From Bruxers to Bone Loss: Occlusion as the Hidden Variable in Implant Complications

Written by Dr. Agatha Bis

You placed the implant. It osseointegrated. The crown looked perfect. The patient was happy… until they were not.

Maybe it started with mild discomfort. Then came screw loosening. A chip in the porcelain. Soreness they could not explain. Or worse, bone loss around the implant that seemed to come out of nowhere.

Sound familiar?

We have 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 are not. They are 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 is not properly directed, the implant does not 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 are already screening for bruxism. But here is the catch, most bruxers do not know they are bruxing. They will not tell you. You will not 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 Did Not Plan For

Let us be clear: occlusion is not just about contact. It is 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 Is Not Peri-Implantitis

We have 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 will 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 are 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. Do not 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 are stabilized. Locking in the bite too soon can trap dysfunction.

Final Thought: Occlusion Is Not Optional

Implants do not fail because they are weak. They fail because we placed them in systems we did not fully understand.

From bruxers to bone loss, occlusion is the silent variable driving most complications. And if you are not assessing it, managing it, and designing for it, you are leaving your implants vulnerable.

Successful implants are not just placed. They are 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