal of the implant

If any of these are present, it is worth a prompt look. Peri-implantitis in its early stages can often be stopped before it causes irreversible bone loss. Once the implant is mobile, the bone has usually been lost to the point where saving it is no longer realistic.

What causes a dental implant to fail?

Failures fall into two broad categories. Early failure happens in the first few months, before the implant has fused with the bone (osseointegration). It is usually related to surgical factors, infection at the site, poor bone quality, or overload from biting forces on a not-yet-integrated implant. Late failure happens months or years after the implant has integrated, and is most often related to peri-implantitis or progressive overload.

Across both categories, the most significant modifiable risk factor is smoking. Smokers show roughly twice the failure rate of non-smokers, mostly because smoking impairs healing and the blood supply to the bone and gum around the implant. Other risk factors include poor oral hygiene, uncontrolled diabetes, a history of severe gum disease around natural teeth, and grinding or clenching (bruxism) that puts excessive force on the implant.

Peri-implantitis: the gum disease of implants

Peri-implantitis is the implant world’s equivalent of periodontitis. It is an inflammatory condition where bacteria in plaque trigger a chronic immune response around the implant, leading to progressive loss of the bone that supports it. The early stage (mucositis) is reversible with better cleaning and professional debridement. Once bone loss is visible on an x-ray, the condition is peri-implantitis and is no longer fully reversible — the goal becomes stopping progression and keeping the implant functional for as long as possible.

The frustrating thing about peri-implantitis is that it is often painless until it is advanced. By the time the implant feels loose, the bone loss is usually significant. This is why regular review appointments around implants are worth keeping — they let us catch the early signs (slight redness, bleeding on probing, small bone changes on x-ray) before the disease has done irreversible damage.

Can a failing implant be saved?

Sometimes, and the earlier we catch it, the better the odds. For early peri-implantitis, a thorough cleaning under the gum (similar to scaling and root planing around a natural tooth), combined with better home care and quitting smoking, can halt the disease. For more advanced cases, surgical access to decontaminate the implant surface, sometimes with a bone graft to fill in the defect, can buy years of additional function.

The honest answer for a Pymble patient: not every failing implant can be saved, and we will not pretend otherwise. If the bone loss is severe, the implant mobile, or the infection not responsive to treatment, the right answer is to remove the implant, let the site heal, and plan for a replacement. We will always lay out the realistic options, with the costs and the timeframes, and let you decide.

What happens if the implant has to come out?

Removal is usually straightforward. The implant is unscrewed (or, if it has fused solidly and the threads are damaged, the surrounding bone is carefully sectioned to free it). The site is then cleaned, sutured, and left to heal. Healing typically takes 3-6 months, and a new implant can be placed once the bone has regenerated. In sites where a lot of bone has been lost, a bone graft at the time of removal is often needed to set the stage for a future implant.

Can the implant be replaced?

Yes, in most cases. Once the site has healed, a new implant can be placed, often with a bone graft to ensure there is enough volume to hold it securely. The second implant has slightly lower success rates than the first, partly because the bone at the site has been through more. The alternative options are a bridge using the neighbouring teeth, or a removable partial denture. We will walk through the realistic options for your specific site at the consultation.

If you live in Pymble, Gordon, Turramurra, Wahroonga or anywhere else in the Ku-ring-gai area and you have an implant that is not feeling right, call our practice. We see neighbouring Gordon patients and other nearby residents, and the earlier we see a failing implant, the more options we have.

Frequently asked questions

How common is dental implant failure? Overall, dental implants fail in around 5% of cases over 10 years in healthy non-smokers. The risk is higher in smokers, patients with uncontrolled diabetes, and patients with a history of severe gum disease around their natural teeth.

Is a failing implant painful? Early peri-implantitis is often painless. As it progresses, you may notice tenderness on biting, swelling, or a small pimple on the gum. Pain that wakes you up at night is a late sign and should be seen urgently.

Can a failed implant be replaced? Yes, in most cases. The site usually needs to heal for 3-6 months after removal, sometimes with a bone graft, before a new implant can be placed.

Is peri-implantitis reversible? Early peri-implant mucositis is reversible with better cleaning and professional debridement. Once bone loss is visible on an x-ray, the condition is no longer fully reversible, and the goal becomes stopping progression rather than curing it.

How can I prevent implant failure? The basics matter most: good oral hygiene with brushing and flossing (including around the implant), quitting smoking, regular check-ups and cleans, and addressing any grinding or clenching with a night guard.