Want All Your Teeth Out and Replaced With Implants? Read This First

Did someone tell you implants are better than teeth and last forever?

Then you should know that every medical and dental therapy, implants included, always carries a small percentage of failures or imperfect healing. In other words: most patients heal perfectly, while a small minority will run into some trouble. That’s how it is, no doubt about it. Anyone who says otherwise is lying, and knows it. Even the “best colleague in the world” — a mythological creature, of unicorn-like memory — will have a few failures in their personal caseload.

The 100% does not exist. It is right and sacrosanct for every operator to keep studying, to use modern, better-performing materials, precisely in order to push complications and failures to a minimum. But to a minimum, not to zero.

Many factors drive the effectiveness of a therapy, not least the operator with their experience and skill. And yet even the most seasoned operator (the unicorn dentist above) loses an implant now and then. This is true not only in implantology, but across all the other dental — and medical — therapies too.

Here is a summary of some success rates reported in the literature.

Dental implants

• Survival rate: over an average follow-up of 10-13 years, the survival rate of dental implants is around 93-95% (Jung et al., 2014).
• After 20 years the success rates drop to 78-92% (Kupka et al., 2024, Clinical Oral Investigations).

Lovely numbers, on paper. But there’s a detail that whoever promises eternity is careful not to mention: an implant can survive and fall ill at the same time. The largest systematic review ever published on this point — 102 studies, more than 13,000 patients, coordinated by AO and AAP (Galarraga-Vinueza et al., 2025, Journal of Periodontology) — counted peri-implant mucositis in 46% of patients and peri-implantitis, the inflammation that eats the bone around the screw, in roughly 1 patient in 5. These are not implants that fell out: they are implants in function that nonetheless demand care, check-ups, sometimes surgery. When you read “how long do implants last”, keep it in mind — I’ve written about it at length in how long dental implants really last. And a concrete figure, not a brochure one: in a cohort followed for ten real years (Zamparini et al., 2023) 95.6% of implants were still there, but what kept them standing was obsessive control of hygiene and occlusion. Not luck.

Prosthetic restorations (crowns and bridges) on endodontically treated (non-vital) and untreated (vital) teeth

A recent systematic review of the literature [https://onlinelibrary.wiley.com/doi/10.1111/jopr.13735] lists the various scenarios and their success rates.

• Single crowns on vital teeth: 5-year survival rate 95-98%.
• Single metal-ceramic crowns with a cast metal post on non-vital teeth: 5-year survival rate 90%.
• Single metal-ceramic crowns with a fibre post on non-vital teeth: 5-year survival rate 91%.
• Single metal-ceramic crowns without a post on non-vital teeth: 5-year survival rate 86%.
• Single all-ceramic crowns with a fibre post on non-vital teeth: 5-year survival rate 95%.
• Bridges supported by vital teeth: 5-year survival rate 85%.
• Bridges supported by non-vital abutments: 5-year survival rate 81%.

This means every treatment must be faced consciously, by both the patient and the colleague who carries it out — with confidence and trust, but also with the awareness that in the vast majority of cases everything will go well, and only rarely might it become necessary to deal with inadequate healing or failures. Such conditions are almost always solvable with a second treatment, which leads to the final success of the therapy.

Every operator will always do their best to avoid complications and failures, but controlling every variable is hard. It can happen, for instance, that out of personal conviction the patient doesn’t follow the prescribed antibiotic therapy to the letter, or takes painkillers that hinder the early process of osteointegration (anti COX-2) after surgery. Many factors can influence healing.

And here the recent literature is merciless in reminding us that the variables are not all on the operating table. A 2025 scoping review (Shenoy et al., Frontiers in Oral Health) mapped failures across more than forty years of data: early failures run between 0.5% and 5.2%, late ones between 0.5% and 7.8%, and the names that keep coming back are always the same — smoking, uncontrolled diabetes, periodontitis, occlusal overload. Nothing exotic. The good news is that many of these variables can be governed: the systematic review by Carra and colleagues (2023, Journal of Clinical Periodontology) showed that those who skip maintenance check-ups carry an almost fourfold risk of implant failure (odds ratio 3.76) compared with those who return regularly, and that in the diabetic patient good glycaemic control sharply reduces peri-implantitis. Translated: you don’t “fit and forget” an implant. And when something does go wrong, it’s rarely a “rejection” in the sense people imagine — on that misunderstanding I’ve written why dental implant rejection does not exist.

Another very important aspect is invasiveness. The failure of a very extensive, invasive treatment will potentially be harder to correct. By contrast, with a treatment tailored for the least possible invasiveness and the greatest possible effectiveness, the “trouble” for the patient in any correction phase will be kept to a minimum.

Photo by Eleonora Francesca Grotto on Unsplash