Red Flags Before Implant Placement: What You Can’t Afford to Miss
Implant dentistry has become so routine, it’s easy to forget one important truth: placing an implant in the wrong mouth is still a mistake, no matter how perfect the placement is.
What you do before implant placement often matters more than the surgery itself. A successful implant isn’t just about osseointegration, it’s about long-term function, comfort, and survival under real-world forces. And too often, dentists skip or overlook key warning signs that could sabotage the case.
Here are the top red flags you must identify and address before you even think about placing that implant.
1. Unstable Occlusion
If your patient’s bite is constantly changing, their teeth are shifting, or they’ve had recent wear or mobility; you’re dealing with an unstable occlusion. Placing an implant into that chaos is asking for trouble.
Why it matters:
Implants don’t adapt. They can’t move, shift, or adjust to new forces. If the bite keeps changing, your implant becomes the immovable object in a moving system—and that creates overload, fractures, or even bone loss.
What to do:
Stabilize first. Use a deprogrammer, orthotic, or provisional to test bite stability before placing the implant.
2. Parafunction (That the Patient Doesn’t Know About)
Most patients with parafunction don’t admit it, because they don’t know it’s happening. But look closer: scalloped tongues or cheeks, worn incisors, wear facets on buccal cusps of upper teeth, or even unexplained fractures. These are all clues.
Why it matters:
Clenching or grinding loads implants differently than natural teeth, and without proprioception, the implant takes the full hit. If you restore without managing parafunction, expect complications.
What to do:
Screen for signs. If suspected, consider a trial orthotic or splint before implant placement to assess force distribution and joint response.
3. Poor Bone with No Plan for Load Direction
Yes, CBCT shows you bone. But it doesn’t show you function. Poor quality bone in the wrong vector, combined with poor occlusion, will lead to early failure or micro-fractures.
Why it matters:
Even perfectly integrated implants can fail if lateral forces are not controlled, especially in D3/D4 bone or grafted sites.
What to do:
Always plan for axial loading. That starts with proper implant angulation and ends with occlusal design that supports vertical force and eliminates lateral stress.
4. Anterior Wear or Missing Canine Guidance
This one gets missed all the time. The anterior teeth, especially canines, are your protection. If they’re worn, missing, or non-functional, posterior implants take the brunt of excursive forces.
Why it matters:
You can’t have group function on an implant. If the anteriors aren’t doing their job, your implant will end up trying to do it, and it’s going to fail.
What to do:
Restore the anterior guidance first. Composite build-ups, crowns, ortho, or provisionals can help re-establish guidance and protect future implant restorations.
5. Unexplained Joint or Muscle Symptoms
If your patient has joint noises, facial pain, headaches, or frequent “bite changes,” stop and assess this first. That implant case might be walking straight into a TMD storm.
Why it matters:
Implants freeze the system. If you lock in an unstable joint or skip proper functional assessment, you risk worsening the patient’s symptoms and destabilizing the occlusion.
What to do:
Evaluate TMJ first. Ask about pain, clicking, deviation on opening, and muscle tenderness. If present, treat conservatively before moving to surgical solutions.
Final Thoughts: It’s Not Just About the Bone
Too often, we think implant planning starts with the CBCT. But the most important diagnostics don’t show up on a scan. They show up in the occlusion, in parafunction, in muscle activity, in joint behavior, in the forces at play every time the patient swallows or chews.
Ignoring these red flags won’t cause failure overnight. But six months later, when the patient returns with pain, fractured porcelain, or mobility, you’ll wish you had looked closer.
Implants don’t fail in isolation. They fail in systems that weren’t stable to begin with.
So before you pick up the scalpel, pick up the articulating paper. Talk to your patients. Check the joints. And don’t just look for bone, look for balance.
Want more on this?
Join my “Why Your Implants Fail” course series where we cover occlusion, bite analysis, and case planning protocols designed to protect your implants and your patients.
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