Peri-implantitis: the early signs and how to stop it before the implant is lost

What it is, and why it differs from gum disease

Around an implant there are two layers: the gum, then the bone it has fused with. When tartar and bacteria collect at the neck of the implant, the gum becomes inflamed first, a stage that cleaning can reverse. If the inflammation continues it moves into the bone, which starts to erode around the implant. That stage is called peri-implantitis.

The difference from gum disease around a natural tooth is that the tissue around an implant resists less, and bone lost around it does not come back on its own. So early signs around an implant are taken more seriously.

The signs you should not ignore

• Bleeding from the gum around the implant when brushing or flossing.
• Redness or swelling of the gum around the implant, or tenderness when touched.
• An unpleasant taste or smell in that area despite good hygiene.
• The gum receding so that part of the implant metal shows.
• Pus when the gum is pressed.
• A change in the bite or slight movement of the restoration, which is a late sign.

Why it starts silently and how it is caught early

A natural tooth has a nerve that warns with pain. An implant has none, so inflammation around it can advance for months with hardly any pain. By the time pain or movement appears, a large part of the bone may already be gone.

That is why it is caught early at follow-up visits, by measuring the pocket depth around the implant and by an X-ray compared with earlier ones. The routine visit when you feel nothing is the one that catches the problem in time.

The role of guided cleaning in prevention

Regular cleaning at the clinic removes the bacterial film from around the implant with tools that do not scratch its surface. In guided cleaning the film is stained first so its location shows, then removed with a spray of fine powder and water instead of metal scraping. This protects the implant surface and the gum together.

What can be treated without surgery, and what needs more

At the gum-inflammation stage, and in the early stages of bone loss, careful cleaning around the implant with a prescribed mouthwash and corrected brushing is usually enough, followed by close review. Sometimes the shape of the restoration is adjusted if it gets in the way of cleaning.

When the bone loss is large, the area is opened surgically to clean the implant surface directly, and the lost bone may be rebuilt with a graft. In advanced cases removing the implant and planning another is the safer choice. The decision depends on how much bone remains, and the scan shows that.

How to keep your implants for many years

• Brush twice a day, with special floss or interdental brushes for the area around the implant and under the restoration.
• Keep the follow-up and cleaning visits the dentist sets, even when you feel nothing.
• Stop smoking; it is one of the strongest drivers of inflammation around implants and slows healing.
• Keep diabetes and any chronic condition under control with your physician.
• Come to the clinic at the first bleeding or swelling, rather than waiting for pain.