From Bruxers to Bone Loss: Occlusion as the Hidden Variable in Implant Complications
You placed the implant. It osseointegrated. The crown looked perfect. The patient was happy… until they weren’t.
Maybe it started with mild discomfort. Then came screw loosening. A chip in the porcelain. Soreness they couldn’t explain. Or worse, bone loss around the implant that seemed to come out of nowhere.
Sound familiar?
We’ve been trained to blame surgical technique, hygiene, or even material fatigue. But the real culprit in many of these cases is one that gets overlooked over and over again: Occlusion.
The Problem No One Talks About
We like to think of implants as replacements for teeth. But they’re not. They’re replacements for roots. And unlike natural teeth, implants have no periodontal ligament, no proprioception, and no shock absorption.
So when a patient bites down with just a little too much force, or the load isn’t properly directed, the implant doesn’t “feel it.” It just takes the hit. Over and over again.
The result? Micro-trauma. Fatigue. And failure.
Bruxers: Your Implant’s Worst Enemy
You might think you’re already screening for bruxism. But here’s the catch, most bruxers don’t know they’re bruxing. They won’t tell you. You won’t see wear facets on a brand-new crown. But you will see: tooth wear on teeth, chipping, bite changes, wear facets, dentin exposure.
When these red flags go ignored and implants are placed in parafunctional patients without occlusal control, the results are predictable: fractured components, chipped ceramics, mobility, or even implant loss.
And then we ask, “Why did it fail?”
Occlusion: The Hidden Load You Didn’t Plan For
Let’s be clear: occlusion is not just about contact. It’s about direction, timing, and distribution of force.
Even if your contacts look “light” on articulating paper, you might still be applying heavy lateral forces during excursions—or locking the mandible in a retruded position. This is especially dangerous on implants, which lack adaptive feedback.
Common occlusal mistakes in implant cases:
Restoring with broad occlusal tables on posterior implants
Allowing excursive contacts on anterior implants
Using the same occlusal scheme for implants as natural teeth
Ignoring signs of TMD or parafunction before restoration
Bone Loss: When It’s Not Peri-Implantitis
We’ve been conditioned to look for infection when we see radiographic bone loss. But what if the issue is mechanical, not bacterial?
Repeated lateral forces can trigger bone remodelling, even when hygiene is good. If your implant is taking the hit, especially in low-density bone or a poorly loaded arch, you’ll see the classic signs of “failing” implants:
Progressive bone loss
Loose screws or abutments
Fractures in the crown or abutment
Unexplained pain or sensitivity
You can graft again. Re-tighten the screw. Remake the crown. But unless you fix the occlusion, you’re just buying time.
What You Should Be Doing Instead
Design for vertical load only.
Implants thrive under axial load. Eliminate shear, minimize wide contacts, and avoid non-axial guidance, especially in posterior restorations.
Use diagnostic tools beyond paper.
Shimstock, articulating foil, Tekscan, don’t rely on just one. Layer your diagnostics to see true load and timing.
Control parafunction early.
If you suspect bruxism, start with a splint or orthotic before implant placement. You need to stabilize the occlusion first, not after the problem shows up.
Watch for shifting occlusions.
Patients with TMD, collapsing bites, or unstable joints are not ideal implant candidates until they’re stabilized. Locking in the bite too soon can trap dysfunction.
Final Thought: Occlusion Isn’t Optional
Implants don’t fail because they’re weak. They fail because we placed them in systems we didn’t fully understand.
From bruxers to bone loss, occlusion is the silent variable driving most complications. And if you’re not assessing it, managing it, and designing for it, you’re leaving your implants vulnerable.
Successful implants aren’t just placed. They’re protected.
Want to learn how?
Join my course series “Why Your Implants Fail” where we unpack the hidden forces behind implant complications, and give you the step-by-step clinical tools to get it right the first time.
▶️ Register now at TMJWhispererAcademy.com