Peri-Implantitis: Inflammation Around an Implant

Peri-implantitis is an inflammatory process in the tissues around a dental implant, during which the jaw bone that supports the implant can be gradually lost. It is important to distinguish it from the milder, reversible form — peri-implant mucositis (inflammation of the gum, i.e. the soft tissue, only, without bone loss). Implants are a long-term and successful treatment, but, like natural teeth, the tissues around them must be kept healthy; without care and regular dental check-ups the risk of peri-implantitis rises. In its early stage this condition is often painless and the patient may not feel it — which is exactly why regular check-ups and hygiene are decisive. Below we explain in plain language what peri-implantitis is, its signs, its causes, treatment approaches and, most importantly, how it can be prevented.

What is peri-implantitis?

Peri-implantitis is an inflammatory disease affecting the gum and bone tissue around an implant. It can be compared to gum disease around natural teeth: just as, around a natural tooth, inflammation first begins in the gum and, if left uncontrolled, can spread to the bone that holds the tooth, there are two similar stages around an implant. The milder form — peri-implant mucositis — is inflammation of the soft tissue (the gum) only, with no bone loss; this form can be reversible with treatment. The more severe form — peri-implantitis — is characterised by inflammation together with the gradual loss of the bone that supports the implant. Lost bone does not return on its own, which is why early detection and treatment matter greatly. This is the opposite of the process by which a healthy implant fuses with the bone (osseointegration).

• Peri-implant mucositis — inflammation of the gum (soft tissue) only, with no bone loss; can be reversible with treatment.
• Peri-implantitis — inflammation plus the gradual loss of the bone that supports the implant; more severe and harder to treat.
• Lost bone does not restore itself — which is why early detection plays a key role.

Peri-implant mucositis and peri-implantitis — what is the difference?

It is important to distinguish these two, because their severity and treatment differ. Peri-implant mucositis is inflammation of the gum around the implant: the gum may become red, swollen and bleed when brushed, but the bone that supports the implant has not yet been lost. This stage is usually considered reversible with professional cleaning and proper home hygiene. If mucositis is left uncontrolled, the inflammation can deepen and reach the bone — this is when peri-implantitis develops and the bone that supports the implant gradually decreases. Treatment of peri-implantitis is more complex, and it is not always possible to fully restore the lost bone; for this reason the main goal is to stop the process as early as possible. Only the dentist can determine which stage you are at, on the basis of an examination and X-ray images.

What are the signs of peri-implantitis?

The signs of peri-implantitis are not always obvious — especially in the early stage the condition is often painless, so the patient may not feel the problem themselves. This is exactly why regular dental check-ups are important: the dentist can detect inflammation and bone loss before you feel it. If one or more of the signs below are present, you should see a dentist; do not try to assess them yourself:

• Redness, swelling or tenderness of the gum around the implant.
• Bleeding from the gum when brushing or during examination (probing).
• Discharge of pus from the gum margin, or a persistent unpleasant taste/odour in the mouth.
• Gum recession or the metal part of the implant starting to show.
• In the late stage, a feeling that the implant is mobile — this is a serious sign and calls for an urgent dental examination.

The causes and risk factors of peri-implantitis

The main cause of peri-implantitis is the inflammation created by bacterial plaque (biofilm) that builds up on the implant and at the gum margin — that is, insufficient hygiene is the central factor. Alongside this, some factors can increase the risk. Only a dentist can assess how much they apply to you; we list them here as risk factors, not as a diagnosis.

• Insufficient oral hygiene and the build-up of plaque — the main factor.
• Smoking — a known risk factor that affects tissue health and healing negatively.
• A past or present history of gum disease (periodontitis).
• Some general health conditions, such as uncontrolled diabetes.
• Residual prosthetic cement left under the gum (excess cement).
• A lack of regular professional care and check-ups.

How is peri-implantitis treated?

The treatment approach depends on the stage of the disease and is decided by the dentist. At an early stage (peri-implant mucositis or mild peri-implantitis) treatment usually starts with non-surgical methods: professional cleaning of the implant surface (decontamination), removal of plaque and improvement of home hygiene. In more advanced cases, surgical intervention may be needed to clean below the gum and treat the affected area; in some selected cases a bone graft may be used to restore lost bone. In very severe cases, when the implant has lost enough support, its removal may be recommended. The outcome of treatment depends on the stage, general health and hygiene, and no outcome can be guaranteed in advance — which, once again, shows why early detection is important.

How can peri-implantitis be prevented?

The good news is that the risk of peri-implantitis can be significantly reduced, and the basis for this is daily hygiene together with regular professional care. The steps below help reduce the risk, but no measure gives a 100% guarantee — your dentist determines the programme suited to your individual risk factors:

• Daily proper hygiene: careful but gentle cleaning of the implant and the gum margin (a brush, interdental brushes or the aids your dentist recommends).
• Regular dental check-ups and professional cleaning — the most reliable way to detect inflammation early.
• Stopping or reducing smoking.
• Keeping conditions such as gum disease or diabetes under control.
• Seeing a dentist without delay at the first signs (bleeding, redness, swelling).

To learn about the signs and prevention of peri-implantitis and an individual care plan for your case, contact Dr. Bakhtiyar Aliyev in Baku.

This article is for general information only and does not replace individual medical advice or examination. Consultation with a dentist is recommended for an accurate diagnosis and treatment plan.