What Is Peri-Implantitis? Symptoms, Causes, Treatment & Prevention
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Dental implants are designed to function as a long-term replacement for missing teeth. However, just like natural teeth can develop gum disease, dental implants can develop a condition known as peri-implantitis—a progressive inflammatory disease associated with bacterial biofilm that affects the gum tissue and bone supporting a dental implant.
Peri-implantitis is one of the most common biological complications associated with dental implants. If diagnosed and treated early, the condition may be controlled and, in selected cases, the implant may be preserved. However, when left untreated, peri-implantitis can lead to progressive bone loss, implant instability, and eventual implant failure.
According to Dr. Hamid Shafie, a best-selling author of two textbooks on implant prosthodontics and a leading implant prosthodontics expert in Washington, D.C., successful management of peri-implantitis requires identifying the underlying cause and treating both the infection and the damaged supporting tissues.
What Is Peri-Implantitis?
Peri-implantitis is an inflammatory disease affecting the tissues surrounding a dental implant. It is associated with bacterial biofilm and involves progressive loss of the bone that supports the implant.
Unlike simple gum irritation, peri-implantitis is destructive because it attacks the foundation that keeps the implant stable.
A dental implant depends on healthy bone integration and stable surrounding tissue. Once significant bone loss occurs, the implant may lose its ability to function properly.
Peri-Implant Mucositis vs. Peri-Implantitis
Peri-implant mucositis and peri-implantitis are related but different conditions.
Peri-implant mucositis involves inflammation of the soft tissue around an implant without progressive supporting bone loss.
Peri-implantitis involves inflammation around the implant together with progressive loss of supporting bone.
This distinction is important because early evaluation and treatment of inflammation may help prevent or limit progression to more destructive disease.
What Causes Peri-Implantitis?
Several factors can contribute to the development or progression of peri-implantitis.
Bacterial Accumulation Around the Implant
Dental plaque contains bacteria that can trigger inflammation around the implant.
When plaque is not effectively controlled, bacteria can accumulate around the implant surface and cause inflammation that may progress deeper into the supporting tissues.
Inadequate Implant Maintenance
Dental implants require professional maintenance, just like natural teeth.
Patients who do not receive regular dental examinations and professional cleanings may have a higher risk of developing implant-related inflammation, infection, and complications.
History of Gum Disease
Patients who have previously experienced periodontal disease may have an increased risk of developing peri-implantitis because they may be more susceptible to bacterial-related tissue inflammation and destruction.
Smoking and Tobacco Use
Smoking reduces blood flow and can interfere with the body's ability to heal, respond to inflammation, and fight infection.
Tobacco use is an important risk factor associated with implant complications.
Poorly Designed Implant Restorations
The shape and design of an implant crown can influence how easily bacteria accumulate around the implant.
Poorly contoured restorations may make cleaning more difficult and contribute to plaque accumulation and inflammation around the implant, increasing stress on the surrounding tissues.
Excessive Bite Forces
Overloading an implant with excessive or unfavorable chewing forces can contribute to mechanical complications, and may also affect the tissues surrounding an implant, potentially contributing to inflammation and bone loss
Bruxism, an uneven bite, and poorly designed restorations can increase the mechanical demands placed on an implant.
What Are the Warning Signs of Peri-Implantitis?
Peri-implantitis may develop gradually, and some patients do not notice symptoms until the condition has progressed.
Common warning signs include:
Bleeding Around the Implant
Bleeding during brushing or flossing around an implant should not simply be considered normal.
It may indicate inflammation in the surrounding tissues.
Redness or Swelling
Healthy tissue around an implant should generally appear firm and healthy.
Persistent redness, swelling, or tenderness may indicate an inflammatory process.
Bad Taste or Bad Breath
A recurring bad taste or persistent odor around an implant may be associated with bacterial accumulation or inflammation.
Gum Recession
As the supporting tissues deteriorate, the gums may begin to recede, exposing more of the implant structure.
Pus Around the Implant
The presence of pus or drainage around an implant is a significant warning sign that infection is active and requires professional evaluation.
Implant Mobility
A healthy, properly integrated dental implant should not move.
Movement of the implant itself may indicate compromised supporting bone or implant stability and requires prompt evaluation.
It is important to remember that a loose crown does not necessarily mean the implant itself is loose. A retaining screw, abutment, or other prosthetic component can become loose while the implant remains stable.
If your implant crown feels loose, read our guide to Why Is My Dental Implant Crown Loose?
What Happens If Peri-Implantitis Is Left Untreated?
Untreated peri-implantitis can continue destroying the bone around the implant.
As bone support decreases, several problems may develop:
Implant instability
Gum recession
Exposure of implant threads
Aesthetic problems
Difficulty chewing
Progressive bone loss
Implant failure
Once extensive bone loss occurs, treatment becomes more complex and may require implant removal, bone reconstruction, and future implant replacement.
This is why early diagnosis is critical.
If you are concerned that your implant may be failing, see our guide to Signs of Dental Implant Failure.
How Is Peri-Implantitis Diagnosed?
A proper diagnosis requires more than simply looking at the implant.
An implant specialist may evaluate:
Gum tissue condition
Bleeding around the implant
Pocket depth measurements
Implant stability
Existing bone levels
Changes compared with previous X-rays
The condition of the implant crown and surrounding structures
Your bite and chewing forces
Advanced 3D imaging may be recommended to evaluate the extent of bone loss and determine the appropriate treatment approach.
The purpose of the evaluation is to determine not only whether bone loss is present, but also what may be causing it and whether the implant can be predictably maintained.
