Peri-implantitis is inflammation in the gums and other tissues around a dental implant that also causes progressive loss of the bone supporting it. It usually develops when bacterial plaque builds up around the implant. Early signs can include red, swollen, or bleeding gums, although symptoms may be subtle. A dentist or periodontist checks the tissues and X-rays to assess the problem and plan care.
How Does Peri-Implantitis Affect a Dental Implant?
A dental implant is a small device, usually made of titanium or another suitable material, placed in the jawbone to support a replacement tooth. The gum tissue and bone around the implant help keep it stable and functional. Like natural teeth, implants can develop problems when bacteria accumulate around their surfaces.
Peri-implantitis is a disease affecting the tissues around an implant. It involves inflammation of the surrounding gums and progressive damage to the supporting bone. As bone is lost, the implant may become less stable and more difficult to maintain. The American Academy of Periodontology distinguishes peri-implantitis from inflammation that affects only the soft tissues around an implant.
What Is the Difference Between Peri-Implantitis and Peri-Implant Mucositis?
Peri-implant mucositis and peri-implantitis are two related inflammatory conditions, but they differ in whether supporting bone is being lost.
- Peri-implant mucositis: Inflammation affects the soft gum tissue around the implant, without additional supporting bone loss caused by the disease. It may improve when plaque is removed and effective oral hygiene is established.
- Peri-implantitis: Inflammation affects the gums and is accompanied by progressive loss of the bone supporting the implant. Treatment may therefore require more than routine cleaning.
Peri-implant mucositis can precede peri-implantitis, but it does not inevitably progress to it. Recognizing and managing inflammation early is an important part of protecting the tissues around a dental implant.
What Causes Peri-Implantitis?
The main cause is the buildup of bacterial plaque, also called a biofilm, on and around the implant. Plaque can collect near the gumline and on surfaces that are difficult to clean. The resulting inflammatory response may damage the surrounding tissues and, in peri-implantitis, lead to progressive bone loss.
The MSD Manual Professional Edition describes peri-implantitis as a plaque-associated condition and notes its association with poor plaque control and a history of severe periodontitis, a disease that damages the tissues supporting natural teeth.
Which Factors Can Increase the Risk?
Several factors may make peri-implant disease more likely or harder to control. They do not mean that a person will necessarily develop peri-implantitis, but they can help a dental professional decide how closely an implant should be monitored.
- Inadequate plaque removal: Difficulty cleaning around the implant can allow plaque to accumulate and remain in place.
- Previous gum disease: A history of periodontitis, particularly severe disease, is an important risk indicator.
- Irregular professional maintenance: Missing recommended dental reviews and professional cleaning can allow inflammation to go unnoticed or untreated.
- Smoking: Smoking is associated with an increased risk of peri-implant disease and can make maintaining oral health more challenging.
- Diabetes, particularly when poorly controlled: Diabetes is considered a relevant risk factor, although the strength of the relationship can vary across studies and individuals.
- Difficulty accessing the implant for cleaning: The shape or position of an implant-supported crown or bridge may make effective home care more difficult.
These factors can overlap. A dentist may review oral hygiene, smoking, diabetes management, previous periodontal problems, and the design of the implant-supported restoration when assessing the overall risk.
What Signs and Symptoms Can Occur?
Peri-implantitis may cause changes in the gums around an implant. Some signs are noticeable during everyday oral care, while others are found during a dental examination. The MSD Manual Consumer Version describes redness, swelling, tenderness, bleeding, and sometimes pus around affected implant tissues.
- Redness or swelling of the gum around the implant.
- Tenderness or discomfort in the surrounding gum tissue.
- Bleeding during brushing or when a dental professional gently examines the area.
- Pus or other discharge from the gum beside the implant.
- Changes in gum position, such as recession that exposes more of the implant or its components.
These changes are not specific to peri-implantitis. For example, gum inflammation may occur without supporting bone loss. An implant can also have underlying tissue changes that are not obvious from symptoms alone. Persistent bleeding, swelling, discharge, or discomfort around an implant should be assessed by a dentist rather than managed only with home care.
How Is Peri-Implantitis Diagnosed?
