Peri-implantitis is one of the most important conditions for anyone with dental implants to understand – and one of the most commonly overlooked. It’s the leading cause of implant failure in patients who have successfully completed treatment, and it progresses silently in its early stages, which means many patients aren’t aware there’s a problem until significant damage has already occurred.
The good news is that peri-implantitis is both preventable and treatable when caught early. Understanding the warning signs puts you in a far stronger position to protect your implants for the long term.
Peri-implantitis is an inflammatory condition that affects the tissue and bone surrounding a dental implant. It is driven by bacterial biofilm – the same plaque that causes gum disease – accumulating around the implant fixture and triggering an immune response in the surrounding tissue. Left untreated, this inflammation leads to progressive bone loss around the implant, which eventually compromises its stability and can result in implant failure.
The condition is closely related to periodontal disease – gum disease – and patients who have a history of periodontitis are at a higher risk of developing peri-implantitis. This is one of the reasons that gum health is assessed so carefully before implants are placed, and why ongoing periodontal maintenance remains important for implant patients long after treatment is complete.
The British Society of Periodontology has patient information on peri-implant conditions and how they’re managed, which is worth reading alongside any clinical advice you receive.
Healthy tissue around a dental implant should not bleed when you brush or when it’s probed at a dental appointment. Bleeding on contact is one of the earliest and most reliable indicators of inflammation – and in the context of an implant, it should always be taken seriously.
Occasional mild bleeding after particularly vigorous brushing in a patient with otherwise stable implants isn’t necessarily cause for alarm, but persistent or unprovoked bleeding around an implant site warrants an assessment. It’s one of the first signs that peri-implantitis may be developing, and catching it at this stage – before bone loss has occurred – gives the best chance of successful management.
Healthy gum tissue around an implant should be firm, pale pink, and sit snugly against the implant crown. Redness, puffiness, or a change in the texture or colour of the surrounding tissue are all signs of inflammation that shouldn’t be ignored.
These changes can be subtle in the early stages of peri-implantitis – which is one of the reasons regular professional monitoring is so important. A trained clinician will notice changes in tissue health that a patient might not observe at home.
A successfully integrated implant should be entirely comfortable in normal function. Pain or discomfort when biting, chewing, or applying pressure to the implant – particularly if it develops after a period of normal function – is a warning sign that something has changed and needs to be assessed.
It’s worth noting that peri-implantitis isn’t always painful, particularly in its earlier stages. The absence of pain doesn’t mean the implant is healthy, which is why relying on symptoms alone to monitor implant health is never sufficient.
A healthy implant is stable and immovable. Any detectable movement of the implant itself – as opposed to movement of a loose crown or restoration – indicates that osseointegration has been compromised and that significant bone loss may have occurred.
If you notice any movement in your implant, contact your dental team promptly. Looseness at this stage indicates advanced peri-implantitis and requires urgent assessment. Early-stage peri-implantitis does not cause movement – by the time looseness is detectable, the condition has typically been progressing for some time.
An unpleasant taste or persistent bad breath that doesn’t resolve with normal oral hygiene can be a sign of infection or suppuration – the discharge of pus – around an implant. This indicates active bacterial infection in the peri-implant tissue and requires prompt professional attention.
This symptom is more commonly associated with moderate to advanced peri-implantitis and should always be investigated. If you notice it, don’t wait for your next scheduled appointment – contact your practice and describe the symptoms so they can prioritise your assessment.
In some cases, peri-implantitis causes visible changes that patients notice themselves – the gum tissue receding around the implant crown, exposing a portion of the implant surface or the metal collar of the abutment, or a change in the appearance of the tissue that wasn’t there before.
Gum recession around an implant can be caused by factors other than peri-implantitis, but it should always be assessed by a clinician. Where it is associated with bone loss, it is a sign that the condition has already progressed beyond its earliest stages.
Treatment for peri-implantitis depends on the severity of the condition at the time of diagnosis – which is one of the most compelling arguments for regular monitoring and early intervention.
In the early stages, peri-implantitis can often be managed non-surgically. Professional cleaning around the implant – removing biofilm and deposits from the implant surface and the surrounding pocket – combined with improved home care and more frequent maintenance appointments is often sufficient to stabilise the condition where it is caught early.
At The Briars, Guided Biofilm Therapy is provided as standard at hygiene appointments by our hygienists Meryl Colley, Amiee Mosher, and Monica Robotin. GBT is particularly effective at removing biofilm from around implant surfaces and is a core part of the peri-implantitis prevention and management approach at the practice.
Where peri-implantitis has progressed to involve significant bone loss, more involved treatment may be needed – including surgical access to the implant surface to enable thorough debridement, and in some cases regenerative procedures to attempt to restore lost bone. Sharmila Khopade, our specialist periodontist, manages complex peri-implant cases at The Briars, and can accept referrals from other practices where patients require specialist input for this condition.
The Waterlase laser is also available at The Briars for use in periodontal and peri-implant treatment, offering a precise, minimally invasive approach to managing diseased tissue around implants.
The most effective approach to peri-implantitis is to prevent it from developing in the first place. This means excellent oral hygiene at home, consistent attendance at professional maintenance appointments, and prompt investigation of any of the warning signs described above.
If you have dental implants and haven’t had a professional maintenance appointment recently, or if you’ve noticed any of the signs described in this article, get in touch with our team at The Briars. Early assessment and intervention give your implants the best possible chance of lasting for the long term.
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