If you’ve been told your dental implant has bone loss around it, your first question is probably: Can it be fixed? The honest answer is that it depends — and one of the most important factors is something most patients have never been told to think about: where exactly the implant is sitting inside the bone.
A 2022 study published in the International Journal of Periodontics & Restorative Dentistry proposed a revised classification system for peri-implantitis that incorporates three-dimensional implant position precisely because position so heavily determines both prognosis and the range of diseased implant corrective treatment options that remain available for a failing implant. Understanding this can help you ask better questions and make more informed decisions about your care.
Key Takeaways
- Whether a failing implant can be saved depends not only on how much bone has been lost, but on the implant’s three-dimensional position within the jaw.
- Implants placed in the center of the ridge are the most treatable, with regenerative therapy offering predictable outcomes in many cases.
- Implants positioned too far toward the lip or cheek significantly limit treatment options and often carry a poor to hopeless prognosis.
- Early diagnosis dramatically improves outcomes — implants with early-stage bone loss recover at nearly twice the rate of those with advanced disease.
- CBCT imaging plays an important role in fully evaluating position and bone morphology before treatment decisions are made.
Table of Contents
Why “Bone Loss Around an Implant” Is Not a Single Diagnosis
Peri-implantitis has been recognized as a clinical problem for decades, but for much of that time, it was treated as a single, uniform diagnosis. An implant either had it or didn’t. That approach created a significant problem: an implant with minor early bone loss around a few threads was lumped together with one that had lost the majority of its supporting bone. Naturally, their treatment outcomes looked very different — and that inconsistency made it nearly impossible to evaluate what treatments actually worked.
The Rosen classification, first introduced in its original form in 2012 and updated in 2022, addresses this by staging peri-implantitis based on the percentage of bone lost relative to the implant’s total length. Early disease involves less than 25% bone loss, moderate disease falls between 25% and 50%, and advanced disease exceeds 50%. Each stage points toward a different set of treatment options and a different expectation for success.
The Factor Most Patients Don’t Know to Ask About
Staging by bone loss alone, it turns out, still leaves an important variable unaccounted for. The 2022 update to the classification adds a second dimension: where the implant sits within the alveolar ridge from front to back, also called the buccolingual position.
The classification organizes implants into three positional subcategories. Subcategory A describes implants placed in the center of the ridge — the ideal location. Subcategory B applies to implants positioned too far toward the cheek or lip, called buccal malposition. Subcategory C applies to implants positioned too far toward the tongue or palate.
This distinction matters enormously for treatment planning. A centrally positioned implant with moderate peri-implantitis and an angular, contained bone defect may be an excellent candidate for regenerative therapy — bone grafting procedures that can restore lost support and give the implant a long-term future. The same level of bone loss in a buccally malpositioned implant may lead to a completely different recommendation, including possible removal.
What Happens When an Implant Is Placed Too Far Forward
Buccal malposition is particularly consequential because of how it affects the bone surrounding the implant. When an implant is placed too far toward the lip or cheek, the thin wall of bone on the outer surface of the jaw is more vulnerable to breakdown. There is often minimal or no keratinized gum tissue in that area, which further compromises the implant’s defenses against bacterial infection. The resulting bone loss tends to be harder to contain, making grafting procedures less predictable.
In some cases, implantoplasty — a procedure that smooths and reshapes the exposed implant surface — may be used in combination with soft tissue grafting to improve the local environment and reduce the risk of continued disease. But if buccal malposition is severe and bone loss is advanced, the most appropriate recommendation may be extraction. As the authors of the Rosen paper note, recognizing this before treatment begins is far better than discovering it only after a flap is opened, at which point treatment planning opportunities have already passed.
Why Imaging Before Treatment Is Non-Negotiable
One of the core recommendations in the revised classification is the use of baseline periapical radiographs taken at the time of final prosthesis placement. Without this reference point, it is difficult or impossible to determine how much bone has been lost or how quickly the disease is progressing. For evaluating buccolingual implant position — particularly whether an implant extends through or beyond the buccal plate of bone — a cone beam CT scan is often necessary.
This level of imaging is not always standard practice in general dental offices. It is one of the reasons that a periodontal evaluation is valuable for implant patients, both at the time of placement and throughout maintenance care.
Does Proximity to Adjacent Teeth or Implants Matter?
Yes. The classification also flags implants that are positioned too close to adjacent teeth or other implants with an added designation, noting that crowding in this area can contribute to bone loss and complicate both diagnosis and treatment. In some cases, the health of a neighboring tooth may be affected as well, and decisions about the implant may need to account for that relationship.
The Sooner a Problem Is Identified, the More Options You Have
Research shows that implants with early bone loss recover at nearly twice the rate of those with advanced disease following treatment. The window for effective, predictable intervention is real — but it closes as disease progresses and as positional factors narrow the available treatment approaches.
Our periodontist in York and Hanover is trained to comprehensively evaluate and treat peri-implantitis, including advanced imaging interpretation, surgical management, and the full range of diseased implant corrective treatment options appropriate to each patient’s stage of disease. If you have concerns about an existing implant — or simply want to make sure a new one is being monitored properly — contact our York or Hanover office to schedule an evaluation.
Sources
Content reviewed and approved by Dr. Sourvanos to ensure clinical accuracy and alignment with current evidence-based standards.
- Rosen, P. S., Froum, S. J., Sarmiento, H., & Wadhawani, C. P. K. (2022). A revised peri-implantitis classification scheme: Adding three-dimensional considerations to facilitate prognosis and treatment planning. International Journal of Periodontics & Restorative Dentistry, 42(3), 291–299. https://doi.org/10.11607/prd.5876
