An implant cannot decay, but the gum and bone holding it can become inflamed, and that is what usually threatens an implant over the long term. Daily cleaning around and under the crown, and regular professional checks, do most of the work of keeping it healthy. Problems found early are much easier to manage than ones discovered after bone has been lost.
Long survival, but not automatic health
Implants have a good long-term record. A systematic review by Howe and colleagues in the Journal of Dentistry (2019) estimated 10-year survival at 96.4% across prospective studies. When the authors adjusted for patients lost to follow-up, the estimate fell to 93.2%, and the risk of implant loss was higher in people aged 65 and over.
Survival is not the same as health, though. A meta-analysis by Lee and colleagues, also in the Journal of Dentistry (2017), found that about one in five people with implants (19.8%) had peri-implantitis, an inflammatory condition that destroys the bone around an implant. Nearly half had peri-implant mucositis, the earlier stage where only the gum is inflamed. Peri-implantitis also became more common the longer implants had been in place.
Mucositis can usually be reversed with better cleaning and professional care. Peri-implantitis is harder to treat. That is why cleaning and check-ups matter so much.
Looking after the site in the first weeks
For the first few days after surgery, choose soft, cool foods such as yoghurt, eggs, soup that is not too hot and mashed vegetables. Chew on the other side, and do not rinse hard. Some swelling and tenderness are normal and usually settle within a few days. Smoking and alcohol slow healing and are best avoided.
Over the next few months the bone grows onto the implant surface, a process called osseointegration. Keep the area clean but gentle, and follow the instructions you were given, because they are tailored to your surgery. Contact the practice if pain or swelling is getting worse rather than better after the first few days, or if the implant feels loose.
Daily cleaning that protects the bone
Brushing the gum line
Brush twice a day with a soft brush, angling the bristles towards the gum line around the implant crown as you would for a natural tooth. A single-tufted brush or small interdental brush can reach the curved area where the crown meets the gum. Our guide on how to brush properly applies to implants too.
Cleaning under and beside the crown
Plaque that sits at the junction between crown and gum is what inflames the tissue. Use an interdental brush, a floss threader or floss designed for implants to clean the sides and underneath. For an implant bridge or a full-arch implant bridge such as All-on-X, a water flosser can help flush debris from underneath. Our guide to cleaning dental implants at home goes through the tools in more detail.
Signs that need a check
Early peri-implant disease is often painless, so watch for these:
- Bleeding when you brush or clean around the implant
- Red, puffy or tender gum around the crown
- A bad taste or persistent bad breath from that area
- Gum shrinking back so the metal collar shows
- Any looseness in the crown or implant, which needs prompt review
Once an implant has healed, bleeding around it is not normal and is worth having checked rather than waiting to see if it settles. Our article on signs of dental implant failure explains what to look out for, and the same principle applies to natural teeth, as our guide to bleeding gums describes.
What raises and lowers the risk
| Tends to protect an implant | Tends to put it at risk |
|---|---|
| Cleaning under and around the crown every day | Smoking or vaping |
| Regular professional maintenance visits | Missing maintenance visits |
| A night guard if you grind your teeth | Untreated grinding |
| Well-managed diabetes | Poorly controlled blood sugar |
| Treating gum disease around remaining natural teeth | A history of gum disease that is not being managed |
Smoking is a well-recognised risk factor for bone loss and implant failure, as is a history of gum disease. Grinding puts heavy loads on the crown and screw, and a night guard can protect them. Poorly controlled type 2 diabetes has been linked with worse gum and bone health around implants, while well-controlled diabetes does not appear to raise the risk.
Professional maintenance for life
An implant needs ongoing care in the same way natural teeth do. At maintenance visits, your dentist or OHT checks the gum around the implant, cleans with instruments that are safe for implant surfaces, and reviews the bite and the crown. How often you need to come in depends on your risk, so ask what interval suits you. Our guide to a routine scale and clean explains what a standard visit involves.
X-rays taken from time to time show the bone level around the implant, and comparing them over the years is one of the most reliable ways to spot bone loss early. Our article on dental x-rays and how often they are needed explains how imaging intervals are decided.
Questions about implant care
How long can an implant last?
Many implants last a long time. Reviews of prospective studies estimate 10-year survival in the mid-90s per cent range. The crown on top may need replacing sooner because of normal wear.
Can an implant get gum disease?
The implant itself cannot decay, but the gum and bone around it can develop peri-implant mucositis and peri-implantitis, which behave much like gum disease and can lead to implant loss if left untreated.
Do I still need check-ups if all my teeth are on implants?
Yes. A full-arch implant bridge still needs professional cleaning and regular checks of the gum, bone and fittings, because cleaning under a fixed bridge perfectly at home is difficult.
Is bleeding around an implant normal?
Not once it has healed. Bleeding suggests the gum is inflamed and should be checked promptly.
If you have an implant and would like a maintenance check, or you are still comparing ways to replace a tooth, the team at Lumi Dental in Melrose Park can help. Read about our dental implants service, compare an implant, bridge or denture, or see our current offers. After your examination you will usually receive a written treatment plan, often by email.
