A friend told me that she placed implants at 18 and 19, and they failed. Then she had gone back to remove them, meticulously clean and graft, and then she had placed 2 new ones at that same site.
And then, lo and behold, they failed again!
That reminded me of some literature I had read in prosth residency so I wanted to brush up on the subject and share with you.
Lower Success
The literature shows us that reimplanting in a previously failed site carries a somewhat lower success rate compared to placing an implant in a fresh site.
Why? Here are a couple of reasons:
Bone Loss and Poor Quality: When an implant fails, it often results in some bone loss around the area. The bone might be structurally weaker or may contain some scarred tissue around it, making it a bit more compromised.
Residual Infection: If the implant failed due to an infection (like peri-implantitis), there’s a chance that some bacteria may still be present. Even after cleaning out the area, it can be tricky to completely eliminate all bacteria.
Biomechanical Stress: The previous implant may have failed due to too much bite force or because of its placement in an awkward angle that created stress. If we’re not careful to fix these issues when re-placing a new implant, the same stresses can lead to another failure.
Changes in Blood Supply: After implant removal, blood flow to the area can be reduced, which may slow down healing and bone regeneration. Healthy blood flow is important for bone strength and stability, so decreased blood supply can make it harder for the implant to succeed.
What does the Lit Say?
There are several articles that back this up:
1. “Survival of dental implants at sites after implant failure: A systematic review” – Journal of Prosthetic Dentistry, 2019
- Objective: This is a systematic review that evaluated the survival rates of implants placed in previously failed sites and identified factors impacting outcomes.
- Findings: It concluded that implants in previously failed sites tend to have lower survival rates, often due to compromised bone quality and infection risks. The authors suggested that bone grafting and longer healing times could help improve results.
- Link to Article
2. “Successive Reimplantation of Dental Implants Into Sites of Previous Failure” – Journal of Oral and Maxillofacial Surgery, 2019
- Objective: This study looked at outcomes of reimplanting dental implants multiple times in the same site, exploring which factors improved or reduced the chances of success.
- Findings: It reports that while reimplanting in previously failed sites is possible, each successive reimplantation has a lower success rate. Addressing initial failure causes—like infection or bone issues—improved outcomes for reimplanted implants.
- Link to Article
3. “Implant survival after consecutive implant failure: A retrospective study” – International Journal of Oral and Maxillofacial Implants, 2015
- Objective: This retrospective study looked back at cases where implants were reimplanted after one or more failures to understand patterns in survival rates.
- Findings: Survival rates were lower with each successive failure and reimplantation. However, outcomes improved when causes of the first failure, like infection, were managed and addressed.
- Link to Abstract
4. “Outcome of dental implants placed in sites of previous failures” – Clinical Oral Implants Research, 2012
- Objective: This study examined factors like bone quality, infection control, and grafting to understand their impact on implant outcomes in previously failed sites.
- Findings: Success rates were generally lower for reimplants in failed sites compared to new sites. However, infection control, thorough debridement, and bone grafting significantly improved the prognosis.
- Link to Abstract
Where do we go from here?
A couple of tips for rebuilding:
- Build it back up. Make sure the proper bone grafting protocols are implemented. For example, if something has a crazy amount of bone loss and is totally blown out, I generally refer those out. There’s no shame in it even though it can feel shameful. But making sure that the patient is set up for success is going to be more important in the long run. Last thing you want is to place another implant in less than optimal bone and then get another failure. In these situations, I often foot the bill for the patient.
- Eliminate the infection. Infection is a major concern if the initial implant failed due to peri-implantitis. To reduce the risk of reinfection, thorough debridement of the site is essential, potentially supplemented by antimicrobial treatments. In cases where peri-implantitis was the cause, you should wait until all signs of infection have cleared before proceeding with a new implant.
- Biomechanical considerations. The previous implant might have failed due to excessive load or unfavorable stresses. When reimplanting, ensure that the position and angle will optimize load distribution. No off axis loads!
- Reset patient expectations. When an implant fails. It becomes a new ballgame. Don’t overpromise and underdeliver. Instead, explain to patients that this is not an easy fix and that it will take time. Taking the time to educate them can make all the difference.
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