Something Is Wrong With My Implant

Screw loosening and breakage in fixed implant bridges

A screw that comes loose is not so much a fault as, more often than not, a message: the load is not being spread correctly

This is the most common problem people notice with an implant bridge, and the good news is that it is usually resolved with a short procedure. The bad news is that the loosening is usually not a fault in the screw itself. If the same screw keeps coming loose, the real problem lies elsewhere, and it will keep coming back for as long as nobody looks for it there. On this page we explain why screws come loose, when loosening turns into a break and what you should not do in the meantime.

Short answer

An implant bridge is attached to the parts underneath with a small screw, and that screw is tightened to a specific torque. Under a load repeated thousands of times as you chew, it can come loose; the most common causes are one point touching before the others when you bite, grinding your teeth at night, a bridge that has been extended towards the back and a load-bearing structure that is not strong enough for the load. Carrying on chewing with a loose screw breaks it, and removing a broken screw is a much harder job.

First signs: A clicking when you bite, slight movement, a change in taste
Most common cause: An uneven bite and overloading
If it keeps happening: A load distribution problem, not a screw problem
What not to do: Carry on chewing on that side

Medically reviewed by Bilge Ilgın, Dentist · ImplantologyLast reviewed 2026-09-06

Why the screw comes loose

Most fixed implant bridges are screw-retained: the bridge is fixed to the implants, or to the abutments on top of them, with small screws. This is no ordinary screw; it is tightened to a specific torque, and that torque creates a controlled tension in the body of the screw. That tension is what holds the connection together. When the tension drops, the screw comes loose and the bridge starts to move.

The most common thing that reduces the tension is an uneven load. If one point touches before the others when you bite, all the force piles onto that point and the implant beneath it. This impact, repeated with every bite, gradually loosens the screw. That is why the time spent on the bite on the day the bridge is fitted determines half of the problems that come up years later.

The second cause is grinding your teeth at night (bruxism). The force produced while grinding can be both greater and much longer-lasting than chewing force, and it is repeated every night without you knowing. The third is design: when the bridge extends behind the last implant, that section works like a lever and strains the screw furthest back. The fourth is a load-bearing structure that was not strong enough from the start; in a long bridge carried on a small number of implants, the screws carry more than their share.

A less talked-about cause is the bridge not fitting the implants exactly. When the bridgework does not sit without tension, the screws are under strain from the moment they are tightened, and over time that strain turns into loosening or breakage. This comes down to the laboratory and impression stage; it shows up months after fitting, as screws that keep coming loose.

The result of carrying on chewing with a loose screw is predictable. A screw that has lost its tension now takes the load it should be carrying on its body, and it fatigues. At some point it breaks. The broken piece stays inside the implant, and removing it takes special instruments and careful work; in some cases the internal thread of the implant is damaged and it becomes a much bigger job. Acting while the screw is only loose prevents this entire chain of events.

One-piece, or monoblock, designs have no abutment screw to come loose; the body and the top part are the same piece. This removes the problem of screw loosening and of the micron-scale gap at that connection. The trade-off is that the angle cannot be corrected later by changing the top part, so the planning has to be right from the outset. This is not a ranking of which is better; the two designs simply make their compromises in different places.

Which situations are easy to resolve and which go deeper

The same symptom can correspond to very different procedures. The distinction is made with an examination and an X-ray.

The tooth can be saved

If the screw has only just come looseThe bridge is taken off, the screw is cleaned or replaced with a new one and tightened again with a torque-controlled instrument. The bite is adjusted in the same session. If you come in early, the procedure is short and the implant is not affected at all.
If one point touches first when you bite and this can be correctedA contact that makes the load pile onto a single point can be balanced with an adjustment of a few minutes. If this adjustment is not made, the same screw comes loose again within a few months; once it is made, the problem usually ends.
If the screw has broken but the inside of the implant is soundThe broken piece is removed with special instruments and a new screw is fitted. The procedure takes longer than dealing with a loose screw and needs more careful work, but the implant is saved.
If night-time grinding has been identified and is being managedFor patients who grind their teeth, a night guard markedly reduces the load on the structure. A solution that stops at tightening the screw falls short here; the real intervention is reducing the load.

