Dental implants can be a long-term, stable solution for replacing missing teeth, but their longevity does not depend only on successful placement. Once the implant has integrated with the bone and has been restored with a prosthetic restoration, it is important to maintain the health of the surrounding tissues regularly. It is precisely in this area that peri-implantitis can develop – inflammation around a dental implant which, if not recognised in time, can lead to loss of the supporting bone.

Peri-implantitis does not always present immediately with severe pain. In some patients, the first sign may be mild bleeding around the implant, redness of the gum, an unpleasant taste or discomfort during cleaning. For this reason, the condition is sometimes detected only at a follow-up appointment, when the dentist assesses the tissues and uses an X-ray to check whether there is bone loss around the implant.

It is important to emphasise that a dental implant is not a solution that can be completely neglected after placement. An implant cannot develop caries like a natural tooth, but the tissues around the implant can become inflamed. This is why daily hygiene, professional cleaning and regular check-ups are essential for the long-term preservation of the implant and the prosthetic restoration attached to it.

The aim of this article is not to create fear of implants, but to explain how to recognise possible signs of inflammation, why peri-implantitis develops and what can be done to reduce the risk. Implants can be a very successful treatment, but they require responsible maintenance, especially in patients who have previously had gum disease, smoke, or have difficulty cleaning the areas around their implants properly.

What is peri-implantitis?

Peri-implantitis is an inflammatory condition affecting the tissues around a dental implant and is associated with loss of the supporting bone around the implant. This means it is not merely a superficial irritation of the gum, but a deeper problem that can compromise implant stability if it is not treated in time. In the beginning, changes may be mild, but as inflammation progresses, the support around the implant can become increasingly weakened.

A dental implant is placed into the jawbone and serves as a support for a crown, bridge or other prosthetic restoration. For it to remain stable in the long term, the bone and soft tissues around it must remain healthy. When bacterial deposits accumulate around the implant, the surrounding tissue can react with inflammation. If the inflammation is limited to the soft tissue only, this is an earlier and milder stage. If it affects the bone, we refer to it as peri-implantitis.

Peri-implantitis is often compared with periodontitis, meaning inflammation of the supporting tissues around natural teeth. However, an implant and a natural tooth are not anatomically the same. A natural tooth has a periodontal ligament, a connective tissue that attaches it to the bone and contributes to defence and pressure sensation. An implant is directly connected to the bone, so the tissues around it may react differently to inflammation and bacterial deposits.

For this reason, problems around implants should not be assessed only according to whether the implant hurts or not. Absence of pain does not necessarily mean everything is fine. Bleeding, a change in gum colour, tissue recession or an unpleasant odour may be sufficient reasons for an examination, especially if they recur or last for more than a few days.

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

Before peri-implantitis develops, a milder form of inflammation called peri-implant mucositis can often appear. The difference between these two conditions is important because it determines the seriousness of the problem and the treatment options. In the simplest terms, peri-implant mucositis affects the soft tissue around the implant, while peri-implantitis also involves bone loss.

This difference is not just a professional formality. If inflammation is recognised at the mucositis stage, it can often be stopped with professional cleaning, improved hygiene and regular follow-up appointments. Once peri-implantitis develops, treatment can be more complex because the problem no longer affects only the gum, but also the structure that supports the implant.

Peri-implant mucositis

Peri-implant mucositis is inflammation of the soft tissue around an implant without loss of supporting bone. It may present as redness, swelling and bleeding during brushing or cleaning between the teeth. The patient may sometimes feel mild sensitivity, but often there is no pronounced pain.

This condition most often develops because bacterial deposits accumulate around the implant. The problem may be insufficiently detailed cleaning, an area around the prosthetic restoration that is difficult to access, or lack of regular professional maintenance. In some patients, inflammation develops more quickly because of previous periodontal disease, smoking or other factors that affect tissue health.

The good news is that peri-implant mucositis is often reversible. This means the tissue can calm down if the cause is removed and good hygiene is established. This is precisely why early response is important. Bleeding around an implant should not be considered normal, especially if it happens repeatedly.

Peri-implantitis

Peri-implantitis is a more serious condition because, in addition to soft tissue inflammation, it also involves bone loss around the implant. Since bone provides support for the implant, its loss can compromise the long-term stability of both the implant and the prosthetic restoration. At first, symptoms may be similar to those of mucositis, but the problem is deeper and requires more detailed diagnostics.

