Peri-implantitis: symptoms, causes, and treatments

Peri-implantitis is an inflammation that attacks the tissues around a dental implant. In practice, it shows up as irritated gums and a progressive loss of the bone holding it in place. The longer it is left, the more it weakens the implant and can cause it to fail.

Before it gets to that point, there is often a warning sign: peri-implant mucositis. The problem is that this condition can progress quietly, before clearer symptoms appear. But if you act early, you can usually limit the damage.

In this article, we help you spot peri-implantitis, understand what causes it, and discover the treatments available today.

This is an infection that causes irritation around your dental implant. It starts by irritating the gum around the implant, then can gradually destroy the bone holding it in place. The source is often a buildup of bacteria under the mucosa.

To put it simply, you can think of peri-implantitis as a kind of periodontitis, but for implants. The problem is that it often progresses subtly. So many people only notice it at a fairly advanced stage.

Dentists generally distinguish two phases:

• Peri-implant mucositis: the inflammation stays only on the gum, with no bone involvement.

• Peri-implantitis itself: the bone around the implant starts to break down.

Why is it important to know the difference?

Because the earlier the problem is detected, the greater the chances of recovery.

Peri-implant mucositis is reversible and only affects the soft tissue around the implant. Peri-implantitis is a step further: the inflammation sets in and starts attacking the bone. The earlier it is detected, the better it can be treated.

Careful: mucositis does not necessarily turn into peri-implantitis. But if the condition persists for several months without treatment, bacteria can gradually infiltrate the bone and cause irreversible damage.

So, as soon as there is irritation around an implant, it is better to see a dentist or an implantology specialist.

Current knowledge is clear: the best way to avoid bone loss around an implant is to monitor it regularly and act at the first signs.

This infection causes inflammation of the tissues. The most common signs are bleeding, a reddening gum, and, if it worsens, bone loss that can weaken the implant.

At first, symptoms are often subtle. Watch out for:

• Bleeding when brushing,

• Red or swollen mucosa around the implant,

• Unusual sensitivity,

• Persistent bad breath ,

• The gum receding slightly.

These symptoms can resemble peri-implant mucositis, a reversible condition. But without treatment, it can progress into peri-implantitis.

A prompt consultation is recommended in case of:

• Pus discharge,

• Significant pain,

• Significant swelling of the gum or cheek,

• A feeling of implant mobility,

• Fever linked to an infection.

The sooner you act, the more you limit bone loss and increase your chances of keeping the implant in place.

Peri-implantitis is mainly linked to a buildup of bacteria around the implant. But certain factors can really encourage its onset or speed up its progression. Knowing them is already a good way to put suitable preventive habits in place.

When you do not take enough care of your teeth and dental implants, plaque and tartar build up. Micro-organisms then inflame the mucosa, and go on to attack deeper tissue.

The riskiest situations are:

• Brushing too lightly,

• The lack of cleaning between teeth,

• Dentist visits that are too infrequent,

• Maintenance that is not suited to implants.

Smoking and diabetes are among the biggest enemies of peri-implantitis. They slow down healing, keep inflammation going, and weaken the body's natural defenses against infection.

Other factors can also play a role:

• Having had periodontitis in the past,

• Poorly controlled diabetes,

• Certain diseases affecting the immune system,

• Too much mechanical pressure on the implant,

• Insufficient follow-up after placement.

People who have already suffered from periodontal disease are particularly at risk of developing peri-implantitis sooner or later. Other factors can also encourage peri-implantitis:teeth grinding (bruxism), crowns that are hard to clean, or a poorly fitted prosthesis. But in all cases, it is mainly the buildup of bacterial plaque that triggers the irritation.

To diagnose peri-implantitis, the dentist combines a clinical exam and X-rays. They look for signs of inflammation, measure pocket depth, and check for bone loss.

During the consultation, several things are examined:

• The presence of bleeding or pus discharge,

• The appearance of the gum around the implant,

• Implant stability,

• How the bone evolves on X-rays.

The practitioner also carries out peri-implant probing to check the depth of the tissue. This helps spot any inflamed pockets and assess how serious it is. X-rays are just as important: by comparing them with older ones, they can measure exactly how the bone loss has progressed and adjust the treatment accordingly.

Treatment for peri-implantitis varies depending on how severe the problem is. The goal is to control the infection, calm the irritation, and save as much as possible of the tissue supporting the implant.

For early-stage cases, treatment is attempted without surgery. The idea is to remove the bacteria responsible and improve hygiene around the implant.

This can involve:

• A professional cleaning of the implant surfaces,

• Local disinfection,

• Tailored hygiene advice ,

• Sometimes, antiseptics or antibiotics.

Generally, this approach works well as long as the bone loss remains moderate. The goal is to prevent the condition from progressing and reduce bacteria around the implant.

Even if the symptoms disappear, you need to keep monitoring to make sure the condition does not come back. Sometimes, non-surgical treatment is enough to stabilize things in the long term and avoid a more serious operation.

If the disease is more advanced, surgery may be necessary. It allows access to the infected areas, cleaning of the diseased mucosa, and, in some cases, repair of the bone damage.

Depending on the situation, the dentist may:

• Surgery to clean up the area,

• Reducing the pockets around the implant,

• Trying bone regeneration if that is feasible.

The choice mainly depends on the extent of bone loss and the overall condition of the implant. During the procedure, the practitioner starts by thoroughly cleaning the implant surface to remove all bacteria. If all goes well, they can also use bone regeneration techniques to rebuild part of the lost tissue. Results vary depending on the extent of the damage, but the earlier you act, the better your chances of keeping the implant for a long time.

Explantation is the removal of the implant when it can no longer be preserved. It is a last-resort solution, reserved for cases where the bone is too damaged or the implant is no longer stable.

After removing it, different options can be considered, such as rebuilding the bone and then placing a new implant, if conditions allow.

To avoid problems, nothing beats good oral hygiene and regular visits to your dentist. It is the best way to limit the risk of inflammation and catch complications in time.

How often you need check-ups varies from person to person. For example, if you smoke or have already had periodontitis, you will probably need to come in more often. These appointments are also a chance for a deep cleaning, to prevent plaque and tartar from building up in the hardest-to-reach spots.

To keep your dental implants for a long time, remember to:

• Brushing your teeth at least twice a day,

• Cleaning between your teeth every day,

• Not missing your check-up appointments,

• Cutting back or stopping smoking,

• Keeping your diabetes well managed if you have it.

After treatment for peri-implantitis, personalized follow-up is essential. Regular check-ups help monitor the state of the mucosa and avoid the risk of recurrence.

Peri-implantitis is therefore a complication that can jeopardize the success of a dental implant if it is not addressed in time. Fortunately, there are warning signs that can help spot it early, before the bone is too damaged.

If you notice bleeding, swelling, or discomfort around an implant, do not wait to make an appointment with your dentist. With good hygiene, regular follow-up, and appropriate treatment, you have every chance of keeping your dental implants for a long time.