Patient guide · For patients
Can a new implant go where one was removed? Healing time, what studies report on re-implantation, and how short implants can avoid large grafts.
Yes, a new implant can usually be placed where an implant had to be removed; in suitable cases this can be planned, once the site has healed, with a short implant that fits the remaining bone, without a large bone graft or an open sinus lift. Because studies report that second implants in previously failed sites survive somewhat less often than first implants, the decision rests on understanding why the first implant was lost, a clinical examination and 3D imaging. This article explains the process, what the literature reports and where the limits lie.
One Anatomy. Two Surgical Philosophies.
When bone height in the upper back jaw is limited, two different paths can be taken. Both are documented in the literature. Which one fits depends on the anatomy, the available bone and the patient.
Atrophic posterior maxilla: after tooth loss, bone height decreases and the sinus floor moves closer to the mouth.
Lateral window sinus floor elevation
Short implant + internal (transcrestal) sinus lift
| Augmentation-driven path | Anatomy-driven path | |
|---|---|---|
| Surgical access | Side wall of the sinus | Implant site |
| Graft volume | Large | Limited, autogenous if needed |
| Implant length | Usually standard / long | Short |
| Timing | Same session or staged | Usually same session |
Two philosophies, one goal:
Minimally invasive implantology.
When an implant has to come out, one of the following reasons is usually behind it:
Removal is done with instruments designed to preserve as much of the surrounding bone as possible. How much bone survives the removal also sets the limits for what comes next.
After an implant is removed, a new one is usually not placed straight away; the socket is first allowed to heal, the inflammation to resolve completely and the bone to remodel. The time depends on the amount of bone loss, the severity of inflammation and the location; in practice it is a matter of months and is monitored with follow-up X-rays. In a cohort study of single implants, re-implantation took place on average 5.8 ± 5.2 months after removal of the first implant (Grossmann 2007).
This waiting period is also an opportunity to address the cause. If peri-implantitis was involved, the gum health around the remaining teeth and implants is brought under control; modifiable risk factors such as smoking, clenching and oral hygiene are discussed, and a night guard is planned if needed.
A 3D scan (CBCT) taken after healing shows, to the millimetre, the height and width of the remaining bone and its distance from structures such as the sinus floor or the lower jaw nerve. Whether a short implant or a graft is needed depends largely on this image.
This question has been studied directly, and the picture should be presented honestly:
So a new implant is possible, but it calls for more careful planning than the first attempt. Most of these data come from retrospective studies, and the implant types used may differ from today's. Still, they all carry the same message: no new implant should be placed before the question "why was the first one lost?" has been answered.
When an implant is removed, particularly after peri-implantitis, a vertical bone defect often remains. To fit a new standard-length implant, this loss is usually compensated with larger procedures: vertical or horizontal bone augmentation with grafts (block grafts, guided bone regeneration) or, in the back of the upper jaw, an open sinus lift. These are well-documented methods, but they mean additional healing time, more swelling and their own risks of complications.
The minimally invasive question is: can the remaining bone safely carry a short implant? If it can, the same goal may be reached without a major augmentation.
The short-implant literature offers guidance. An ITI consensus report found survival rates of 86.7–100% for implants of 6 mm or less over 1–5 years of follow-up; it concluded that short implants are a valid option to avoid the possible side effects of augmentation, while noting that their outcomes are more variable (Jung 2018). A multicentre randomised trial comparing 6 mm short implants with longer implants placed with sinus grafting in the back of the upper jaw found no significant difference between the groups in survival, bone level or complications at five years (Thoma 2018).
These studies were not carried out in previously failed sites, so their results cannot be transferred directly to this situation. What they show is that when bone height is limited, a short implant is an option that can be considered instead of a large graft. For general information see the short implants page.
A short implant is not the right choice for every site where an implant was removed. A bone graft or an open sinus lift may still be the better route when:
The last point matters most: a new implant placed without removing the cause faces a similar risk, whatever its length. For cases where the upper jaw bone is severely resorbed, see also the alternatives to zygomatic implants page.
A few months are usually allowed for the site to heal and the inflammation to resolve completely; one study reported a mean of 5.8 months (Grossmann 2007). Timing is set after examination and a follow-up X-ray, according to the amount of bone loss.
A systematic review reported a mean survival rate of 88.84% at the second attempt, somewhat lower than for implants placed in a site for the first time (Zhou 2016). To improve the odds, the cause of the first loss is identified and risk factors are brought under control first.
In suitable cases, yes. If enough bone height remains after healing, a short implant may make a vertical bone graft or an open sinus lift unnecessary. Whether this is possible is determined with a 3D scan.
In some selected situations, when there is no infection and enough bone remains, this can be considered. For implants removed because of peri-implantitis, healing is generally awaited first; the decision depends on the inflammation and the amount of remaining bone.
Not always. If the bone loss is limited, a graft-free plan with short or narrow implants may be possible; if it is advanced, a graft may be needed. The right option is decided after examination and 3D imaging.
The right plan for a site where an implant was removed is decided after a clinical examination and 3D imaging, weighing the cause of the loss, the remaining bone and the restoration needed. A pre-assessment can start from an existing panoramic X-ray or CBCT. For other questions see the FAQ page, and for the overall approach the article on minimally invasive implantology.
This article is for general information and does not replace an examination or a personal treatment plan.
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