The patient may notice bleeding, redness, swelling, an unpleasant taste or gum recession around the implant. In advanced cases, pus, greater discomfort or a feeling of mobility may occur. However, implant mobility is usually not an early sign, but rather a sign that support has already been seriously compromised.

This is why peri-implantitis should not be left “until it hurts”. By the time the implant starts to move, the options for preserving it may already be significantly more limited. Regular check-ups and X-rays help detect changes in the bone before the patient feels serious symptoms.

How does inflammation around a dental implant develop?

Inflammation around a dental implant most often begins with the accumulation of bacterial biofilm, meaning soft deposits that remain on the surface of the implant, the prosthetic restoration and the surrounding gum tissue. These deposits are not always visible to the patient, but they can be enough to trigger an inflammatory reaction. If they are not removed regularly and thoroughly, the tissue around the implant gradually becomes red, swollen and prone to bleeding.

With natural teeth and implants, the basic problem often begins in a similar way: bacteria remain in an area that has not been cleaned well enough. However, an implant does not have exactly the same biological protection as a natural tooth. The tissues around an implant may be more sensitive to plaque accumulation, especially if the prosthetic restoration is difficult to access for cleaning or if the patient has not received individually tailored hygiene instructions.

At first, inflammation affects the soft tissues. If action is taken at this stage, the condition can often be calmed. If inflammation continues, it may spread towards the deeper structures and lead to bone loss around the implant. At that point, it is no longer merely superficial irritation, but peri-implantitis.

Daily cleaning technique also plays an important role. Brushing only the visible tooth surfaces is often not enough, because problematic deposits tend to remain precisely at the transition zone where the crown emerges from the gum. This area requires careful cleaning with a toothbrush, interdental brushes, floss or other aids, depending on the shape of the prosthetic restoration.

Professional dental cleaning also has an important role because the patient cannot always remove all deposits on their own, especially around more complex prosthetic restorations.

During professional maintenance, the dentist or dental hygienist can assess hygiene, clean areas that are difficult to reach and give precise instructions for home care.

The most common causes and risk factors for peri-implantitis

Peri-implantitis most often develops as a combination of several factors. Bacterial deposits play a key role, but previous periodontal disease, smoking, implant loading, the shape of the prosthetic restoration and regularity of check-ups can also influence the development and progression of inflammation. This is why risk is not assessed in the same way for every patient.

Some patients have excellent hygiene and stable tissues for years after implant placement. Others require more frequent check-ups and more detailed instructions, especially if they had periodontitis before implant placement or if cleaning around the implant is difficult because of the position of the prosthetic restoration. An individual approach is therefore an important part of long-term maintenance.

Insufficient oral hygiene around the implant

Insufficient hygiene is one of the most important risk factors for inflammation around implants. This does not necessarily mean that the patient “does not brush their teeth”, but often means that certain areas are not cleaned well enough. An implant may support a crown, bridge or other prosthetic restoration whose shape requires special aids and a more precise cleaning technique.

The problematic area is often the margin where the prosthetic restoration emerges from the gum. Deposits, food debris and bacteria can remain there. If the patient cleans only with a regular toothbrush and does not use interdental brushes or other recommended aids, part of the deposits may remain unremoved.

It is important that hygiene around an implant is not assessed only by the feeling of cleanliness. The tissue may bleed even if the implant looks tidy at first glance. This is why it is useful for the dentist to show the patient the exact cleaning technique and recommend aids according to the specific implant and prosthetic restoration.

Previous periodontal disease

Patients who have previously had periodontitis may have a higher risk of developing inflammatory changes around implants. The reason is not that implants are impossible in such patients, but that the tissues require more careful monitoring and maintenance. If a person has had a tendency towards gum inflammation and bone loss around natural teeth, tissue control after implant placement must also be taken seriously.

Before implant therapy, it is important to stabilise the periodontal condition. After implant placement, maintenance does not end; it becomes part of a long-term plan. Regular check-ups, professional cleaning and good home hygiene are especially important in patients who have previously had periodontal problems.

