What can go wrong with a dental implant.

The main complications, in order of how often they come up

1. Gum infection around the implant (peri-implantitis)

This is the leading cause of long-term implant failure. Bacteria accumulate at the gum line around the implant, the gum becomes inflamed, and over time the bone supporting the implant erodes — similar to advanced gum disease around a natural tooth.

How it happens: Inadequate cleaning around the implant, plaque buildup, smoking (which impairs gum tissue healing and immunity), and existing gum disease that wasn't addressed before placement.

How it's prevented: Regular professional cleanings, careful brushing and flossing around the implant, treating gum disease before placing implants, and not smoking.

How it's caught: Routine dental visits — your dentist or hygienist checks the gums around each implant for redness, bleeding on probing, and pocket depth changes. The earlier it's caught, the easier it is to manage.

2. Failed osseointegration

Sometimes the bone doesn't fully grow around the implant during the healing period. The implant becomes loose or fails to support the crown. This typically shows up in the first few months after placement, before the crown goes on.

How it happens: Insufficient bone volume or density at the placement site, infection during healing, biting down on the area too soon, certain medications (notably some bone-loss medications) that interfere with bone remodeling, or smoking.

How it's prevented: Proper case planning with CBCT 3D imaging to confirm bone volume, surgical guides for accurate placement, bone grafting where indicated, restricting load on the implant during integration, and managing risk factors.

What happens if it fails: The implant is removed, the site is given time to heal (often with a bone graft), and a new implant is placed once the bone has rebuilt. Plan financially for this contingency by asking your provider about their failure-coverage policy upfront.

3. Nerve injury

A risk specifically for lower-jaw implants near the inferior alveolar nerve. If the implant is placed too close to or in contact with this nerve, the result can be numbness, tingling, or persistent altered sensation in the lower lip, chin, or tongue. Numbness can be temporary (resolves over weeks to months) or, rarely, permanent.

How it's prevented: CBCT 3D imaging to map the nerve location precisely before surgery, and surgical guides to keep the implant placement away from the nerve. This is one of the strongest reasons to use a provider who routinely does CBCT planning rather than 2D X-rays alone.

4. Sinus complications

For implants in the upper-back jaw, the maxillary sinus sits just above the bone. If the bone is thin, an implant can extend into the sinus cavity, potentially causing sinus infections or inflammation.

How it's prevented: Pre-surgical imaging measures bone thickness; if there isn't enough, a sinus lift procedure adds bone to the sinus floor before placement. Skip a provider who doesn't address this if you're getting an upper-back implant.

5. Mechanical complications

The implant post itself rarely breaks (titanium is robust), but the components on top can have issues:

• Loose abutment screw — the screw connecting the abutment to the implant can loosen over time, particularly if you grind your teeth. Usually a quick fix.
• Fractured crown — the visible crown can chip or break, similar to any dental restoration. Replaceable.
• Loose crown — the cement or screw holding the crown can fail. Re-cement or re-screw.

These are repairs, not replacements of the implant itself.

6. Surgical complications during placement

As with any oral surgery, possible immediate complications include bleeding, infection of the surgical site, swelling that lasts longer than expected, and reactions to anesthesia or sedation. Cleveland Clinic notes that the initial healing period takes about a week; severe or worsening symptoms after that window are reasons to call your provider, not wait.

Risk factors — things that change your individual risk

Smoking

Smoking meaningfully raises the risk of every category above — failed integration, peri-implantitis, slower healing, and higher long-term failure rate. The mechanism: nicotine constricts blood vessels and impairs the blood supply to healing tissue.

Many surgeons require quitting (or at least pausing) for several weeks before and after implant placement. Some practices won't accept smokers as candidates at all. If you smoke and want implants, talk to your provider candidly — pretending otherwise is the worst-case scenario for your outcome.

Uncontrolled diabetes

Diabetes affects healing, including bone integration. Well-controlled diabetes (stable blood sugar, regular medical care, A1c in target range) is generally compatible with successful implants. Uncontrolled diabetes is a meaningful risk factor and may need to be brought under control before surgery.

Certain medications

Some medications affect bone metabolism and can interfere with osseointegration. Notable categories:

• Bisphosphonates and other bone-loss medications (used for osteoporosis, some cancers) — can in rare cases lead to a complication called medication-related osteonecrosis of the jaw. Tell your provider every bone-loss medication you've ever taken, including IV forms.
• Long-term high-dose corticosteroids — affect bone remodeling and immunity.
• Immunosuppressants — affect healing and infection risk.

Don't omit medications during your medical history — your provider needs the complete picture to plan safely.

Bone density and volume

If your jaw doesn't have enough bone, the implant has nothing to anchor to. CBCT imaging assesses this. Solutions include bone grafting, sinus lift, alternative implant designs (shorter implants, angled placement, mini implants for some cases), or All-on-4 designs that work around limited bone. Read about bone grafting →

Untreated gum disease

Active periodontal disease at the time of placement is a strong risk factor for peri-implantitis later. A good provider will treat any active gum disease before scheduling implant surgery, not after.

Bruxism (teeth grinding)

Grinding puts excess force on the implant and the crown above it. Doesn't disqualify you from implants, but typically requires a custom night guard to protect the work.

Who isn't a candidate

A small number of conditions make standard implant surgery inadvisable. These include:

• Active cancer treatment in the head/neck region with radiation therapy to the jaw
• Recent IV bisphosphonate therapy (timing of risk varies — consult your oncologist and surgeon)
• Severe uncontrolled systemic conditions affecting healing
• Insufficient bone that cannot be augmented
• Patients still growing — see the FAQ on age

"Not a candidate" doesn't always mean "never." Many disqualifying factors are temporary; the right provider will tell you whether your case is "no" or "not yet."

Warning signs after surgery — when to call your provider

Some level of discomfort and swelling is normal in the first week. The following are not normal and warrant a call:

• Pain that's getting worse rather than better after the first 3–4 days
• Bleeding that doesn't stop with gentle pressure
• Fever above 100.4°F (38°C)
• Numbness or tingling that persists or worsens, particularly in the lower lip, chin, or tongue
• Pus, foul taste, or unusual drainage from the surgical site
• The implant or temporary feels loose or moves

If you can't reach your provider and symptoms are severe, go to an emergency room or urgent care. Don't wait it out.