Peri-Implantitis: Symptoms, Causes, Treatment and Prevention

Peri-implantitis is inflammation of the tissues around a dental implant together with progressive loss of the bone that supports it. Bleeding, discharge, swelling, a bad taste or persistent odor near the implant, or a change in the prosthesis should be examined even if nothing hurts. Treatment depends on how far the damage has spread, how stable the implant is, the design of the prosthesis and your risk factors. It can slow the disease, but it cannot promise that lost bone will return or that the implant can be kept.

Fast-spreading swelling, fever with feeling generally unwell, trouble breathing or swallowing, or bleeding you cannot stop needs urgent assessment locally. Call your local emergency services. An online form cannot handle an emergency.

Peri-implant mucositis vs peri-implantitis: what is the difference?

Peri-implant mucositis affects the soft tissue around an implant, with no progressive bone loss beyond the initial remodeling that is expected after placement. Peri-implantitis combines signs of inflammation with progressive bone loss. The two cannot be told apart from a photo or a description: it takes a clinical examination and a comparison of good-quality X-rays. People often call this an implant gum infection, but the term covers two different conditions: mucositis and peri-implantitis.

An implant can stay firm despite bone loss. Conversely, a loose crown or screw does not necessarily mean the implant has lost its anchorage.

Peri-implantitis symptoms: signs to have examined

No single sign settles the question, but each one justifies an examination

• bleeding that keeps recurring when you brush or when the dentist probes;
• swelling, redness, pain or new tenderness;
• pus, discharge, a bad taste or a localized odor;
• gum recession or increasingly visible metal;
• a change in your bite, your speech or how stable the prosthesis feels;
• bone loss spotted on a check-up X-ray;
• real movement of the implant, a late sign that can be unfavorable.

A persistent odor or bad taste does not always come from an implant. Our guide to bad breath (halitosis) reviews the dental causes and when to see a dentist.

The absence of pain is not reassuring on its own. The disease can progress silently, even around an implant that has been in function for several years, which is why monitoring matched to your individual risk is worthwhile.

Risks of chronic peri-implantitis

Bone loss is progressive: the longer the disease stays active, the more supporting bone is lost, and the harder it becomes to keep the implant and to build a prosthesis that can be cleaned. When an implant can no longer be kept, removing it may leave a bone defect and call for a different treatment plan. Progress varies from person to person, and only an examination can place your case.

What causes peri-implantitis?

Peri-implantitis is multifactorial. A persistent bacterial biofilm plays a central role, but risk may also be influenced by

• a history of gum disease (periodontitis);
• smoking;
• poorly controlled diabetes;
• a prosthesis that is hard to clean underneath;
• irregular follow-up;
• prosthetic design, excess cement, an unfavorable implant position or mechanical stress.

These factors do not prove fault and cannot predict what will happen to any one person. Your file has to be assessed as a whole. Our guide to smoking, diabetes, bruxism and dental implants covers these situations in detail.

Is peri-implantitis contagious? It cannot be reduced to simple transmission between people: the biofilm, the body’s response, the local environment and the risk factors all interact. Normal hygiene within the household remains appropriate.

How peri-implantitis is diagnosed

The clinician reviews your history, illnesses, medications, smoking, past gum disease and cleaning habits. They examine the tissues, the depth of the gum pockets, probed gently, bleeding, discharge, mobility, the bite and how easily the area can be cleaned. X-rays are compared with baseline images when those exist.

Three-dimensional imaging (see our guide to CBCT and 3D planning for dental implants) is not always needed for this problem. It is requested when its diagnostic benefit justifies the exposure and when it could change how the problem is managed.

What to bring to the appointment

• X-rays from before placement, after placement and from check-ups;
• the operative report and the prosthetic plan;
• your implant passport;
• a list of illnesses, medications and allergies;
• a timeline of your symptoms and any care already received;
• details of your professional maintenance visits.

Peri-implantitis treatment options

From least to most invasive

Treatment usually starts by reducing inflammation, making cleaning easier and correcting the factors that can be changed. Professional cleaning, coaching in suitable cleaning techniques and adjustment of the prosthesis may be needed.

If the disease persists or the damage is advanced, surgery can be discussed to reach the implant surface, reshape the tissues or, in some configurations, attempt a reconstructive approach. The choice depends on the shape of the bone defect, the position of the implant and whether the area can be kept clean.

Can the implant always be saved?

No. Whether it can be kept depends on its stability, the amount and shape of the remaining bone, its position, whether the infection can be controlled and whether a cleanable prosthesis can be built. Removal can be safer than a series of unpredictable treatments.

For a wider view of implants in difficulty, see our guide to dental implant failure: warning signs, causes and what happens next.

Limits, alternatives and when to postpone

• No remote diagnosis. A photo or a description cannot tell mucositis from peri-implantitis. A clinical examination and compared X-rays are needed.
• No promise about bone. Some reconstructive approaches aim for a gain in selected defects, but complete regeneration cannot be promised. The realistic goal is often to control the disease and keep the area cleanable.
• Medication is generally not enough. An antibiotic may be appropriate in some situations judged by a professional, but it does not remove deposits, fix a prosthesis that cannot be cleaned or replace lost bone. It cannot replace professional cleaning of the biofilm, and taking one on your own can delay the diagnosis.
• After an implant is removed. The alternatives can include a new implant, bone reconstruction, a bridge, a removable denture or a monitored wait. A new solution may be possible right away or may be delayed until the site has healed and the infection has been cleared: the choice and the timing are decided after an examination, depending on your situation and on risk factors such as smoking or diabetes.
• If the implant was placed elsewhere. Tell the clinic that placed it and ask for your records, but do not wait for a trip if your symptoms need an examination: a local clinician can assess the urgency and share findings. Our guide to a dental problem after treatment in Turkey walks through the steps.

Preventing peri-implantitis and its return

Peri-implantitis can come back: even after it improves, lasting maintenance and control of risk factors remain necessary.

• Clean every accessible surface daily with suitable tools (see caring for full-arch dental implants).
• Have your technique checked rather than adding more gadgets.
• Follow a maintenance schedule based on your risk.
• Keep an eye on your remaining teeth and any history of gum disease.
• Ask for help to stop smoking.
• Have diabetes followed by your medical team.
• Report a prosthesis that moves, traps food or prevents cleaning.
• Keep your baseline X-rays and implant references.

Sources

• European Federation of Periodontology (EFP), patient information on dental implants
• European Federation of Periodontology (EFP), clinical practice guideline on peri-implant diseases, published in the Journal of Clinical Periodontology
• 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions, consensus report on peri-implant diseases and conditions

Asking for an opinion on your implant file

If a sign worries you, a first read of your file can help you prepare for a consultation with Assoc. Prof. Dr. Türker Yücesoy, an oral and maxillofacial surgeon. Note which area is affected, the date and place of placement, your symptoms and how they have changed, whether you smoke, your medical history, your implant passport and the treatment you have already had. You can attach your panoramic X-ray or CBCT scan through the contact page.

This read does not give a remote diagnosis. No diagnosis or emergency treatment is provided through a form: if a sign is urgent, get seen locally first.