Periodontal disease and peri-implantitis are not the same condition, but they share a common inflammatory logic. Both are associated with bacterial deposits, tissue response and loss of support if the process is not controlled. This is why patients with a history of periodontitis should not rely solely on the idea that an implant “is not a real tooth”, because the surrounding tissues can still be affected by inflammation.

Smoking

Smoking is one of the important factors that can negatively affect the health of tissues around implants. It reduces blood supply, slows healing and can weaken defence responses in the oral cavity. In patients who smoke, inflammatory changes sometimes do not look as pronounced as they do in non-smokers, because bleeding may be less visible even though a problem exists.

This can create a false sense of security. The patient may not notice bleeding, may not have severe pain and may think the implant is stable, while inflammation gradually develops around it. This is precisely why smokers with implants should be especially consistent with check-ups and professional maintenance.

It is important to discuss smoking without judgement. The aim is not to shame the patient, but to explain that smoking changes the conditions for healing and tissue maintenance. If a person cannot stop smoking completely, even reducing the number of cigarettes, improving hygiene and attending more regular check-ups can have a significant preventive role.

Incorrect loading of the implant

The implant participates in chewing every day, so the forces acting on it must be properly distributed. If the bite is unfavourable, if the prosthetic restoration is not properly adjusted or if the patient grinds their teeth at night, the implant and surrounding tissues may be exposed to additional load. Loading itself is not the same as peri-implantitis, but it can make tissue stability more difficult when inflammation is already present.

A good example is a patient who has an implant on one side and a habit of chewing mainly on that side. If bruxism is also present, the implant may be exposed to greater forces than planned. In such situations, the dentist does not assess only hygiene, but also the bite, tooth contacts, the prosthetic restoration and any signs of wear.

In cases of bruxism, a custom-made protective splint is often recommended. It does not treat peri-implantitis, but it can reduce mechanical load on the implant and prosthetic restoration. This is particularly important in patients who have several implants, implant-supported bridges or signs of wear on natural teeth.

Insufficiently regular check-ups

Peri-implantitis does not have to develop dramatically. In many cases, the initial signs are quiet: slight bleeding, mild swelling, an unpleasant taste or a feeling that the gum around the implant has changed. If the patient comes for an examination only when the implant hurts or begins to move, the problem is often already advanced.

Regular check-ups are not just a quick check to see “whether the implant is in place”. During a check-up, the dentist assesses the condition of the gum, the depth of the spaces around the implant, the presence of bleeding, hygiene, the prosthetic restoration and, when necessary, the condition of the bone on an X-ray. These are details that the patient cannot reliably assess at home.

In practice, the schedule of check-ups is determined individually. Someone with excellent hygiene, stable tissues and no additional risk factors may have a different plan from a patient who smokes, has a history of periodontitis or has a complex prosthetic restoration on several implants. This is not a sign that the implant is “problematic”, but that it needs to be maintained according to the actual risk.

Symptoms of peri-implantitis: how to recognise a problem

One of the challenges with peri-implantitis is that symptoms do not have to be strong at first. Patients often expect pain to be the main sign of a problem, but inflammation around an implant can progress even without pronounced pain. This is why changes in the gum tissue are often more important than pain itself.

The first sign can be very simple: blood on the toothbrush or interdental brush while cleaning the area around the implant. If this happens once, after more forceful cleaning, it does not necessarily mean a serious problem. But if bleeding recurs, especially in the same place, it is a sign that the tissue is reacting with inflammation and that an examination is needed.

Symptoms that may indicate a peri-implant problem include:

bleeding around the implant during brushing or cleaning
redness and swelling of the gum around the implant
an unpleasant taste in the mouth
bad breath that persists despite hygiene
sensitivity or discomfort on pressure
gum recession around the implant
the presence of pus in the implant area
a feeling that the prosthetic restoration has changed or “sits differently”
implant mobility in advanced cases

Here it is important to distinguish between the implant itself and the crown on the implant. Sometimes the patient feels that the “implant is moving”, when in fact the crown or the prosthetic screw has loosened. This also needs to be checked, but it is not the same as loss of implant stability in the bone. On the other hand, if the implant itself is truly mobile, this is a serious sign that requires urgent dental assessment.

Bad breath can also be an important signal. If deposits remain around the implant or inflammation develops, the patient may notice a taste that returns even after brushing. This does not always mean peri-implantitis, but it is an important enough reason for an examination.

