Hello, I'm Dr. Junghoon Choi, director of Seoul Crown Dental Clinic.
"My implant feels loose — do I need to have it removed?"
"While eating, I can feel the crown rotating slightly. Is that a big problem?"
Short answer: Looseness in an implant restoration most often starts with a loose screw, and in many cases it can be resolved with a straightforward tightening procedure. The cause falls into one of three categories, and the right treatment depends on which one applies — so identifying the source of movement comes first.
If your crown is held in place with cement, the cement can dissolve or detach over time, leaving the crown loose. If it is a screw-retained crown, the screw that locks the crown in place may have come undone. In either case, the fixture (the artificial root embedded in the bone) and the abutment (the connector piece between the fixture and the crown) are typically intact — only the upper crown is moving. This situation is generally resolved by re-tightening the screw or re-cementing the crown.
Here the problem is not the crown screw but the screw that secures the abutment to the fixture. You may feel the crown and abutment moving together, or notice a slight rotation when chewing. If this is left unaddressed, the repeated loading on the screw can cause it to fracture. Removing a fractured screw is considerably more involved and time-consuming than simply re-tightening one, so having it checked as soon as movement is noticed keeps more options available.
When bone is lost around the area where the fixture meets the surrounding bone, the fixture itself can become mobile. In this situation the issue is the stability of the fixture rather than the screw or crown, and a detailed examination is needed to assess bone levels before deciding on a course of treatment. This stage is reached in relatively fewer cases, but earlier detection means more options for managing it.
Clinically, we check from the outside inward: crown first, then the abutment screw, then the fixture. Most cases of looseness are identified at the first or second step. An X-ray is taken to assess screw condition and bone height, and in some situations the crown is removed for a direct visual check. In shorter cases this can be checked the same day, though an additional visit is sometimes needed depending on the situation.
People who grind their teeth or clench heavily at night can experience repeated screw loosening. The forces generated during sleep-time grinding are much greater than ordinary chewing forces, placing ongoing stress on the implant restoration. If the same problem keeps recurring after tightening, it is worth reviewing your bite and grinding habits alongside the screw. I have written a separate article on how grinding habits affect the lifespan of a restoration if you would like to read more.
A screw can be slightly loose without any noticeable movement or sensation. Because this is difficult to detect by feel alone, a check-up every six months to a year is generally a good idea. At each visit we assess not only screw tightness but also the condition of the gum tissue around the crown and the level of the surrounding bone. The earlier a small change is caught, the smaller the intervention needed.
If your implant crown has no movement at all, chewing feels normal, and bone levels on regular X-rays are being maintained, continuing to observe the current situation is the appropriate approach. Age of the restoration alone is not a reason to recommend replacement. I have also put together a separate guide on what to check when you are told a crown needs to be redone. The deciding factor should be current function and tissue health, not how long the restoration has been in place.
Q. My implant is loose — can it be tightened on the same day I come in?
If the cause is confirmed to be a loose crown screw or abutment screw, same-day treatment is possible in many cases. An X-ray and crown removal are typically part of the process, so letting us know in advance when you book makes preparation easier.
Q. Will the screw just come loose again after it is tightened?
If the same location loosens repeatedly after tightening, there is likely an underlying cause — such as excessive bite force or a grinding habit — placing too much load on the screw. Repeated loosening without any such cause is uncommon.
Q. What if there is no looseness but I feel discomfort around the implant?
If you feel a dull heaviness or pressure around an implant that does not feel loose, it is a good idea to have the gum and bone checked. Inflammation can develop independently of looseness, so we would check with an X-ray and a gum examination together.
Q. My implant is more than ten years old — does it still need to be checked?
With longer-standing restorations, wear on the restoration materials and accumulated fatigue on the screw become more relevant, which makes it all the more important not to miss regular check-up intervals. Even without any current discomfort, having an X-ray to document bone levels gives a useful baseline record of your situation.
When treatment keeps repeating, the redo has to be designed right. If you have questions, feel free to ask.
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