How Is Peri-Implantitis Treated?
Treatment depends on the severity of the disease, the amount and shape of bone loss around the implant, implant stability, the condition of the surrounding tissues, the restoration, and the patient's individual risk factors.
Non-Surgical Treatment
For selected early cases, treatment may include:
Professional implant cleaning and debridement
Removal of bacterial deposits
Improved home-care techniques
Management of contributing risk factors
Correction of restorative or mechanical problems
Antibacterial therapies
More frequent maintenance visits
The goal is to reduce inflammation and control the factors contributing to disease progression.
Surgical Treatment
More advanced cases may require surgical intervention.
Treatment options may include:
Surgical debridement
Implant surface decontamination
Bone regeneration procedures
Gum tissue reconstruction
Removal of damaged or inflamed tissue
Correction or replacement of a problematic restoration
Implant revision procedures or removal when the implant cannot be predictably maintained
The goal is to eliminate infection, stabilize the surrounding tissues, and preserve the implant whenever possible.
The appropriate treatment depends on the individual case. In selected patients with favorable bone-defect anatomy and sufficient implant stability, regenerative treatment may be considered to rebuild lost supporting bone.
Can a Dental Implant With Peri-Implantitis Be Saved?
Sometimes, yes.
The possibility of saving an implant depends on:
The amount of remaining supporting bone
The shape and extent of the bone defect
The severity of inflammation and infection
Implant stability
The condition of surrounding tissues
The position of the implant
The condition of the implant restoration
The patient's overall health and risk factors
Early intervention generally provides a better opportunity to control the condition and preserve the implant.
However, if the implant has lost significant stability or supporting bone, removal and replacement may become the more predictable option.
For more information, read Can a Failed Dental Implant Be Saved? Implant Rescue vs. Replacement.
Can Bone Be Regenerated Around a Dental Implant?
In selected cases, lost bone around a dental implant may be treated with regenerative procedures.
The suitability of bone regeneration depends on factors such as the amount and shape of bone loss, implant stability, control of inflammation, implant position, and the condition of the surrounding soft tissue.
Bone regeneration is not appropriate for every failing implant.
If you have exposed implant threads or bone loss around an implant, see our guide to How Does Bone Regeneration Over Exposed Dental Implant Threads Work?
How Can Peri-Implantitis Be Prevented?
Patients can reduce their risk by:
Maintaining excellent oral hygiene.
Scheduling regular implant maintenance appointments.
Treating gum disease before implant placement.
Avoiding smoking and tobacco products.
Using recommended cleaning tools around implants.
Addressing bite and restorative problems early.
Dental implants require lifelong maintenance. They are not immune to biological complications.
Frequently Asked Questions
Is peri-implantitis the same as gum disease?
They are similar inflammatory conditions, but periodontal disease affects the tissues supporting natural teeth, while peri-implantitis affects the tissues surrounding a dental implant and involves progressive supporting bone loss.
Can peri-implantitis be cured?
Early peri-implantitis can often be controlled with appropriate treatment, particularly when it is identified early. Advanced cases may require surgical or regenerative procedures to manage infection and restore supporting tissues.
The long-term prognosis depends on the severity of the condition and whether the underlying causes can be effectively controlled.
Does peri-implantitis mean my implant will fail?
No. Some implants affected by peri-implantitis can be maintained after appropriate treatment, especially when the condition is identified early before significant loss of implant stability. However, advanced bone loss or implant mobility may make removal and replacement the more predictable option.
How quickly does peri-implantitis progress?
The progression varies from patient to patient. Some cases may progress slowly, while others can cause significant bone loss if left untreated.
Can a dentist clean peri-implantitis?
Treatment depends on severity. Professional cleaning and non-surgical treatment may be sufficient in some early inflammation cases, but advanced cases may require specialized surgical treatment.
A proper examination is necessary to determine the appropriate approach.
When Should You See an Implant Specialist?
You should schedule an evaluation if you notice:
Bleeding around your implant
Swelling or redness
Gum recession
Persistent bad taste or bad breath
Pus around the implant
Pain or discomfort around the implant
Implant or restoration movement
Changes in your bite
Pain when chewing
Visible implant threads
Early evaluation may help identify the source of a problem before additional bone or tissue is lost and improve the chances of preserving your implant.
Not every implant problem is peri-implantitis, and not every complication means that an implant has failed. A professional evaluation is necessary to identify the underlying problem.
For a complete overview of implant complications, read our Dental Implant Problems and Implant Rescue guide.
You may also find these resources helpful:
Signs of Dental Implant Failure
Why Is My Dental Implant Crown Loose? Causes, Treatment & Prevention
Can a Failed Dental Implant Be Saved? Implant Rescue vs. Replacement
How Does Bone Regeneration Over Exposed Dental Implant Threads Work?
Advanced Treatment for Peri-Implantitis in Washington, D.C.
If you are experiencing signs of peri-implantitis or have been told that you have bone loss around a dental implant, schedule a comprehensive evaluation to determine the cause of the problem and the available treatment options.
At Vitality Personalized Care, Our experienced implant team evaluate complex implant complications involving the implant, surrounding bone and soft tissues, bite, and prosthetic restoration.
Dr. Shafie specializes in complex implant complications, implant rescue, revision therapy, and reconstruction of failing dental implants. His expertise in implant prosthodontics allows him to evaluate both the biological and mechanical factors contributing to implant problems.
Early diagnosis and appropriate treatment are essential for protecting your implant, supporting bone, and long-term oral health.
To schedule a comprehensive implant evaluation with Vitality Personalized Care in Washington, D.C., call 202-925-6210.
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