Should you be afraid of a screw-in tooth?

What the screw actually is

A dental implant has up to three parts, and "screw" can mean two of them.

• The implant. A small threaded post placed in the jawbone. Over the healing period, the bone fuses with it. This is what replaces the root of the tooth.
• The connecting part (abutment). It joins the implant to the tooth on top.
• The crown. The visible tooth. It is either fixed with a small screw that the dentist can undo, or cemented in place like a crown on a natural tooth.

So "screw-in tooth" can mean the whole implant with its crown. The screw that can come loose is a small one inside the tooth, holding the crown or the connecting part. The screw is inside the crown, not something you feel. The hole it goes through is sealed with a filling material.

How the whole treatment runs, stage by stage, is explained on the dental implants page.

What can go wrong with the screw, and how often

The 46-study review counted problems over five years around single-tooth implants that stayed in place:

• screw loosening in 8.8 per cent¹
• the crown coming loose in 4.1 per cent
• chipped porcelain in 3.5 per cent
• soft-tissue problems in 7.1 per cent
• bone loss of more than 2 mm in 5.2 per cent

The crown is a separate part from the implant and may need repair or replacement while the implant stays in place. In the same review, about 96 in 100 crowns were still in use after five years and about 89 after ten. These are pooled averages across many studies. They are not the result of one clinic or implant brand, and not your personal risk.

A loose screw usually shows as a crown that feels wobbly or a bite that feels different. That is usually a repair, not a failed implant, but you cannot tell a loose screw from a loose implant yourself, so have it checked soon and avoid chewing on it until then. A loose screw can usually be tightened, and a damaged crown can be repaired or replaced. Clenching or grinding adds force: in people judged likely to clench or grind, the odds of implant failure were about 2.2 times higher² (an odds ratio). The review did not test whether a night guard prevents this.

Another long-term concern is inflammation around the implant. Inflammation of the gum alone is called peri-implant mucositis; an older 11-study review found it in about 43 in 100 patients³. Peri-implantitis is that inflammation with loss of the supporting bone; a 57-study review found it in about 20 in 100 patients⁴. These are prevalence figures, how many people had it when examined, not five-year risks, and they vary widely with the definition used. In people treated for gum disease in the past, peri-implantitis was about 3 times as common⁵. Daily cleaning and regular check-ups help guard against it; tell your dentist if you smoke, have diabetes or have had gum disease.

Screw-retained or cemented crown?

You may read that screw-retained crowns are always better, or that leftover cement causes most problems around implants. We have not reviewed the studies behind those claims, or the reviews that compare the two for single teeth, so we cannot say one is safer.

For full-arch bridges on implants, a 2026 umbrella review found lower technical complication rates⁶ with screw-retained frameworks and monolithic zirconia. That finding is about whole-jaw bridges, not single crowns.

The practical differences are these:

• A screw-retained crown can be taken off by the dentist to repair it, check the implant or clean around it. It has a small access hole, which is filled. On a front tooth, the angle of the implant decides where that hole lands, so planning matters.
• A cemented crown has no access hole. Removing it is harder, and cement that is left under the gum has to be cleaned away when it is fitted.

Ask your dentist which type is planned for you, and why.

If the surgery is what worries you

• The risks of surgery. Numbing takes away the pain of surgery, not its risks. An implant can fail to fuse with the bone, and bleeding, infection or lasting numbness of the lip or chin can follow surgery in the mouth. Your dentist should explain your own risks before you agree.
• Local anaesthetic. The area is numbed for the surgery. Tell your dentist if you have had trouble getting numb before.
• Conscious sedation. For anxious patients, sedation is an option in some cases. It is not sleep. UK standards require that verbal contact with the patient is kept⁷ throughout. The American Dental Association defines moderate sedation as still responding purposefully to spoken instructions⁸. Sedation is a medicine with its own risks, so the same guideline requires continuous pulse oximetry and at least one other trained person⁸ besides the dentist.
• Checks and instructions first. Your medical history is reviewed before sedation. With a serious illness, a high body weight or sleep apnoea, extra checks⁸ are needed first. You are also given instructions on eating and drinking beforehand, and UK standards say these are given in writing as well as spoken⁷. Follow them exactly.
• Someone to take you home. Under the UK standard, sedation other than inhalation sedation in adults must not be given if an escort cannot be assured. You and your escort should be given written and spoken aftercare instructions and a way to get advice out of hours; the UK standards require both⁷. The NHS advises not driving for 24 hours⁹ after a sedative injection.
• No safety percentage. These standards are not studies of how often problems happen, so they give no complication rate, and we quote none. A rate you are given elsewhere should say which sedation, which patients and which problem it counts.

The sedation page explains the options and who they are for. Say what worries you most at the first appointment: the needle, the noise, the time in the chair or what comes after. Each has its own answer.

When to see your dentist

Contact your dentist, rather than waiting for your next check-up, if:

• The crown feels loose or wobbly, or your bite feels different
• The crown chips, cracks or comes off; keep it and bring it with you
• There is bleeding, pus, a bad smell or a bad taste around the implant
• The gum around the implant recedes, or metal starts to show
• You feel pain when you bite

After surgery, pain or swelling that is severe or getting worse, fever, or swelling that affects breathing or swallowing need care straight away. In an emergency, go to the nearest emergency department or call 112.

Frequently asked questions