Peri-implantitis: how to spot inflammation around an implant early – and prevent it

An implant cannot get tooth decay – but the tissue around it can become inflamed. In its early stage this is called mucositis, in the advanced stage peri-implantitis. Knowing the warning signs and attending regular check-ups goes a long way towards preventing it.

The international classification of the 2017 World Workshop distinguishes two stages. Peri-implant mucositis is inflammation of the soft tissue around the implant without loss of bone. Its typical sign is bleeding on gentle probing.

In peri-implantitis, the inflammation is accompanied by loss of the bone that supports the implant. It is considered a plaque-associated condition – a consequence of bacterial deposits. Mucositis is generally regarded as reversible; peri-implantitis is considerably harder to treat.

A widely cited review (Derks & Tomasi, 2015) reported a weighted mean of 43% for mucositis (range 19–65%) and 22% for peri-implantitis (range 1–47%). The wide range shows how much the figures depend on the study, the patient group and the definition used.

A more recent meta-analysis (Diaz et al., 2022, 57 studies) found peri-implantitis in 19.53% of patients and 12.53% of implants. These numbers are no reason for alarm – but a good reason to take daily care seriously.

Risk factors: what the evidence says

According to the consensus report on peri-implantitis (Schwarz et al., 2018), there is strong evidence for three factors:

• a history of chronic or severe periodontitis (gum disease)
• poor plaque control – deposits that are not removed thoroughly
• no regular maintenance care after implant treatment

For smoking and diabetes the authors rated the evidence as inconclusive, and for residual cement and lack of keratinised mucosa as limited. That does not mean these factors are irrelevant – see Implants with diabetes, osteoporosis or blood thinners.

Notably, peri-implantitis can start early and often progresses in an accelerating rather than a linear pattern – faster than periodontitis around natural teeth. That is why early detection matters.

• gums around the implant bleed when brushing or using interdental brushes
• redness or swelling of the tissue around the crown
• pus or an unpleasant taste
• receding gums with metal parts becoming visible

Pain often appears late. If you notice any of these signs, have them checked by a dentist promptly – at home by your own dentist or after talking to us.

Treatment according to the 2023 EFP guideline

In 2023 the European Federation of Periodontology (EFP) published an S3 guideline on preventing and treating peri-implant diseases. In simplified form it recommends:

• Mucositis: improved home care plus professional mechanical cleaning. Antibiotics (local or systemic) are not recommended for this. Re-assessment after 2–3 months.
• Peri-implantitis: first non-surgical cleaning below the gum line followed by re-evaluation. If that is not sufficient, surgical treatment follows, then close supportive care.

Which steps make sense in an individual case is decided by the dentist after examination and an X-ray.

1. Treat gum disease before implants. The EFP recommends stabilising periodontitis first.
2. Clean thoroughly every day – including the spaces between teeth. See Caring for your implants.
3. Attend regular maintenance visits, even if nothing hurts.
4. Stop smoking and, with diabetes, keep blood sugar well controlled – both are explicitly recommended by the EFP guideline.

About the authorDr. med. dent. Hasan CoşkunCo-founder of LHC Clinic, Istanbul

Dr. Coşkun studied dentistry at Charité – Universitätsmedizin Berlin (graduated 2000) and worked as a dentist in Germany for around 20 years. He has placed more than 10,000 implants and now practises in Istanbul with a focus on implant dentistry.

Diesen Artikel auf Deutsch lesen →

This article is for general information and does not replace a personal examination. Whether and which treatment is suitable for you can only be assessed after examination and a consultation.