My Implant Has Come Out — What Now? First Work Out Whether It Is the Crown, the Screw or the Implant

My Implant Has Come Out — What Now? First Work Out Whether It Is the Crown, the Screw or the Implant

Direct answer: Put the piece into a clean container with a lid, do not refit it yourself, and have a dentist establish as soon as possible whether what came away is the crown, the retaining screw or the implant in the bone; abutment screw loosening is reported as one of the more common mechanical complications [F1], while "it came out" can also involve a retention problem or the surrounding bone [F2], and these situations are managed differently. If there is heavy continuing bleeding, if facial swelling worsens rapidly, if there is fever, or if swallowing or breathing becomes difficult, seek emergency medical help immediately.

Geographic scope: Global. All cited evidence comes from international peer-reviewed literature; no country-specific reimbursement scheme or regulation is involved. The procedures, materials and fees actually available to you should follow your own health system and your dentist's assessment.

TL;DR — Keep the part, protect the site, and do not put it back yourself

What you experience as "my implant has come out" may be no more than the crown above it or a retaining component coming loose, or it may be the implant in the bone losing its support. The two are managed very differently, and the appearance of the piece that came out will not always tell them apart.

Put the piece into a clean container with a lid. Do not scrub it, soak it in alcohol, apply glue to it or try to screw it back yourself; avoid chewing on that side for the time being, and contact your dentist for an examination as soon as you can. If there is heavy continuing bleeding, if facial swelling worsens rapidly, if there is fever, or if swallowing or breathing becomes difficult, seek emergency medical help immediately.

What to do right now: keeping secondary damage to a minimum

First, keep the piece safely

Wash your hands, pick up the crown, screw or other component, put it into a clean container with a lid and bring the whole thing with you to the appointment. Do not scrub it hard, and do not disinfect it yourself with alcohol, bleach or any other agent; whether a component can be reused has to be judged by the dentist after checking for distortion, wear and the state of the connecting surfaces.

Then protect the site

Do not keep pushing at it with your tongue or touching it with your fingers, and do not probe it with any implement. If there is bleeding, press gently with clean gauze; avoid chewing on that side and avoid hard foods for now. Do not put household adhesive into your mouth, and do not push a component back simply because "it looks as though it fits".

Arrange a professional examination as soon as possible

The clinical reasoning here does not mean declaring that everything must be remade the moment a loose piece appears; it means first establishing which layer the problem lies in — the crown, the retaining screw, the abutment, the implant in the bone, or the bone and gum around the implant. Where necessary, occlusal examination and imaging are used alongside, and only then can it be decided whether the answer is cleaning and re-securing, replacing a component, remaking the prosthesis, or going further and dealing with infection and a bone defect.

The "single tooth" you see is in fact a structure of different layers

The crown or prosthesis has come off

If the implant in the bone is still stable, the problem may lie in the cement, in damage to the crown, in occlusal loading or in the design of the restoration. The dentist will check whether the crown can safely be reused, whether the connecting surfaces are intact, and whether the occlusion needs adjusting or the crown needs remaking.

The screw, abutment or a connecting component has loosened

This belongs to the mechanical category. The risk in tightening it yourself is that you cannot confirm whether the thread has been distorted or the interior contaminated, and you have neither professional instruments to control the process nor a way to check the state of the connection. Tightening alone, without finding out what is happening with the loading or the component, can also be followed by further loosening.

The implant in the bone has itself come out or become mobile

This usually calls for assessment of osseointegration, infection, bone loss and the remaining bone volume. Management may include removing an unstable implant, infection control, wound care, bone grafting and later reconstruction, but not everyone follows the same path, and an implant cannot be pressed back into the wound at home.

Common causes: mechanical problems and biological problems must be looked at separately

A systematic review including 18 studies reported abutment screw loosening as one of the more common mechanical complications and gave a figure of 16.21%; the overall prevalence of mechanical failure ranged from 5.6% to 7.7% [F1]. Where the 16.21% comes from matters: going back to the body of the review shows that it is taken from a single prospective study published in 1995, which followed patients for 6 years and recorded abutment screw loosening in 12 of 74 implants [F1]. In other words it is the raw proportion from one study, not a pooled estimate across the 18 studies — which is why it can be higher than the 5.6% to 7.7% figure for overall mechanical failure. The implants and types of prosthesis included in the studies were not entirely alike, so these figures are not the personal risk attaching to your particular implant.

Another systematic review and meta-analysis, of single implant-supported crowns, estimated the cumulative incidence of screw loosening after five years of use at 8.8%, loss of retention at 4.1%, and the cumulative proportion with bone loss exceeding 2 mm at 5.2% [F2]. This too shows that "it came out" has more than one cause: some cases involve a component or a retention problem, and others involve the surrounding bone.

