Depending on how long you've had your implant, the dental implant screw showing could be normal or it could be pathological. Ultimately it all comes down to whether the status of your screw fixture is healthy or if it is afflicted by disease.
The image below is the x-ray of what it looks like in the photo above.
You most likely won't be able to tell if it is normal or abnormal unless you get a consultation with your dentist.
When the implant screw showing is normal
If you've had your dental implant for a long time such as many years, the implant screw fixture showing near the gums could be normal. Over time, it's not unusual for implants to slowly experience very mild loss of bone around the fixture with each passing year.
Studies have shown that under normal circumstances, there may be a dramatic loss of vertical bone within the first year of implant placement. However, the rate of bone loss slows down with subsequent years.
That means you will still lose bone albeit very slowly and that is also the reason why we say if you've had your implant for a very long time, it could be considered normal.
What it looks like:
Metal titanium threads from the screw fixture is visible near the gum line.
A gap between the implant crown and the gums.
When the implant screw showing is abnormal
An implant screw that is showing is pathological if you've had it done recently or if it's showing signs of disease such as peri-implantitis.
Recently done. While implants can slowly lose bone over their lifetime, it is not normal for them to lose enough to have the screw visible within the first year or two.
Peri-implantitis. An inflammatory disease that affects the soft and hard tissues surrounding the dental implant. That means the gums and the bone (periodontium) can be affected.
Peri-implantitis
Peri-implantitis is an oral disease that affects dental implants. It is akin to gum disease such as gingivitis and periodontitis which affect your natural teeth. Since you don't have a natural tooth there, you can't get it but what you can get is peri-implantitis!
Consequences of no treatment:
Swollen bleeding gums.
Bone loss around the implant.
Potential loss of implant (it may fall out).
Screw fixture will become more and more visible.
In other words, the condition will get worse if you leave it untreated. Ultimately you risk losing the entire implant which you've spent a lot of time and money into getting if you don't intervene and get it treated.
You will need to see your dentist in order to have this condition corrected. Home remedies will not be able to help you so don't even bother with the at home methods.
How to reduce implant screw showing
Unfortunately treatment to correct an implant screw that is visible will require extensive dental work especially if it has peri-implantitis.
You will most likely need to have the screw fixture and crown replaced but you'll most likely require a bone graft before all of that can be done.
Treatments:
Implant removal. The entire screw fixture along with the tooth cap will need to be surgically removed from your jaw bone. Yes, you'll be without it for a while.
Bone graft. Graft new bone to replace the lost bone from the previous treatment. You'll most likely need 4-6 months of healing prior moving to the next step.
Implant placement. Once the bone graft is fully healed you can have a new dental implant screw placed into your jaw. This will also require another 4-6 months of healing where you wait for the screw to osseointegrate with the jaw.
New implant crown. Finally you can have a new dental implant crown made once you are ready. No, the old cap cannot be used because the screw position and shape of the space will be completely different.
In summary, you can expect the entire implant procedure to be redone. That is the only way to fix an implant screw that is showing.- Ultrasonic used first and then hand scalers afterwards. Teeth polished with prophy cup and paste.
Do I have to fix it?
Since the entire procedure will be costly and it'll take about a year or so to complete, whether or not you should fix it would depend on your situation.
What to take into consideration:
How much of the screw is visible?
Is my condition normal or abnormal?
If your condition isn't pathological, the decision to move forward would be up to you. However, if your implant is losing bone due to disease, you may not have an option to decide because you have to do it.
Alternative treatment
The treatments listed in the previous section is for severe peri-implantitis but if your condition is only starting and it's still mild, you may be able to salvage your implant.
While you may not be able to regrow the gums to cover the exposed threads of the screw that is showing but you can at least prevent it from getting worse.
Local debridement. This is similar to a deep dental cleaning except you do it on the implant. Ultrasonic and hand scalers are used to clean deep beneath the gums.
Implant surface decontamination. The surface of the screw fixture can be decontaminated with: citric acid, air-powder abrasion, gauze soaked in saline, gauze soaked in chlorhexidine, laser treatment.
Essentially all of these treatments are used to halt the progression of disease so it doesn't get worse. Of course you'll need to maintain very strict oral hygiene so that you don't relapse.
Takeaway
If your dental implant screw is visible, it could be normal if you've had it for a very long time. The implant can lose bone overtime albeit very slowly and the consequence of that is you may see visible threads on the fixture after many years.
However, if you're seeing the screw and you've only had the implant fairly recently, it could be an indication that something is wrong. There is a chance you may have peri-implantitis which can cause bone loss and gum recession around the fixture. This condition will require immediate treatment with a dentist.