Gum recession around the implant is another sign that patients often notice for aesthetic reasons, especially if the implant is in the front of the jaw. A longer edge of the crown, a change in the gum line or a darker shadow next to the implant may become visible. Such changes should not be viewed only as an aesthetic problem, as they may sometimes indicate changes in the tissue surrounding the implant.

Does peri-implantitis hurt?

Peri-implantitis does not have to hurt, especially in the early stage. This is one of the reasons patients may underestimate it. If there is no severe pain, it is easy to assume there is no serious problem. However, inflammation around an implant can progress gradually and without symptoms that would immediately prompt the patient to seek urgent care.

Pain is more likely to occur when inflammation is more pronounced, when there is an acute infection, swelling or pressure in the surrounding tissue. The patient may then feel discomfort when chewing, sensitivity to touch or a dull pain in the implant area. But waiting for pain as the main sign is not a good strategy.

It is better to react to earlier signals. Bleeding, swelling, an unpleasant odour, pus or a change in the position of the gum are sufficient reasons for an examination, even if the implant does not hurt. With implants, early control is particularly important because bone loss cannot be assessed simply by looking in the mirror.

Put simply: an implant can look stable while the tissue around it still shows signs of a problem. This is why a follow-up appointment is not a formality, but a way to detect changes before they become more difficult to treat.

How does a dentist diagnose peri-implantitis?

Diagnosis of peri-implantitis begins with a conversation and a clinical examination. The dentist will ask when the implant was placed, whether there have been previous problems, whether bleeding, an unpleasant taste, pain or a change during chewing is present. Information about hygiene, smoking, previous periodontal disease and possible bruxism is also important.

This is followed by an examination of the tissues around the implant. The colour of the gum, swelling, bleeding and the presence of deposits are assessed. Special attention is given to the area where the crown or prosthetic restoration emerges from the gum, because this is often where biofilm accumulates.

Diagnostics may include several steps:

examination of the gum around the implant
assessment of bleeding on probing
measurement of the depth of spaces around the implant
checking for the presence of pus or deposits
assessment of the stability of the crown, bridge or denture on the implant
analysis of the bite and loading
an X-ray to assess the bone around the implant

An X-ray has an important role because it shows whether there is bone loss around the implant. It is even more useful if earlier images are available for comparison with the new image. This allows the dentist to assess whether there has been a change over time, how pronounced the bone loss is and what the possible treatment plan might be.

It is important to emphasise that the patient cannot reliably distinguish peri-implant mucositis from peri-implantitis on their own. Both conditions can begin with bleeding and redness, but only a professional examination can assess whether the bone is involved. This is why it is better to attend an examination earlier, while treatment options are greater and less invasive.

How is peri-implantitis treated?

Treatment of peri-implantitis depends on how advanced the inflammation is, whether there is bone loss, what the hygiene around the implant is like and whether the prosthetic restoration can be cleaned properly. There is no single procedure that is applied equally to every patient. In one patient it may be enough to stop early soft tissue inflammation, while another may require a more complex approach because changes in the bone have already occurred.

The first goal of treatment is always to reduce the amount of bacterial deposits and stop the inflammatory reaction. This sounds simple, but with implants it can be technically more demanding than with a natural tooth. The implant surface, the shape of the crown, the depth of the space around the implant and accessibility for cleaning all influence how thoroughly the area can be cleaned.

It is important to be realistic: not every implant can be saved at every stage. If the patient presents early, the options are usually better. If treatment is delayed until implant mobility, pus or major bone loss occurs, therapy becomes more complex and the prognosis more uncertain.

Treatment of peri-implant mucositis

If inflammation is limited to the soft tissue and there is no bone loss, this is peri-implant mucositis. At this stage, the aim is to remove deposits, calm the tissue and teach the patient how to maintain the area around the implant properly. Often, the problem has developed because a certain part of the prosthetic restoration is difficult to access for cleaning.

For example, the patient may brush their teeth regularly but not use an interdental brush of the appropriate size. The crown on the implant may look tidy, but deposits remain in the narrow space next to the gum. Once this space is professionally cleaned and the patient receives precise instructions, bleeding often decreases and the tissue gradually calms down.

