A dental implant cannot decay, but the gum and bone that hold it can become diseased in much the same way as around a natural tooth. When that inflammation starts to destroy the bone around an implant, it is called peri-implantitis. It is more common than many implant patients expect, it is often painless at first, and the earlier it is found, the more options there are to control it and keep the implant.
Two stages: inflamed gum, then bone loss
Dentists separate disease around implants into two stages, because the outlook is very different.
Peri-implant mucositis is inflammation of the gum around an implant without any loss of supporting bone. It is similar to gingivitis around a tooth and is generally reversible with better daily cleaning and a professional clean.
Peri-implantitis is the next stage, where inflammation is accompanied by progressive loss of the bone around the implant. Lost bone does not grow back on its own, so the aim becomes stopping further loss and, in suitable cases, rebuilding some support. The process mirrors gum disease around natural teeth, which we describe in our guide to gum disease treatment.
How common it is
A systematic review of the research (Derks and Tomasi, Journal of Clinical Periodontology, 2015) estimated that about 43% of people with implants had peri-implant mucositis and about 22% had peri-implantitis. Individual studies varied widely, from 1% to 47% for peri-implantitis, mostly because they used different definitions of disease. The longer implants had been in use, the more peri-implantitis was found.
Plaque is the cause, and some people are more at risk
Peri-implantitis starts with bacterial plaque collecting where the implant crown meets the gum. Several factors are linked with it. The evidence is strongest for past gum disease, poor plaque control and missed maintenance; for the others it is weaker or mixed:
- A history of gum disease. People who have had periodontitis carry a higher risk around implants too.
- Cleaning that misses the implant. Implant crowns can be shaped differently from natural teeth and need deliberate cleaning underneath.
- Smoking, which affects blood flow and healing in the gums, although studies of smoking and peri-implantitis have not been consistent. Our article on smoking and your teeth explains more.
- Diabetes that is not well controlled, where the link is also less clear, discussed in diabetes and gum disease.
- Excess cement left under the gum when a crown is cemented, or a crown shape that is hard to clean.
- Missed maintenance visits once treatment is finished.
Signs that are easy to miss
Early peri-implantitis rarely hurts, so it is often found at a routine review rather than because of symptoms. Watch for:
- bleeding when you brush or clean around the implant
- gum that looks red, swollen or puffy, or feels tender
- pus, a bad taste or a bad smell from the area
- the gum shrinking back so more of the crown or implant shows
- any movement of the crown or implant, which is a late sign and needs prompt attention
At reviews your dentist checks the gum around each implant, measures the pocket depth gently, and compares X-rays with earlier ones to see whether bone levels are changing. Our guide to dental implant aftercare describes what that maintenance involves.
Treatment starts simple and steps up if needed
The European Federation of Periodontology published a clinical practice guideline for preventing and treating disease around implants in 2023 (Herrera and colleagues, Journal of Clinical Periodontology). It describes a stepwise approach: control the risk factors and clean the implant without surgery first, then consider surgery if the disease does not settle, followed by ongoing supportive care.
Cleaning without surgery
For mucositis and early peri-implantitis, the implant and crown are cleaned thoroughly to remove plaque and hardened deposits, using instruments that will not damage the implant surface. The dentist or OHT also reviews home cleaning and may adjust the crown if its shape traps plaque. Mucositis often settles with this alone.
Surgical treatment
When bone loss has occurred and inflammation persists, the gum may be lifted to reach and clean the implant surface directly. Depending on the shape of the bone defect, the area may be reshaped so it is easier to keep clean, or a bone graft and membrane may be used to try to rebuild some support. Results vary between people, so your clinician will discuss realistic expectations for your situation.
When the implant cannot be kept
If too much bone has been lost or the implant is loose, removing it may be the most predictable path. The site is allowed to heal, sometimes with grafting, before a replacement is considered. Our article on bone grafts and sinus lifts explains how bone can be rebuilt.
Prevention protects the bone you have
- Clean around each implant every day, including under the crown, with floss, small interdental brushes or a water flosser.
- Keep your maintenance appointments, often every three to six months, as your dentist advises.
- If you smoke, support to stop can lower your risk.
- Keep diabetes and general gum health under control.
- Book a check if you notice bleeding, swelling or a bad taste around an implant.
Knowing how the parts of an implant fit together can make cleaning easier to understand. Our guide to the parts of a dental implant explains the post, abutment and crown.
What patients ask about peri-implantitis
Can an implant with peri-implantitis be saved?
Often, if it is found early. Cleaning without surgery settles many cases of mucositis, and surgery can stabilise some cases of peri-implantitis. Implants with severe bone loss may need to be removed and replaced.
Does it hurt?
Usually not in the early stages. Bleeding, redness or swelling may be the only signs, so do not wait for pain before having it checked.
Why did my implant get gum disease when it cannot decay?
Plaque bacteria inflame the gum around implants just as they do around teeth. Past gum disease, poor cleaning and missed maintenance are the best established risks, smoking, diabetes and leftover cement may also play a part, and most of these can be managed.
How should I clean around my implant?
Brush twice a day and clean under the crown daily with floss, interdental brushes or a water flosser. Your dentist or OHT can show you the right technique and tools for your implant.
Have an implant checked
Peri-implantitis is common and often quiet, but it is treatable when found in time. If you have an implant and notice bleeding, swelling or looseness, the team at Lumi Dental in Melrose Park can assess it. You will usually receive a written treatment plan after the examination, often by email. See our current offers or learn more on our dental implants page.
