Why Do Dental Implants Sometimes Fail Over Time? Understanding the Role of Ageing, Gum Health, and Biology

Dental implants are widely regarded as one of the most reliable long-term solutions for missing teeth. However, I’ve increasingly seen a trend among elderly patients—particularly those who had implants placed several years ago—returning with concerns about their gum health and changes in the tissues surrounding their implants. Common complaints include gum shrinkage, loss of the thick, attached gingiva around the implants, and even signs of bone loss. Naturally, this raises the question: why do dental implants sometimes seem to deteriorate over time?

Let’s be clear—implants don’t “fail” overnight. When they do, it’s usually the result of a combination of biological, systemic, and lifestyle-related changes.

Ageing and the Gingiva

As we age, soft tissue quality naturally diminishes. The gingiva (gum tissue), particularly in the posterior regions of the mouth, may undergo changes that make it thinner, more fragile, and less keratinised. This degeneration can lead to a reduction in the protective “collar” of attached gingiva around implants, making the area more susceptible to irritation, plaque build-up, and eventual inflammation.

Unlike natural teeth, implants don’t have the same protective periodontal ligament. They rely heavily on the stability of surrounding bone and soft tissue. Any changes in these supporting structures can compromise the implant’s longevity.

Bone Loss and Systemic Changes

Bone remodelling is a natural process, but in older patients—especially those who are osteopaenic or osteoporotic—bone density can drop more significantly. Medications such as bisphosphonates or corticosteroids, which are commonly prescribed for age-related conditions, may also interfere with normal bone turnover, healing, and immune responses.

Furthermore, patients may not always be aware that changes in their nutritional status—such as lower vitamin D, calcium, or protein levels—can impact oral healing and maintenance. These micronutrients play a vital role in maintaining both bone and soft tissue integrity.

Lifestyle and Biological Variation

Another key factor is individual healing capacity. Everyone’s biology is different, and as people age, their ability to heal and maintain stable tissue around implants may decline. Additionally, new medical diagnoses, changes in medication, or even a shift in oral hygiene routines can upset the balance needed to support a healthy implant.

It’s also worth mentioning that many patients had implants placed during a time when tissue management around implants was not as refined as it is today. Modern techniques often emphasise preserving or augmenting soft tissue around implants—something we are much more aware of now than perhaps a decade ago.

So, What Can Be Done?

Regular monitoring, detailed assessments of gum quality and bone levels, and early intervention are key. In some cases, procedures such as soft tissue grafting or guided bone regeneration may be needed to maintain or restore the health of peri-implant tissues. Nutritional support, gum lubricants, and tailored home care instructions should not be underestimated—especially in the elderly.

If you’re noticing changes in your gum health or concerned about the longevity of your dental implants, it’s essential to have a thorough review with your dentist. Implant maintenance is not a one-size-fits-all process, and personalised care can make a world of difference.