What should I do after a failed dental implant?

December 19, 2018 2:34 PM

My implant failed — it came right out of my mouth as the endodontist was checking it. Now I have to wait at least 2-3 months for gum and bone to heal. Meanwhile, I need to decide between several options.

This has been a long saga. Back around 2013, I had a root canal on tooth #30, which is the third molar from the back, lower right. In 2015, the root canal failed and the tooth had to be extracted. I opted for an implant, done by the same doctor who did the root canal and extraction. Then my regular dentist installed the abutment and crown on the implant.

About three months ago, the tooth started to hurt whenever I chewed down on something hard with it. Then the adjacent gums got sore whenever I used a pick on them (something I do to treat gum recession), and the tooth hurt when I pushed on one side or the other.

I returned to the original endodontist (late October) to have this checked out. They took an Xray and looked at it, but said the "bone integration" looked fine. Thinking that the pain was caused by the tooth being slightly high, they ground a bit off it to fix the occlusion. The pain on chewing etc. subsided a little after this but didn't go away.

My regular dentist heard about this problem and asked me to come in, which I did on Dec. 5. By this time (starting about a week or two before), I could feel the tooth move back and forth when I pushed on the side of it, and I could rotate it slightly when I applied a twisting force.

So on Dec. 5, my dentist (the one who had installed the crown) decided that the screw which holds the abutment into the socket on the implant must have come loose. The crown itself would not come off, so they drilled a hole into the top of the crown to get at the screw, took off the crown and abutment, installed a temporary healing cap on the implant, and sent me back to the endodontist for another look-see at the implant. (They sent the crown, cap and screw to the lab for examination; the lab said these parts all looked fine.)

So today I was at the endo. He started using a wrench to take the healing cap off, and when trying to twist it loose, suddenly the entire implant broke loose and came out. He was a bit shaken, and I was not a happy camper. (But apparently, about 5% of all implants fail in terms of coming loose from the bone.)

Now, I need to wait six weeks for the gum to heal and several more months for the bone to heal, before anything further is done.

So my question is, should I:
(a) Start over by having another implant installed, followed by re-installation of the old abutment and crown? (Leave aside the potential need for bone grafts, which has not yet been mentioned and was not needed the first time around.)
(b) Ditto, but with a new abutment and crown?
(c) Skip that and get a bridge installed (not my preference, but it's an option)
(d) Do nothing and live with the gap (which is not visible to others). Keep in mind that I'm in my eighth decade and have 29 other good teeth (having lost only two wisdom teeth along the way).

Advice from anyone with similar experiences appreciated.

posted by beagle to Health & Fitness (15 answers total)

If you don't have a history of/issues with gum disease or dry mouth then you could try the implant again, this time with a bone graft. It seems a bit odd to me that they did the implant the first time around without the graft, really. Fairly often when a tooth is pulled you're gonna need something to fill in a bit of the space where it came from, especially if it's from a failed root canal, which tends to give you some bone loss or deterioration IME.

If you do have the option to reinstall the old hardware then I'd definitely choose that, for the cost savings alone. When mine popped out under similar circumstances, it was thrown away "accidentally" by the dentist who then insisted I needed to have bridgework done instead, by him, of course. I've left the area toothless for over 3 years out of spite for that, and it hasn't caused any shifting of my other teeth, although the molars on the opposite side are a little tired from being the main chewers, but if I had the money I would probably go through another bone graft or two and then the implant again.

I do have a bridge in the front that I'm very happy with, but I don't really want to deal with the amount of cutting on two perfectly healthy molars it would take to put a bridge in the back.
posted by poffin boffin at 3:09 PM on December 19, 2018

I had an implant fail -- tooth grinding on my part, despite a mouthguard -- and decided to have a new one put in. That one is still doing fine (and much lower to avoid the grinding problem.) I'm glad I decided to have a second one put in, rather than leaving it or putting in a bridge, because the reason for failure seemed avoidable the second time around and so far has been. It was annoying and expensive, but easier the second time around.
posted by gingerbeer at 3:26 PM on December 19, 2018

I'd prefer to have an OMFS or periodontist place my implant instead of an endodontist.
posted by Cuspidx at 4:55 PM on December 19, 2018 [2 favorites]

I faced a similar question in my early 30's - I shattered the exact same tooth in an accident and was strongly pushed to have a root canal or implant, depending on the eventual health of the tooth.

At the time I was in no position to deal with such a thing and asked instead that it be removed, I had to ask several times.

Eight years on I have not had one minute of trouble with the gap - it was literally pull tooth, wait a week for the gum to sort itself out and then forget about it. I am very happy with my choice, I'm a few thousand richer and have had way less bother.

