Dental implants are designed to be a permanent solution for missing teeth, but when a screw falls out, it can be both alarming and confusing. In most cases, what’s fallen isn’t the entire implant but the abutment screw—a small but crucial part that holds the implant crown in place.
While a loose or missing screw doesn’t always mean implant failure, it should never be ignored. If left unaddressed, it can lead to infection, damage to the implant, or even bone loss. Knowing why the screw came loose and how to handle the situation quickly can make the difference between a minor fix and a major problem.
Common Reasons a Dental Implant Screw Falls Out
Dental implant screws can loosen or fall out for several reasons—some mechanical, others biological. Understanding the cause is essential for determining the right fix and preventing it from happening again.
1. Abutment Screw Loosening
The most common reason is a loose abutment screw, which connects the implant crown to the implant post. If it wasn’t torqued properly during installation or gradually loosened over time, it can eventually come out completely.
2. Implant Body Failure (Less Common)
In rare cases, the actual implant body (the titanium post embedded in the bone) may become loose or fall out. This usually indicates serious underlying issues like failed osseointegration or advanced infection.
3. Poor Fit or Improper Torque
Improper placement or use of the wrong torque values can result in weak connections. This can happen if the dentist rushed the procedure or didn’t use a torque wrench as recommended.
4. Bruxism (Teeth Grinding)
Patients who grind or clench their teeth put extra stress on the implant components. Over time, this constant pressure can cause the abutment screw to work loose or even damage the crown.
5. Bone Loss or Infection
Peri-implantitis (infection around the implant) or bone loss can weaken the support structure, making the implant or screw unstable. Signs often include bleeding, swelling, or a foul smell.
6. Worn or Failed Components
Over time, crowns, screws, and abutments can wear out—especially with low-quality materials or aging implants. Material fatigue may cause the screw to break or fall out unexpectedly.
Is It the Implant or Just the Abutment Screw?
When something falls out of your mouth after implant treatment, it’s not always clear what came loose. Knowing the difference between a lost abutment screw, a detached crown, or a failed implant body is crucial for understanding the severity of the issue.
Abutment Screw vs. Implant Body
The abutment screw is a small connector that holds the crown to the implant post (the part embedded in the jawbone). If this screw falls out, the crown may detach or feel loose, but the implant post is still intact inside your jaw. This is usually fixable without surgery.
In contrast, if the implant body itself has come out, it means the entire titanium post has lost integration with the bone — a sign of failure. This situation is more serious and often requires full replacement, possibly with bone grafting.
Crown Detachment
Sometimes, it’s not the screw at all. The crown (the visible tooth) may have been cemented onto the abutment and can fall off without screw involvement. If this happens, both the crown and abutment may still be in good condition and simply need to be re-cemented.
How to Tell the Difference
- If you see a small metal screw: it’s likely the abutment screw.
- If you see a tooth-like cap: it’s likely the crown.
- If there’s a metal post with tissue stuck to it: it could be the implant body, and that’s more serious.
In all cases, take a photo and store the fallen parts safely for your dentist to evaluate.
What to Do Immediately After the Screw Falls Out
If your dental implant screw falls out, quick and calm action can help prevent further damage. Whether it’s the abutment screw, crown, or something more serious, follow these immediate steps:
1. Do Not Attempt to Reinsert the Screw Yourself
Trying to screw it back in without proper tools or knowledge can damage the internal threads of the implant or introduce bacteria into the site. Leave it to a professional.
2. Keep the Fallen Part Clean and Safe
Rinse the screw or crown gently with clean water (do not scrub) and store it in a clean, dry container. Bring it with you to your dental appointment—it may still be usable.
3. Avoid Chewing on That Side
Until the issue is resolved, avoid eating or applying pressure on the affected side. Excess force could damage the exposed implant or surrounding tissue.