Saving it is unlikely to hold

If the same screw comes loose more than once a yearThis is not a maintenance job. Screw loosening that keeps coming back tells you there is a problem with the bite, the fit of the bridge or the strength of the load-bearing structure. Tightening it and sending you away each time silences the symptom and lets the cause grow.
If the implant's internal thread was damaged while the broken piece was being removedIf the thread inside the implant has been damaged, a new screw will not hold securely. In this situation the options for saving it are limited, and replacing the implant may come into consideration.
If the bridge does not sit on the implants without tensionIf the problem is not the screw but the fit of the bridgework, changing the screw is not the answer. In this situation the bridge needs to be remade or adjusted to fit; otherwise the loosening and breakages will continue.
If there is also bone loss around itIf the screw problem comes with bone loss around the implant, it is not only a mechanical problem. First it is worked out whether inflammation or load is the main factor; the two are treated differently.

How it is resolved at the clinic

The order matters a great deal: simply tightening the screw and sending you away is the quickest solution, but also the shortest-lived.

1
Access and removal
In screw-retained systems, the access hole on top of the bridge is opened and the bridgework is taken off. In cemented systems, removal can be more laborious; this is one of the practical differences between the two designs.
2
Inspecting the parts
The screw, the abutment and the inner surface of the implant are checked. A screw that has fatigued or become deformed is not reused; it is replaced with a new one. This is a simple but often skipped step that stops the loosening from coming back.
3
Testing each implant on its own
With the bridgework off, each implant is checked for movement in the bone. If there is movement, it is not a screw problem, and things take an entirely different course.
4
Tightening with torque control
The new screw is tightened to the torque set by the manufacturer, using a torque wrench. Tightening by hand is not enough; overtightening breaks the screw. Either mistake becomes a problem that is hard to undo later.
5
Measuring and adjusting the bite
Points that touch first when you bite are identified and balanced. If this step is skipped, the same screw comes loose again for the same reason; this is where the real treatment lies.
6
Sealing the access hole and a check-up
The space above the screw is sealed with a suitable material. A check-up is done a few weeks later; that is the only way to tell whether the torque has held.

Ways to stop it happening again

Screw loosening that keeps coming back ends not with a single procedure but by dealing with the cause. These are the points to discuss.

Rebalancing the bite

The most common and most effective solution. With a bite that spreads the load evenly across the supports, each screw carries only its own share. This adjustment needs repeating at check-ups; the mouth changes over time.

A night guard

For patients who grind their teeth, it reduces the load on the structure at night. It does not stop the grinding, but it spreads the force and protects both the screws and the bridgework.

Simplifying the bridge design

When the section extending behind the last implant is shortened, the lever effect is reduced. This directly lowers the force straining the screw furthest back.

Strengthening the load-bearing structure

If a long bridge is carried on a small number of implants, adding an implant to share the load more widely can be discussed. When screws keep coming loose, this is the route that deals with the source instead of working on the screw.

Adjusting the fit of the bridgework

If the bridge does not sit on the implants without tension, the screws are under constant strain. In these cases the bridgework needs to be remade, or sectioned and refitted.

The price of waiting and of the wrong intervention

These are the most common mistakes in this situation; all of them turn a short procedure into a big job.

Carrying on chewing with a loose screw

A screw that has lost its tension takes the load directly on its body and fatigues. A delay of a few weeks can turn a simple tightening job into removing a broken part.

Trying to tighten it yourself

The torque a screw needs varies by system and cannot be judged by eye. A screw tightened by hand either stays loose or breaks. Opening the access hole the wrong way can also damage the bridgework.

Trying to force out a broken screw

The thread inside an implant is very fine, and once it is damaged it cannot be restored. This procedure has to be done carefully with the right instruments; forcing it can end in losing the implant.