You are quite a bit older than me, I'd say leave the gap and get on with life.
posted by deadwax at 5:25 PM on December 19, 2018 [3 favorites]

Personally, if it were me, I would strongly consider (d) do nothing. If the gap is not visible. My mother recently did this on the advice of her dentist (Canadian).
posted by nanook at 5:40 PM on December 19, 2018 [3 favorites]

I have had a gap in molars since I was 20. It hasnt bothered me yet.
posted by aetg at 8:00 PM on December 19, 2018 [3 favorites]

I've had an implant fail for no obvious reason (I have a pair of congenitally missing teeth--the other implant is fine). I had it replaced (with bone graft). I didn't have the option to reuse the abutment and crown--it turned out to be some esoteric kind of implant that had since been discontinued. (I think my dentist genuinely had a lot of fun figuring out what it was and what had happened to the company.) A bridge was an option, but I was advised against it as the adjacent teeth were fine.

To be honest, if I were you, I'd be tempted ask what I was risking if I did nothing and lived with the gap.
posted by hoyland at 3:53 AM on December 20, 2018 [2 favorites]

Were I you, I'd go with option D. Not visible to others, not likely to impair function, sounds to me like you're going to get by fine without it. And save some pain and money to boot. Hope the situation doesn't prevent you from enjoying holiday goodies right now!
posted by jzb at 4:56 AM on December 20, 2018 [1 favorite]

Do nothing and live with the gap (which is not visible to others). Keep in mind that I'm in my eighth decade and have 29 other good teeth (having lost only two wisdom teeth along the way).

Dear God I would go with this option in a heartbeat.
posted by DarlingBri at 5:01 AM on December 20, 2018 [2 favorites]

I had a terrible time with a dental implant attempt a number of years ago. Multiple failed bone grafts left me miserable since I had to wear a stupid flipper tooth thing for over a year while we kept trying to grow enough bone to seat the implant (I was in university and the tooth was a canine, so it was both an aesthetically and emotionally charged situation!). Finally, after once again going to the periodontist and being told, "welp, looks like you need another bone graft before we implant it," I peaced out of that process and demanded a bridge. My dentist didn't want to do this because it meant chopping into two of my (very few) well formed teeth, but I have never looked back. (He even called me at home to dissuade me, which seemed insane to me! But I mean I guess that's service for you.....)

Anyway, if your tooth isn't visible and its absence isn't causing you grief, then go for the gap. But this is just a note to say that a bridge is a perfectly acceptable solution if it ever comes to it.
posted by Mrs. Rattery at 5:49 AM on December 20, 2018 [1 favorite]

Response by poster: Thanks all! Belatedly, I did find this Ask specifically about the gap question, which didn't turn up in my search for previouslies when posting this. It offers quite a bit of support for option D.
posted by beagle at 6:14 AM on December 20, 2018

I'm missing most of the molars on my left side. They've all been pulled after failed root canals. I chew on the right side of my mouth now and wear a night guard while I sleep, partly for grinding, but mostly to keep my teeth from shifting. They haven't really moved at all and my last extraction (of four) was about three years ago now.

I have a lot of other health problems and implants or bridges were not a good option for me.

It's fine and my quality of life is not at all diminished. You can't see the gaps; those teeth are far back there. Talk to your dentist and endo about the possibility of your teeth shifting (they will likely be worried about this) and see if you can come up with a plan if they are worried about this possibility.
posted by sockermom at 6:16 AM on December 20, 2018

I've had two molars next to each other missing since my late 20's. Lived in a tiny country town with the nearest dentist an old drunk who liked to grope women so I never went in to see what could be done to save them after a car accident. I've had the gap for almost 25 years. None of my teeth shifted, no one has ever mentioned or commented on it and the one remaining molar at the back is still going strong. Honestly I could think of better things to spend my money on than suffering through more dental work in the hopes that it will work. Anyone getting that close to my teeth to see they're missing back there knows me too well to care I'm missing any.
posted by wwax at 8:10 AM on December 20, 2018

I would probably live with the gap, but if you're interested in pursuing one of the other options I would recommend getting a consult with a prosthodontist rather than your regular dentist or endodontist.
posted by thejanna at 9:55 AM on December 20, 2018

I am much younger than you, like third-decade young, and expect to lose a molar in ~5 years. I plan to get an implant because I'm young, but as the tooth in my case is the last one in my mouth after wisdom teeth extraction and wouldn't leave much gap, my periodontist actually suggested option D as the first choice.

Basically the risks of option D are 1) teeth shifting (nightguard will help), 2) you might lose the matching tooth on the top. Given your age and the non-cosmetic impact of the worst case scenario, you can probably afford to lose 2 teeth instead of 1 if it comes to that.

You might still decide that retrying the implant is worthwhile. But definitely option D (do nothing) is better than B (bridge) in basically all cases given your age and health.
posted by serelliya at 2:30 PM on December 20, 2018