Diagnosis involves examining the tissues around the implant and checking for signs of inflammation and supporting bone loss. A dentist or periodontist may ask about symptoms, when they began, previous gum disease, smoking, diabetes, oral hygiene practices, and past dental treatment. These details help place the examination findings in context.
During the examination, the clinician may gently measure the space between the gum and the implant using a periodontal probe. They may record bleeding, discharge, gum recession, and the depth of these spaces. Measurements are particularly useful when they can be compared with earlier records, because changes over time can help identify disease progression.
Dental X-rays are often used to assess the bone around the implant. Comparing current images with earlier images can help distinguish expected bone changes following implant placement from additional bone loss. The European Federation of Periodontology's clinical practice guideline outlines clinical and radiographic findings used to assess peri-implant diseases. The diagnosis is based on the combined findings rather than on a single symptom or test.
How Is Peri-Implantitis Treated?
Treatment aims to control the bacterial biofilm and inflammation, limit further damage, and preserve the implant when this is a reasonable option. The approach depends on the amount and pattern of bone loss, the condition of the gums, the implant-supported crown or bridge, and the patient's ability to keep the area clean.
The European Federation of Periodontology's evidence-based guideline recommends a stepwise approach that begins with non-surgical treatment, followed by reassessment to determine whether further care is needed.
Non-Surgical Treatment
Initial treatment generally focuses on removing plaque and deposits from the implant and surrounding teeth, improving daily cleaning, and addressing relevant risk factors. A dental professional may use instruments designed for cleaning implant surfaces. If the crown or bridge makes the area difficult to clean, it may need adjustment or, in some cases, removal to allow better access.
After this stage, the dental team reassesses inflammation, bleeding or discharge, and the depth of the spaces around the implant. The response to treatment helps determine the next step. Non-surgical treatment may be sufficient in some situations, but established peri-implantitis with persistent inflammation or deeper tissue defects may require additional intervention.
When Is Surgery Needed?
Surgery may be considered when non-surgical treatment does not adequately control the disease. Depending on the findings, a specialist may gently lift the gum tissue to access and clean the affected implant surface. Some procedures aim to reshape the surrounding tissues, while others may attempt to rebuild bone in selected defects. The appropriate technique depends on the clinical situation, and bone regeneration cannot be guaranteed.
Peri-implantitis can be difficult to manage, and not every implant can be preserved. If an implant has lost substantial supporting bone, is not maintainable, or remains affected despite appropriate treatment, removal may need to be considered. This is not an automatic outcome of the diagnosis. The dentist or periodontist should explain the available options, likely benefits, limitations, and risks before a treatment decision is made.
Can Peri-Implantitis Be Prevented?
Good daily oral hygiene and regular professional monitoring help reduce the risk of peri-implant disease. The American Academy of Periodontology recommends brushing, flossing, and regular dental visits to maintain implant health. The exact cleaning methods and review schedule should be tailored to the implant, the surrounding tissues, and the person's oral health needs.
Practical steps include:
- Brush carefully every day, including the gumline around the implant.
- Clean between teeth and around the implant using floss, interdental brushes, or other tools recommended by a dental professional.
- Attend regular dental reviews so that changes in the gums and supporting bone can be monitored.
- Follow recommended treatment and maintenance plans for existing gum disease.
- Seek support to stop smoking and work with a healthcare professional to manage diabetes when relevant.
- Tell the dentist if the implant-supported crown or bridge is difficult to clean.
Maintenance remains important even when an implant feels comfortable and looks healthy. Regular examinations can identify changes that may not be apparent during everyday care and allow the dental team to respond before further damage occurs.
When Should You Contact a Dentist?
Arrange a dental assessment if bleeding, redness, swelling, tenderness, or discharge around an implant persists or worsens. Contact the dental team promptly if the implant or its replacement tooth feels loose, or if discomfort is increasing. These changes can have different causes, so a clinical examination is needed to determine what is happening and whether treatment is required.
If peri-implantitis is identified, ask the dentist or periodontist what the examination and X-rays show, whether the implant can reasonably be retained, what treatment choices are available, and how often follow-up visits are needed. Understanding the findings and maintaining a consistent care plan can help protect the long-term health of the tissues around the implant.