Just tightening it without looking for the cause

Tightening the screw and sending you away every time it comes loose hides the load problem underneath. While this cycle goes on, the bone around the implant keeps carrying the same uneven load.

After the procedure

Screw procedures do not need a healing period; what matters is the follow-up.

The same day
You can use it normally again. If the bite was adjusted, biting may feel different for a day or two; this is your teeth getting used to the new balance, and it is to be expected.
The first weeks
Watch for any sign that the screw is coming loose again. A clicking when you bite, slight movement or a change in taste around that area should be reported; these are early warnings.
The check-up appointment
A few weeks later, the torque is checked to see whether it has held. This check-up is the only way to show whether the procedure has really worked, and it is a step that is often skipped.
The long-term routine
In a system where a screw has already come loose once, check-ups are scheduled more often and the bite is measured again at each one. The aim is to catch the same problem before the screw breaks.

Message us right away if

You feel a clicking or slight movement when you bite. This is the first sign of loosening and the point at which it is easiest to resolve. Waiting can turn a short procedure into removing a broken part.
A bad taste or smell has appeared in that area. Bacteria can build up in the gap of a loose connection. A change in taste or smell can be the first noticeable sign of loosening.
The filling in the access hole has fallen out. When the material sealing the space above the screw falls out, the screw is exposed and debris builds up in the area. It is not very urgent, but the appointment should not be put off.
You notice a crack or break in the bridge. Broken bridgework is usually the outward sign of a load imbalance underneath. Repairing only the break brings the same break back a few months later.

What determines the cost

The same symptom can mean a quick tightening or replacing the bridgework. These are the deciding items:

The extent of the procedure: Tightening the screw, replacing it and removing a broken piece are different jobs. Removing a broken piece takes both time and special instruments.
Availability of spare parts: If it is known which system was used, the part can be obtained quickly. If the system is unknown or has been withdrawn from the market, the same procedure takes longer and costs more.
Bite adjustment and a night guard: These are the items that deal with the cause, and they should not be skipped. A cheap solution that only tightens the screw means the same procedure is needed again a few months later.
If the bridgework needs replacing: If the bridge does not sit on the implants without tension, or the design does not spread the load correctly, remaking the bridgework comes into consideration; this is the largest item in the total.

Frequently asked questions

Is screw loosening a serious problem?

Not if you come in early; it is resolved with a short procedure and the implant is not affected at all. What makes it serious is waiting: carrying on chewing with a loose screw breaks it, and removing the broken piece from inside the implant is a much harder job.

If the screw comes loose, will I lose my implant too?

Not directly. Screw loosening has nothing to do with the implant's anchorage; it concerns the connection on top of it. However, bone loss can develop over time around an implant that is constantly under uneven load, which is why solving the cause matters.

The same screw has come loose for the third time. Is that normal?

No, and at this point the place to look is not the screw itself. The things to consider are a point that touches first when you bite, grinding your teeth at night, a bridge that has been extended towards the back, or a load-bearing structure that is not strong enough. Tightening it each time silences the symptom and lets the cause grow.

Can a broken screw be removed?

In most cases it can; it takes special instruments and careful work. The difficulty is this: the thread inside the implant is very fine, and if it is damaged it cannot be restored. That is why dealing with a broken screw is a job for experienced hands.

Can the same problem happen with a cemented bridge?

With cemented systems you may not feel the screw coming loose, but the same thing can happen in the connection underneath, and it is noticed later. Removal is also more laborious. This is exactly where the practical advantage of screw-retained systems lies: the problem can be seen and dealt with.

Does a night guard really work?

For patients who grind their teeth, yes. It does not stop the grinding, but it spreads the force and protects both the screws and the bridgework. For a patient whose screws keep coming loose and who grinds at night, a solution without a night guard falls short.

Does the screw need to be replaced with a new one every time?

Replacing a screw that has come loose or fatigued is the right thing to do. A screw is a part that works through the tension it holds, and once it has come loose it may not hold the same tension reliably. A new screw is a small but important item in the procedure.

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