What to Do If Your Implant Screw Becomes Visible

Noticing metal where there previously was none is unsettling, and the natural assumption is that something has gone wrong with the implant itself. Often it has not.

Three quite distinct situations get reported in the same words. They look superficially similar, they carry very different levels of concern, and the response to each is different. Working out which one you are looking at is genuinely useful before the appointment, and it changes how quickly you need one. The general first-response guidance is covered in our article on what to do when an implant screw becomes visible; this piece focuses on distinguishing between the three.

This is the most common and the least alarming. Nothing is actually exposed.

The titanium components sit beneath the gum. Where the overlying tissue is thin — under about two millimetres in thickness — the dark metal shows through it, in the same way that a dark object shows through a sheet of thin paper. The tissue is intact and the implant is sealed; the colour is simply being transmitted.

You can usually tell this apart from genuine exposure by touch and by appearance. A shine-through looks like a diffuse greyish or bluish tinge in the gum, often spread over several millimetres and with no defined edge. Run a fingernail or tongue over it and the surface is smooth, continuous gum with no step and no rough metal texture.

Shine-through tends to become noticeable gradually, often over a year or two after the restoration is fitted, as the tissue settles and thins slightly. It is primarily an appearance concern rather than a health one, and it matters most at front teeth.

Options, where it bothers you, include adding connective tissue beneath the gum to thicken it, or replacing a metal abutment with a ceramic or zirconia one that does not transmit the same shadow. Neither is urgent. The relationship between tissue thickness and appearance is discussed in our article on soft tissue architecture and implant aesthetics.

This is the one that warrants proper attention.

Here the gum has receded far enough that the implant body itself, or the lower part of the abutment, is uncovered. The characteristic sign is texture: implant threads have a distinct ribbed or roughened surface, quite unlike the smooth polished collar or the crown. You can often feel the ridges with a fingernail, and floss or an interdental brush may catch on them.

There are two broad reasons this happens, and they need separating.

Recession without bone loss. The soft tissue has migrated downwards but the underlying bone level is stable. Causes include thin tissue to begin with, minimal keratinised gum around the implant, heavy brushing pressure, or an implant positioned slightly too far towards the lip. This is a soft tissue problem and may be manageable with technique changes and, in some cases, grafting.

Recession with bone loss. The bone supporting the implant has receded and the soft tissue has followed. This is peri-implantitis territory and it is a different order of problem, because bone loss around an implant does not reverse on its own and tends to continue if the cause is not addressed. Supporting signs include bleeding when the area is touched, redness and swelling of the collar, discomfort, pus, or a bad taste localised to that site. Our articles on spotting early signs of peri-implantitis and identifying peri-implantitis symptoms cover the presentation in detail.

You cannot tell these apart by looking. The distinction is made with a radiograph compared against the baseline film taken when the implant was placed, together with probing measurements. That is the main reason an appointment is warranted rather than a wait-and-see approach.

Exposed threads also create a practical problem independent of the cause. The roughened surface is far more retentive of plaque than a polished one, so once threads are uncovered the site becomes harder to keep clean, which in turn accelerates whatever is happening.

This one is often missed, and it is usually the most benign — but it does need sealing.

Implant crowns come in two forms. Cemented crowns are glued onto an abutment. Screw-retained crowns are held by a screw passing through a channel in the crown itself, and that channel is filled after tightening: a soft plug over the screw head, then composite on top, shaped and polished to match the crown surface.

That composite plug is a small restoration in a high-load area. Over years it can wear, chip or come out entirely. When it does, you look into the crown and see the metal screw head at the bottom of a small round hole. Typically this is on the biting surface of a back tooth or the tongue side of a front one.

It is easy to distinguish from the other two. The metal is inside the crown, not at the gum. There is a defined circular hole. It has usually appeared suddenly rather than gradually, often while eating.

It is not an emergency, but it should not be left indefinitely. An open channel collects food and bacteria, the screw head can corrode over time, and debris in the channel makes future retrieval of the screw awkward. There is also a risk of chipping the ceramic at the edge of the unsupported hole.

What not to do: do not poke into the hole with anything, do not try to tighten the screw yourself with a household tool, and do not fill it with wax, chewing gum or any household adhesive. Superglue in particular has no place near dental work, as set out in our article on why superglue should not be used on dental restorations.

The straightforward interim measure is to keep the area clean, rinse after eating, and arrange an appointment. Refilling the channel is usually quick, and it also gives the opportunity to check and retorque the screw, which is worthwhile in any case.

• Grey shine-through is intact tissue transmitting the colour of metal beneath; it is a cosmetic matter.

• Exposed threads feel rough and ribbed, and require a radiograph to establish whether bone has been lost.

• An open access hole with a visible screw head inside the crown is common and usually straightforward to reseal.

• Do not attempt to tighten a screw or fill an access channel yourself.

• Any bleeding, swelling, discomfort or bad taste alongside visible metal raises the urgency considerably.

Arrange an urgent appointment where visible metal is accompanied by any movement of the crown or the implant, pus or a bad taste from the site, persistent discomfort, swelling, or a sudden change over days rather than months.

Movement is the one that matters most. An integrated implant has no detectable mobility at all, because there is no ligament between it and the bone. Any movement you can perceive is significant, although it is worth noting that a loose crown or a loosened screw feels similar to a patient and is far more common than a failing implant. Our article on distinguishing a loose crown from a failing implant explains how the two are told apart, and whether a loose implant crown is an emergency covers the urgency question.

A repeatedly loosening screw is its own signal. Screws that come loose more than once usually indicate a mechanical issue — an unfavourable bite contact, an ill-fitting component, or excessive loading from grinding — rather than simple under-tightening. Our article on bruxism and implant screw loosening covers this, and the choice between crown types is discussed in screw-retained versus cemented crowns.

If you can see metal around or within an implant restoration, have it assessed so that the cause can be identified and a baseline radiograph compared. Arrange an appointment through our contact page.

You can read more on our dental implants page, our receding gums page, our emergency dentist page for urgent concerns, and our dental hygiene page for maintenance around implants.

This article is for general information only and does not constitute dental or medical advice. The cause of visible metal around any particular implant can only be determined by clinical examination and radiographic assessment. Always consult a registered dental professional. If you have swelling, pus, mobility or significant discomfort around an implant, seek urgent dental care.

Next review due: 6 August 2027