Peri-implantitis is the leading cause of dental implant failure after successful integration, yet many patients have never heard of it. This inflammatory condition affects the gum and bone around dental implants, and without treatment, it leads to progressive bone loss and eventually implant loss. Understanding the warning signs and prevention strategies is essential for anyone with dental implants — or considering getting them.

What Is Peri-Implantitis?

Peri-implantitis is essentially gum disease around an implant. Just as periodontitis destroys the bone supporting natural teeth, peri-implantitis destroys the bone supporting an implant. It begins as peri-implant mucositis — inflammation of the soft tissue around the implant without bone loss. If untreated, this progresses to peri-implantitis, where the underlying bone is actively destroyed.

Research published by the European Federation of Periodontology estimates that peri-implant mucositis affects 43% of implant sites and peri-implantitis affects 22%. These are significant numbers, yet awareness among patients remains low. The condition is treatable if caught early, making regular monitoring crucial.

Warning Signs to Watch For

Bleeding when brushing around the implant is the earliest and most important warning sign. Healthy implant gums should not bleed during normal brushing. Red or swollen gums around the implant, a bad taste or odour coming from the implant area, and pus discharge are all indicators of infection. In advanced cases, you may notice the implant feels loose or that the gum has receded to expose the implant threads.

The challenge is that peri-implantitis can be painless in its early stages. Unlike a tooth infection that typically causes significant pain, bone loss around an implant often progresses silently. This is why regular dental check-ups with X-rays are non-negotiable for implant patients — your dentist can detect bone changes before you notice any symptoms.

What Causes Peri-Implantitis?

Poor oral hygiene is the primary cause. Bacterial plaque accumulates around implants just as it does around natural teeth, and without thorough daily cleaning, these bacteria trigger an inflammatory response. Patients with a history of gum disease are at significantly higher risk — if bacteria destroyed bone around your natural teeth, the same can happen around implants.

Smoking doubles the risk of peri-implantitis by impairing blood flow and immune response in the gum tissue. Diabetes, particularly when poorly controlled, increases susceptibility. Excess cement left around cemented implant crowns can harbour bacteria in an area impossible to clean. Genetic factors also play a role — some individuals mount a more aggressive inflammatory response to bacterial plaque.

How Is Peri-Implantitis Treated?

Treatment depends on the severity. Peri-implant mucositis (inflammation without bone loss) is treated with professional cleaning of the implant surface, improved home care instruction and more frequent maintenance appointments. At this stage, the condition is fully reversible.

Mild to moderate peri-implantitis requires more intensive treatment: mechanical debridement of the implant surface, sometimes combined with antiseptic or antibiotic treatment. Laser therapy has shown promising results for decontaminating implant surfaces. Advanced peri-implantitis with significant bone loss may require surgical intervention — lifting the gum to access and clean the implant surface, decontaminating it and placing bone grafts to regenerate lost tissue.

The British Society of Periodontology recommends a stepped approach: non-surgical treatment first, followed by surgery only if the initial treatment fails to halt progression. In the most severe cases where bone loss is too extensive, the implant may need to be removed.

Prevention: The 4-Point Plan

1. Daily cleaning: Brush around implants twice daily and use interdental brushes specifically designed for implants. Water flossers are particularly effective for cleaning around implant prosthetics where traditional tools struggle to reach.

2. Professional maintenance: See your hygienist every 3-4 months during the first year after implant placement, then every 4-6 months long-term. Implant maintenance appointments use specialised instruments that clean without scratching the implant surface.

3. Do not smoke: If you currently smoke, quitting is the single most impactful thing you can do for your implant longevity. If you cannot quit entirely, reducing consumption still provides some benefit.

4. Monitor and act early: Check your implant gums daily when brushing. Any bleeding, swelling or changes in how the gum looks around the implant should prompt a dental appointment — do not wait for your next scheduled visit. Early intervention is dramatically more successful than treating advanced disease.