Peri-implantitis: signs, causes and treatment options

Peri-implantitis is an inflammatory condition that affects the gum and bone around a dental implant. It is related to the way gum disease affects natural teeth. This page gives general information about how it is described in published dental guidance, so you can recognize the signs and know when to talk to your dentist. It is not a diagnosis, and it does not replace advice from your own dentist, who knows your mouth.

What peri-implantitis is

Dental guidelines describe two related conditions around an implant. The first is peri-implant mucositis, where the gum tissue around the implant becomes inflamed but the bone has not been affected. The second is peri-implantitis, where the inflammation also involves the bone that supports the implant, and some of that bone is lost over time.

Both conditions start with the same thing: a build-up of bacteria and plaque around the implant. That is why daily cleaning and regular checkups matter so much for people with implants.

Early signs

The early signs can be easy to miss, because they often cause no pain. Watch for:

• Gums around an implant that look red or swollen
• Bleeding when you brush or clean around the implant
• A bad taste or bad breath that does not clear up
• Gums that seem to be pulling back from the implant crown
• Tenderness around the implant

In more advanced cases, a dentist may see pus, deeper pockets around the implant, or bone loss on an X-ray, and the implant may feel loose. Pain is not always present, so do not wait for it before you ask for a check.

What can cause it

Plaque is the main cause, and several things can raise the chance of problems. Published guidance lists:

• Difficulty keeping the area clean, or skipping cleaning between teeth and around implants
• A past history of gum disease
• Smoking and other tobacco use
• Health conditions such as diabetes that are not well controlled
• Missed checkups and maintenance visits
• Leftover material or fit issues around the implant crown

Not everyone with these factors develops a problem, and some people develop one without any of them. Your dentist can talk through the factors that apply to you.

How treatment is approached

Treatment depends on the case, and only your dentist can say what suits you. The European Federation of Periodontology's clinical guideline says that once implants are in use, a supportive care programme with regular checks of the tissue around them should be in place, and that when inflammation or bone loss is found, appropriate treatment should follow. Published reviews describe treatment that commonly begins with a careful examination and professional cleaning of the area around the implant, along with advice on cleaning at home. Advanced cases may need further treatment, and follow-up visits are part of care.

Because every mouth is different, treatment plans are individual. Please ask your dentist what applies to you.

Keeping implants healthy

Good daily habits lower the risk of problems around implants:

• Brush for two minutes, morning and night, with a soft-bristled brush
• Keep the implant site clean every day, and ask your dentist which cleaning aids fit your mouth
• Avoid tobacco
• Keep up with checkups. Your dentist tells you how often to visit

How it differs from gum disease around natural teeth

Peri-implantitis is related to the gum disease that can affect natural teeth, and both start with plaque. The tissue around an implant is not the same as the tissue around a natural tooth, so a dentist checks implants with that in mind. If you have a history of gum disease, tell your dentist, because it can matter for implants too.

Why regular checkups matter for implants

Problems around an implant can develop quietly, so regular checkups are the main way to catch them early. The European Federation of Periodontology's guideline describes supportive care with regular checks as part of looking after implants. Your dentist tells you how often to visit.

What your dentist looks at

At a checkup your dentist looks at the color and shape of the gums around each implant, checks whether they bleed or look swollen, and may take X-rays to see the bone. They also check how the crown fits and how well you can clean around it.

Questions about peri-implantitis

Does peri-implantitis hurt?

Not always. Early signs such as bleeding or swelling can cause no pain, which is one reason not to wait for pain before asking for a check.

Can it happen years after an implant is placed?

Yes. Problems around an implant can appear at any time, which is why ongoing checkups matter and not only the first few months.

Will everyone with implants develop it?

No. Not everyone does, and good daily habits and regular visits help lower the risk.

Is it the same as a loose implant?

No. A loose implant can be a late sign, but inflammation and bone loss around an implant can begin well before that.

Talking with your dentist

It helps to bring a few questions to your next visit. You might ask:

• How often should I come in for implant checkups?
• Which cleaning tools suit my implants?
• Is there anything you want to watch on my X-rays?
• If your gums bleed or are sore around an implant

Your dentist knows your mouth and can tell you what applies to you.

Gum disease and implants

Gum disease and peri-implantitis share a cause: plaque. If you notice bleeding or swollen gums anywhere in your mouth, mention it to your dentist, and read more on our gum disease page.

Replacing missing teeth with implants

An implant can stand in for a missing tooth, but it still relies on steady cleaning at home and regular visits. You can read more about dental implants on our page.

A full set of new teeth on implants

The same principles apply if you have a full set of new teeth held by implants. Clean around and beneath the teeth as your dentist shows you, and keep your checkups. Read about full-arch implants on our page.

Caring for your implants every day

Daily habits are a big part of looking after an implant at home. For a guide to cleaning and the tools that help, see our post on caring for your dental implants at home.

Medicines and dry mouth

Some medicines cause a dry mouth, which can make plaque build up faster. Tell your dentist about changes in your health or medicines, so they can take them into account when they look after your implants.

Grinding and clenching

Grinding or clenching your teeth puts extra load on natural teeth and implants alike. Mention it to your dentist if you grind or clench, or if your jaw feels sore when you wake.

Easier tools for tired hands

If holding a toothbrush or floss is hard, ask your dentist about tools with larger handles or a powered brush. A routine you can keep up is worth more than a perfect technique you cannot.

When to call your dentist

Tell your dentist if you notice bleeding, swelling, a bad taste, a change in how the gums look, or any change in how your implant feels. You do not need to be sure something is wrong before you call.

Source: Herrera D, et al. Prevention and treatment of peri-implant diseases: the EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 2023.