Can an implant harm your body?

Two separate worries usually lie behind this question, and separating them makes the answer clearer. The first is the material: will the part placed in the jaw disrupt something in the body over the years? The second is the procedure: can something go wrong during or after surgery? The answer to the first question is largely reassuring. The answer to the second, as with any surgery, is yes; but these risks have names, most of them can be foreseen, and this is where the real conversation needs to happen.

Most implants are made of titanium or a titanium alloy, and some of zirconium oxide. The US Food and Drug Administration (FDA) states that the safety profiles of these materials are well known. Titanium allergy is the most frequently asked-about topic, and it does exist, but it is very rare. In a study in Spain that screened 1,500 implant patients, 0.6% of patients tested positive for allergy, and almost all of those who tested positive came from a small group who already had symptoms or whose implants had failed for no apparent reason. A systematic review that brings the research together concludes that it has not been proven that titanium causes allergic reactions in implant patients.

On MRI, the answer is short: someone with an implant can have an MRI scan. Titanium is not a metal that is attracted to a magnet. The FDA's advice to patients is to tell the healthcare team about your implant before an MRI scan or an X-ray, because the implant can distort the image, and this effect matters most in scans of the jaw and face. The NHS also notes that the form you fill in before an MRI scan asks about fillings and bridges in your mouth. The parts that need to be mentioned separately are not the implant itself but parts with magnetic properties, such as the magnetic attachments used in some removable dentures.

Cancer is the question that attracts the most scaremongering online, yet it has the least to support it. On current knowledge, implants have not been shown to cause mouth cancer. A systematic review that collected cases of mouth cancer seen around implants found a total of 63 patients in 33 articles published since 1983. Almost half of these patients already had a lesion in the mouth that had the potential to turn into cancer, such as lichen planus. The review's main warning is something else: because these lesions at first look like inflammation around the implant (peri-implantitis), diagnosis can be delayed. In practice, this means that a sore or tissue growth around an implant that does not clear up despite treatment should be investigated, with a biopsy if necessary.

Questions about the brain and the heart also come up often. An implant does not reach the brain: in the upper jaw, an implant's neighbour is not the brain but the sinus, the air space on either side of the nose, and in between lie the bony walls of the eye socket and the base of the skull. Among the known risks the FDA lists is perforation of the sinus floor; this shows itself with symptoms similar to sinusitis, and it is treated. As for the heart, the implant itself does not harm it. For someone with heart disease, what is discussed is carrying out the procedure safely: blood thinners (anticoagulants), the adrenaline in the anaesthetic, and, for people with a prosthetic heart valve or a history of infection of the heart lining (endocarditis), whether preventive antibiotics are needed before the procedure.

The real risks relate to the surgery, and they have names. In the lower jaw, if the implant site is close to the nerve that runs through the jawbone, there may be temporary, and rarely permanent, numbness in the lip and chin. Damage to a neighbouring tooth, infection, the implant failing to take, and inflammation over the years around an implant that is not looked after are also on this list. What reduces most of these risks is planning: a 3D dental CBCT scan shows the position of the nerve and the sinus in advance. The scan has a cost of its own; the FDA notes that a dental CBCT scan gives more radiation than conventional dental X-rays, but generally less than a medical CT scan. That is why it is right to have one when it will genuinely change the plan.

The division below sorts the situations most often seen in patients who come with these questions into two groups: those that do not, on their own, pose a barrier or a danger, and those you must tell your dentist about before planning.

The steps below help turn your concerns into concrete information before your appointment.

1. 1

   Write down your history of allergies and reactions

   Reactions you have had to metal jewellery, watch straps, or orthopaedic screws or plates; any drug allergies; and your experiences with local anaesthetic. Take this with you in writing rather than relying on memory.

2. 2

   Share your health history and medication list

   Heart disease, a prosthetic heart valve, diabetes, bone medication, blood thinners and steroids. This information directly affects both the safety of the surgery and the decision on antibiotics.

3. 3

   Ask why the CBCT scan is needed

   A CBCT scan shows the position of the nerve and the sinus; this is how the risk of numbness in the lower jaw and of sinus problems in the upper jaw is reduced at the planning stage. Asking why it is being taken and what it will change in the plan is a perfectly normal request.

4. 4

   Talk about the risks specific to you

   The general list of risks is the same for everyone; what matters is which of them stands out in your jaw. How close is the implant to the nerve, how close is it to the sinus floor, and is there enough bone? The answers to these questions can be shown on the scan.

5. 5

   Ask for the details of the implant to be used

   The FDA recommends finding out the brand and model of the implant system used and keeping them in your records. Another dentist or an imaging team may need this information in the future.

6. 6

   Agree the maintenance and check-up plan from the start

   In the long term, the most likely problem an implant will face has to do not with the material but with inflammation around it. Check-up intervals and your daily cleaning routine should be discussed before treatment.

The following are the routes discussed with people whose worries about the material or the surgery persist. Each has its own gains and its own trade-offs.

The following are the known risks of implant surgery. Some are rare, and some develop over the years depending on how well the implant is looked after; all of them deserve to be discussed in advance.

The sequence below separates the expected course after the procedure from the signs that should be reported.

1. The first few days

   Swelling, mild bruising and tenderness are normal; numbness fades as the anaesthetic wears off. During this period, all you need to do is leave the area alone and follow the instructions you are given.

2. The first week

   The swelling goes down. Numbness that is still there the next day, discharge from the nose or a feeling of pressure in the upper jaw is outside the normal course and should be reported.

3. The first few months

   At check-ups, wound healing, the gum around the implant and your bite are assessed. If you notice a reaction such as a skin rash, a burning sensation in your mouth or unexplained swelling, mention it at your check-up.

4. The long term

   At least one check-up a year, and regular cleaning. Mention your implant every time before an MRI scan, a CT scan or any other imaging, and keep your implant details in your records.

The questions on this page can change the scope and timeline of treatment at a few points. These are the items:

Additional imaging

A CBCT scan is a basic part of planning. If there is a question about the sinus or the nerve, additional views or repeat imaging may be needed.

Allergy assessment

If there are symptoms or a relevant history, an assessment by an allergy specialist and testing may be added to the plan as a separate stage.

Choice of material

If a material other than titanium is chosen, the plan, the timeline and the options for the bridgework on top may change.

Discussion between doctors

If there is a prosthetic heart valve, bone medication or a mouth lesion that needs monitoring, the opinion of the relevant doctor becomes part of the plan and can affect the timeline.