Short answer: Implant removal is considered when the implant has not fused with the bone, when severe bone loss has developed due to advanced peri-implantitis, or when the implant is fractured, loose or in a position where a prosthesis cannot be made. The procedure is usually performed under local anesthesia with reverse torque instruments or special burs. After the area has healed and, if needed, a bone graft has been placed, a new implant is possible in most patients. Suitability is determined by examination and imaging.
Dental implants are a treatment option that replaces missing teeth and, when planned correctly, functions for many years. However, as with any medical procedure, problems can occur with implants, and although rare, an implant may need to be removed. Hearing the dentist say "the implant needs to be removed" can be worrying for patients; this news is disappointing especially for someone who has invested time and effort in treatment, yet in most cases this procedure is not an end but the first step toward a healthy new start. In this article we look at why an implant is removed, how the procedure is done, the healing process and whether a new implant can be placed.
Why is an implant removed?
An implant is removed when it cannot fulfill its function or when it starts to damage the surrounding tissues. These situations are generally divided into two groups: early and late failures.
Early causes
The implant not fusing with the jawbone in the first months after placement (failure of osseointegration) is the most common cause of early failure. In this case the implant is usually mobile and may loosen on its own. Insufficient initial stability during surgery, infection in the area, loading the implant too early during the healing period and smoking can contribute to this picture.
Late causes
- Peri-implantitis: This is inflammation of the gum and bone around the implant. Similar to gum disease, it starts with the buildup of bacterial plaque. It can be treated at an early stage, but when it progresses and the bone supporting most of the implant is lost, the implant may need to be removed.
- Excessive force and clenching: Clenching or grinding at night, an unsuitable prosthesis design or a bite problem can overload the implant and the surrounding bone.
- Fracture: Although rare, the implant body can fracture; in this case repairing the implant is usually not possible.
- Unsuitable position: If the implant is at an angle or in a position that does not allow a prosthesis to be made aesthetically or functionally, removing it and replanning may be considered.
- Problems related to a nerve or neighboring structures: If complaints such as numbness or persistent pain indicate that the implant is positioned close to a nerve, its removal may be considered.
Not every problematic implant is removed. Situations such as early-stage peri-implantitis, a loosened prosthetic screw or a broken crown can often be resolved while leaving the implant in place. The decision is made based on a clinical examination, measurement of pocket depths around the implant and X-ray or three-dimensional CT images.
How is an implant removed?
In most cases implant removal is performed under local anesthesia as an outpatient procedure. The method used is chosen according to how well the implant has fused with the bone and the amount of bone around it.
- Planning: The position of the implant, the condition of the surrounding bone and its proximity to neighboring structures are assessed with imaging.
- Anesthesia: The area is numbed with local anesthesia; the aim is for the patient not to feel pain during the procedure.
- Removing the prosthesis: If present, the crown and abutment on the implant are removed.
- Removing the implant: A mobile implant can usually be removed easily. For an implant that has fused with the bone, reverse torque instruments are tried first; this method separates the implant from the bone by turning it in the opposite direction and keeps bone loss to a minimum. If this is not enough, fine burs, trephine burs or piezosurgery instruments can be used.
- Cleaning the area: Inflamed tissue is removed and the area is rinsed.
- Bone graft (if needed): If a new implant is planned, bone graft and a membrane can be placed in the resulting defect.
- Sutures: The procedure is completed by suturing the gum.
Depending on the condition of the implant, the procedure can take anywhere from a few minutes to an hour. Bone-preserving techniques such as the reverse torque method are preferred because they leave a more suitable foundation for a new implant. The type and size of the removed implant are recorded; this information serves as a guide when planning the new treatment.
What is the healing process like after implant removal?
Healing after implant removal is similar to healing after a tooth extraction. In the first days, mild pain, swelling and tenderness may occur; these usually subside within a few days. For the first 24 hours, applying cold to the cheek at intervals, eating soft and lukewarm foods, staying away from smoking and not straining the surgical area are recommended.
The surface of the gum usually heals within a few weeks. Bone healing takes longer; in most cases it takes a few months for the placed bone graft to mature and for the bone to be able to support a new implant. During this time, a temporary prosthesis can be used depending on aesthetic or functional needs.
Taking the medications your dentist recommends as instructed and attending your follow-up appointments are important for monitoring healing. In situations such as increasing swelling, fever, discharge or bleeding that does not stop, you should contact the clinic without waiting for your follow-up date.
Is a new implant possible after removal?
Yes, in most patients a new implant is possible; however, success depends on understanding why the first implant failed and eliminating that cause. For example, if factors such as smoking, uncontrolled diabetes, inadequate oral hygiene or untreated clenching continue, similar problems can occur with the second implant.
The timing of the new implant is determined by the condition of the bone:
- Delayed placement: This is the most commonly preferred approach. After the area has healed and the bone graft has matured, the new implant is placed, usually within a few months.
- Simultaneous placement: In selected cases, especially if there is no infection and sufficient bone is present, the new implant can be placed in the same session immediately after the old implant is removed.
- Alternative treatments: If the amount of bone is not suitable for a new implant or the patient prefers another route, options such as a bridge or a removable denture are considered.
What can be done to prevent implant loss?
The foundation of preventing implant loss is regular care and check-ups, just as with natural teeth. Implants do not decay, but the gum and bone around them can become inflamed. To prevent this, pay attention to the following:
- Cleaning around the implant daily with a soft toothbrush, interdental brush or floss
- Having professional check-ups and cleanings at least once or twice a year
- Quitting smoking, or at least cutting down
- Keeping systemic conditions such as diabetes under control
- Using the night guard recommended by your dentist if you clench or grind your teeth
- Going for a check-up without waiting if you notice bleeding, swelling, a bad taste or movement around the implant
You can find answers to other questions about implant treatment and care on our frequently asked questions page.
When should you get an examination in Ankara if you suspect a problem with an implant?
If you notice gum bleeding, swelling, discharge or a bad taste around your implant, or feel movement when chewing, these may be warning signs of a problem that can be treated at an early stage. At our clinic in Oran, we assess the tissues around the implant with an examination and imaging, and explain in clear language whether the implant can be saved and, if needed, what the next steps are.
Frequently asked questions
Does implant removal hurt?
Because the procedure is performed under local anesthesia, pain is usually not felt during it. Afterwards there may be mild pain and swelling for a few days; these complaints are usually brought under control with the measures your dentist recommends.
Can a loose implant be stabilized again?
A loose implant often indicates that fusion with the bone has been lost and usually cannot be stabilized again. However, what is loose may not be the implant itself but the screw or crown on top of it; in this case the implant can be saved. The distinction is made by examination and X-ray.
How long after removal can a new implant be placed?
In most cases, a few months are allowed for the area to heal and, if needed, for the bone graft to mature. In selected cases, the new implant can also be placed in the same session. The timing is determined by the dentist according to the condition of the bone.
Does peri-implantitis always lead to implant loss?
No. Peri-implantitis noticed at an early stage can be treated with professional cleaning, surface decontamination and, if needed, surgical procedures. Implant loss usually occurs in advanced cases that are noticed late.