Full-arch fixed implant prostheses are a different situation again. An umbrella review including 7 systematic reviews reported long-term screw loosening between 5% and 15%, and peri-implantitis between 4% and 18% [F3]. These ranges come from full-arch reconstruction and cannot be used to estimate directly for a single implant; they also remind us that the type of restoration has to be identified before the figures are interpreted.

When a dentist assesses the cause, the following are usually checked at the same time:

• Whether the prosthesis and screw show wear, distortion or fracture.
• Whether occlusal contacts are concentrated, and whether there are signs of grinding or of long-standing chewing on hard objects.
• Whether there is bleeding, suppuration, increased probing depth or bone loss around the implant.
• Whether the shape of the prosthesis creates areas that cannot be cleaned.
• The implant position, the connection design and the record of previous repairs.

These factors can be present together; mechanical loosening can make cleaning harder, while biological inflammation can take away the support of the implant in the bone.

Once you are in the surgery, what directions might management take

A crown or retention problem

The dentist will clean and check the crown, the connecting surfaces and the implant connection. If the structure is intact, it may be possible to re-secure it; if the shape of the crown, damage to it or its connecting surfaces make it unsuitable for reuse, it may need to be remade. Whether the original part can be kept cannot be decided on appearance alone.

A screw or abutment problem

It is necessary to establish whether the component is loose, fractured or lodged inside the implant, and to check the occlusion and the connection design. Management may involve retrieving, replacing or re-securing the component; if the implant itself remains stable, that does not mean the whole implant has to be removed.

Inflammation around the implant or bone loss

Management ranges from professional cleaning and infection control through to surgical treatment, according to the extent of the inflammation and the shape of the bone defect. Antibiotics are not an alternative you can resort to on your own, and the absence of pain alone cannot rule out bone loss.

The implant in the bone has already lost its support

If it is confirmed that the implant has to be removed, whether an implant can be placed again afterwards depends on whether the infection is controlled, on the remaining bone volume, the soft tissue, the occlusion and the reasons for the earlier failure. A systematic review published in 2014, which searched the literature from 1985 to 2011, included 6 articles, 334 patients and 338 implants and reported survival rates ranging from 71% to 100%; the survival rate for implants placed for the second time at a previously failed site (the third attempt overall) was 83.75% [F4]. The authors particularly caution that the number of studies and the samples are limited and that large, well-designed case-control long-term trials are lacking; the review concludes that survival rates of implants placed in the areas of previously failed implants are low, although they should not discourage clinicians from a second or even a third attempt [F4]. This range therefore indicates only that reconstruction remains possible in some cases, and is not a guarantee for re-implantation; read the generation of the literature alongside it as well — this search stopped at 2011, so ask your dentist whether more recent evidence is available.

Data anchors — do not mix figures from different types of prosthesis

Risk factors: what to know before treatment

• Whom these figures apply to: the proportions above come from different implants and types of prosthesis, heterogeneity between studies is high, and they are not the personal risk attaching to your particular implant [F1]; the ranges for full-arch fixed reconstruction cannot be applied directly to a single crown either [F3].
• Complications that can occur: abutment screw loosening is one of the more common mechanical complications; the 16.21% given in the review comes from a single prospective study published in 1995 (6 years of follow-up, 12 of 74 implants), not from a pooled estimate across the 18 studies [F1]; single implant-supported crowns can show screw loosening, loss of retention and bone loss, which represent technical and biological complications respectively [F2].
• Limits and uncertainty of reconstruction: survival reported for re-implantation at a failed site ranges from 71% to 100%, and is 83.75% for a second re-implantation (the third attempt overall); the review concludes that these survival rates are low, although they should not discourage clinicians from a second or even a third attempt [F4]. The number of studies and the samples are limited, large well-designed case-control long-term trials are lacking, and the review was published in 2014 with a literature search that stopped at 2011 [F4]; this range indicates only that reconstruction remains possible in some cases, and is not a guarantee.

Conclusion — keep it, do not put it back, then find out why

When an implant comes out, the most important thing is not to treat "it looks as though it goes back in" as safe. Keeping the piece properly, protecting the site, avoiding chewing on that side, and letting the dentist distinguish between the crown, the screw, the abutment and the implant in the bone is what gives you the chance to choose management that is both relatively conservative and appropriate.

If a crown, a component or an implant has worked loose, bring the piece with you to a dental appointment. A dentist can examine the structure, the occlusion and the tissue around the implant, and will then explain what can be repaired, what needs replacing and what needs rebuilding, together with the reasons and the limits.

Every clinical statement in this article is mapped line by line to its cited source (see the sources and evidence chain below). It has not been clinically reviewed by a licensed practitioner. This is health information, not individual advice; assessment by a clinician is required.