4. Check for Signs of Infection or Bleeding
Look for swelling, bleeding, bad taste, or pus in the area. These symptoms may indicate infection or irritation and require urgent dental care.
5. Contact Your Dentist Immediately
Call your implant provider—whether local or abroad—as soon as possible. If you had the procedure done in another country, seek help from a local dentist while also informing your original provider for guidance.
6. Don’t Ignore It
Even if there’s no pain or discomfort, a missing screw can allow bacteria to enter the implant site. Delaying care could lead to implant failure or bone loss.
Can It Be Fixed Without Replacing the Whole Implant?
A fallen dental implant screw doesn’t always mean a complete implant failure. In many cases, the issue can be resolved with minor adjustments—if caught early and managed correctly.
1. Re-Tightening or Replacing the Abutment Screw
If the implant body is stable and the internal threads are intact, your dentist can often reinsert or replace the abutment screw. This is a straightforward procedure that usually takes less than 30 minutes and doesn’t require surgery.
2. Re-Cementing a Loose Crown
If only the crown fell off and no screw is involved, your dentist may simply clean and re-cement the crown back onto the abutment. As long as the underlying components are in good condition, no additional work is necessary.
3. When the Threads Are Damaged
If the internal threads of the implant have been stripped—often due to over-tightening or patient attempts to self-repair—a repair may not be possible. In some cases, special tools can clean or reshape the threads, but if the damage is extensive, implant replacement may be needed.
4. If the Implant Body Has Failed
If the entire implant body (the post inside the bone) has come loose or fallen out, it’s considered a failed implant. This usually requires removal, healing time, and possibly a bone graft before a new implant can be placed.
5. Cost and Timeline
- Minor fixes (screw tightening or crown reattachment): $100–$500
- New abutment or screw: $200–$600
- Full implant replacement with grafting: $3,000–$5,000+
How to Prevent It From Happening Again
Once a dental implant screw has come loose or fallen out, it’s important to understand what caused it and take steps to prevent a repeat issue. Many of the causes are avoidable with proper care and regular monitoring.
1. Ensure Proper Torque During Placement
The abutment screw must be tightened to the manufacturer-recommended torque value using a precision tool. If it’s over- or under-tightened, it’s more likely to loosen over time. Choose a dentist who follows strict torque protocols and uses the correct tools.
2. Schedule Regular Dental Checkups
Routine exams can catch small problems—like a loosening screw or crown—before they become serious. Your dentist can check implant stability, inspect the crown, and re-tighten components as needed.
3. Manage Bite Force and Bruxism
Teeth grinding (bruxism) and excessive bite pressure can stress implant components. If you grind your teeth at night, wear a custom night guard. For severe bite issues, your dentist may adjust the crown shape to reduce impact forces.
4. Use High-Quality Implant Systems
Lower-cost or generic implant parts may not fit precisely or hold up well under daily chewing forces. Choosing high-quality, name-brand systems (like Nobel Biocare, Straumann, or Zimmer) can reduce the risk of screw loosening and long-term failure.
5. Practice Good Oral Hygiene
Although implants don’t decay, the surrounding gum and bone can still become infected. Brush and floss regularly around the implant site, and use any recommended rinses to keep the area clean and inflammation-free.
6. Address Any Signs of Movement or Discomfort Early
If you ever notice the crown feeling loose, clicking sounds while chewing, or discomfort at the implant site, schedule a dental visit immediately. These are often early signs of screw loosening.
Conclusion
A dental implant screw falling out is unsettling—but it doesn’t always signal implant failure. In many cases, the issue is limited to a loose abutment screw or crown, both of which can be fixed without replacing the entire implant.
The key is acting quickly: don’t try to fix it yourself, avoid chewing on the affected side, and get in touch with your dentist as soon as possible. Identifying the cause—whether it’s improper torque, grinding, or bone loss—can help prevent it from happening again.
With proper care, quality components, and routine follow-ups, your dental implant can continue functioning safely and effectively for years.
