Most Implant Problems Arrive Before Failure
A 2025 retrospective cohort from Ohio State University College of Dentistry tracks 1,282 implants in 732 patients and finds that outright implant failure was...
The dental implant has an oddly heroic job description. It is asked to replace a tooth, resist physics, survive biology, tolerate human hygiene, and then sit quietly while everyone gives the crown most of the compliments. "Evaluation Endosseous Dental Implants success Rate, Adverse Events, and Associated Risk Factors: A Retrospective Study," from Saponaro, Lang, Hammoudeh and colleagues, is useful because it looks past the heroic ending. In this Ohio State University cohort, outright implant failure was uncommon; soft-tissue complications did most of the talking.
That distinction matters. Failure is dramatic. Mucositis is administrative. Peri-implantitis is the problem that has usually filled out several forms before anyone calls it a crisis.
The Data Anchor
The study reviewed electronic health records for adults who received at least one endosseous dental implant at Ohio State University College of Dentistry between January 2016 and October 2021. The final dataset included 1,282 implants in 732 patients, with care delivered across predoctoral, specialty, residency, and faculty practice settings. Median follow-up was 2.2 years (Q1-Q3: 0.8-4.0), which is enough to catch early trouble but not enough to pretend this is a 10-year survival study wearing sensible shoes.
The cohort was pleasingly real-world and therefore messy: 54% female, median patient age 58.3 years, 10% diabetes mellitus, 8% osteoporosis/osteopenia, 36% periodontitis by patient history, and 16% current smokers. Most implants were Zimmer Biomet (69.5%), followed by Straumann (10.6%), Astra Tech (9.8%), and Nobel (6.9%).
Key Findings
Any adverse event occurred in 208 implants (16.2%). The incident rate was 7.5 per 100 person-years (95% CI: 6.4-8.5), and the 5-year event-free rate was 86.0%.
Implant failure was recorded in 51 implants (4.0%). Failure to osseointegrate occurred in 37 implants (2.9%); loss of osseointegration occurred in 34 implants (2.7%), with overlap because some immediately loaded implants could be classified both ways.
Soft-tissue complications outnumbered failures. Peri-implant mucositis was recorded in 92 implants (7.2%) and peri-implantitis in 33 implants (2.6%); mechanical complications affected 84 implants (6.6%), mostly abutment screw loosening (5.3%).
Periodontal history mattered biologically, not mechanically. Adjusted models associated periodontitis history with any adverse event (HR 1.88), peri-implantitis (HR 4.98), and mucositis (HR 1.91), but not implant failure (HR 1.72; P = 0.364).
Diabetes pointed toward soft tissue, not failed integration. Diabetic patients were more likely to have soft-tissue complications (HR 1.79; P = 0.023), but the study did not find diabetes predictive of implant failure.
Limitation: this is retrospective chart review data. Bone loss was not quantified because radiographs were not standardised, comorbidities were partly self-reported, and chart-note quality did some of the heavy lifting.
💡 The Clinical Bottom Line
This paper does not make implant dentistry look fragile. It makes it look familiar: a high-success treatment whose most useful warning signs are often soft, inflammatory, and written in the maintenance notes before they ever appear as catastrophic failure.
For Monday morning, the practical move is not panic; it is sharper risk sorting. Patients with periodontal history and diabetes deserve a maintenance conversation that is specific, documented, and boringly persistent. That is where the action is. The implant may be made of titanium — but the prognosis still has a sulcus.
Dr Samuel Rosehill is a general dentist with a prosthodontic focus, practising at Ethical Dental in Coffs Harbour, NSW. He holds a BDSc (Hons) from the University of Queensland, an MBA, an MMktg, and an MClinDent in Fixed & Removable Prosthodontics (Distinction) from King's College London.
Reference: Saponaro PC, Lang L, Hammoudeh H, Barnett SD, Nassani LM, Hsieh Y-L, Azer SS. Evaluation Endosseous Dental Implants success Rate, Adverse Events, and Associated Risk Factors: A Retrospective Study. International Journal of Oral and Maxillofacial Implants, 2025. DOI: 10.11607/jomi.11345
This article was originally published on samrosehill.com.