How to Tell the Patient That an Implant Failed?

Benjamin Zander—conductor of the Boston Philharmonic and a brilliant speaker on leadership and communication—once said in a podcast that there’s no such thing as “I’m not a good musician because I have a bad ear for recognizing sounds.”That’s nonsense—because when your mother calls you with just a simple “hello,” you already know if she’s mad, angry, sad, or happy.

The human ear is amazing at recognizing emotion through sound. In my case, it works very well with my wife—a simple “Hola” and I already know I’ve left my underwear on the bathroom floor.

The ear doesn’t lie

In implant dentistry, when osseointegration period has finished and the patient is scheduled for the final impression…You’ll have that moment. A moment of true hear recognition at his best !!! You pick up the instrument, tap the implant, and immediately you (and your brain) recognize—you’re in trouble.

That dull, weak sound on percussion… uh oh.

And then you try again, just to be sure.

That’s when the denial phase starts.

Toc toc.Toc toc again.Still dull. Duller.

You start to sweat (at least one drop).Denial continues. You try to convince yourself:“No, it can’t be. An implant cannot fail with me.”

You come up with the genius idea that maybe it’s just the healing abutment—that it’s not tight enough. So you grab the screwdriver, go in—and the patient jumps out of the chair with a loud “OUCHHHHH!”

Your hearing is now fully activated. And your sweat, too.

It’s over.

The implant has mobility. It’s really lost.

Then the funny thing happens—you start imagining a thousand excuses to try and fool the patient.

I once had a teacher who told patients it was the abutment, not the implant, and said they just had to replace the prosthetic abutment.(How stupid is that? Patients aren’t stupid—they know what failed. And with that attitude… you failed them.)

This same teacher also published a paper on the survival rate of a technique—but removed the failed implants from the stats to increase the reported success rate. Egos, right?

“No Andre, we removed "your failed implants" from the statistics because they made the technique with "my implants" look bad.”

Oh really?? I asked.

“But shouldn’t that be the most important thing to report? Maybe, just maybe, that matters to the regular clinician out there?To show that a particular technique might work for a super surgeon like you… but fails in a normal guy like me?Isn’t that what evidence is supposed to be—not your ego?”

Anyway, never lie to the patient. never lie to the medical community , just simply Don't lie !!! Even if it hurts.Even if you didn’t do such a great job. Stand tall. Tell them the problem. Tell them the truth.

Yes, you’ll suffer. You’ll sweat. You might even lose the patient—or your reputation…But you won’t lose your integrity.

Patients always know when you’re lying. They might not say it—but they feel it.

Lower your ego. Stay humble. You don’t control 100% of the healing process. You can optimize it, but you cannot prevent implant loss in every case.

This week, I lost two implants—same site, different patients, same implant size and width. How awkward is that? One was in a famous doctor. The other in the wife of a good friend.

Maybe the healing time from extraction to implant placement was too short. Who knows? maybe i suck .... or maybe we cannot control nothing !!! you choose .....who knows …

But I told them the truth. They were sad. They understood. And we move forward.

Never abandon your patient.

Just go to sleep., Wake up the next day, and do it better than the last time.

It will eventually integrate.

And when it does…you’ll recognize the sound.