Treatment at this stage may include:

professional cleaning of the area around the implant
removal of plaque and calculus if present
checking the prosthetic restoration and whether it is accessible for cleaning
education on the proper use of interdental aids
a follow-up appointment after a defined period

This stage is important because it represents an opportunity to stop the problem before it affects the bone. This is why bleeding around an implant should not be left for months, especially if it recurs with every cleaning.

Non-surgical treatment of peri-implantitis

In peri-implantitis, when bone loss is already present, treatment is more demanding. A non-surgical approach may include cleaning the implant surface, removing biofilm, disinfection protocols and regular monitoring of the condition. The aim is to reduce inflammation and stop further progression of the disease.

At this stage, the dentist assesses how accessible the implant surface is for cleaning. If the pockets around the implant are deep, if the shape of the prosthetic restoration is unfavourable or if deposits are located in areas that are difficult to reach, surface cleaning alone may not be sufficient. Even so, the non-surgical approach is often the first step because it shows how the tissue responds to therapy and improved hygiene.

At this stage, the patient is usually given very specific instructions. It is not enough to say “clean better”. It is necessary to show where deposits are retained, which aid to use and how to pass it correctly around the implant. Sometimes the difference between poor and good hygiene is not the length of brushing, but whether the right aid is used in the right place.

Surgical treatment of peri-implantitis

In more advanced cases, a surgical approach may be necessary. This is most often considered when better access to the implant surface is needed, when inflamed tissue needs to be cleaned and when the shape of the bone defect must be assessed. Surgical treatment is not the same for every patient, because the plan depends on the amount of bone lost, the position of the implant, the condition of the soft tissue and the possibility of further reconstruction.

A surgical approach can allow better visibility and more thorough cleaning of an area that cannot be treated well enough non-surgically. In certain cases, regenerative procedures may also be considered, but only if the tissue condition, the shape of the defect and the general conditions allow it. This cannot be decided without detailed diagnostics.

Here it is particularly important to avoid unrealistic expectations. Surgical treatment does not automatically mean that the implant will definitely be saved. It can be part of the plan when there is a realistic possibility of controlling inflammation and preserving the implant, but the prognosis always depends on the specific findings and the patient’s cooperation in maintaining hygiene after the procedure.

When can an implant not be saved?

In some cases, an implant cannot be predictably saved. This most often occurs when bone loss is severe, when the implant is mobile or when inflammation is so advanced that further treatment would not have a stable result. Such a decision is not made lightly, but after an examination, X-ray analysis and assessment of all factors.

It is important to understand that removing an implant is not a failure on the part of the patient, but sometimes the best way to stop inflammation and protect the surrounding tissue. Once the condition has settled, further treatment can be planned, but it depends on the amount of remaining bone, general health, hygiene and tooth replacement options.

This is precisely why early response is so important. The earlier inflammation is recognised, the greater the possibility of simpler treatment and preservation of the implant.

How to maintain dental implants properly at home

Implants require daily maintenance, similar to natural teeth, but often with even more attention to detail. The reason is simple: an implant cannot develop caries, but the tissue around it can become inflamed. If deposits remain in the area where the crown emerges from the gum, the risk of peri-implant mucositis and peri-implantitis increases.

With home hygiene, the most important thing is to clean the areas that a regular toothbrush struggles to reach. The patient often cleans the visible surfaces of the crown well, but the problem develops in the narrow transition between the prosthetic restoration and the gum. This is the area where bacterial biofilm most easily remains.

The following can be used to maintain implants:

a soft toothbrush for daily brushing
interdental brushes of the appropriate size
dental floss or special floss for prosthetic restorations, if recommended
an oral irrigator as an additional aid, but not as the only cleaning method
special aids for implant-supported bridges or dentures
individual instructions according to the shape of the crown, bridge or denture

It is important to emphasise that an oral irrigator can be a useful addition, but usually does not replace mechanical cleaning. Water can help remove food debris and refresh the area, but biofilm often has to be mechanically disrupted with a toothbrush, interdental brush or another appropriate aid.

One practical example: a patient with a single crown on an implant may have a simpler routine than a patient with an implant-supported bridge. With a bridge, there are spaces beneath the prosthetic restoration that require a special cleaning technique. If these spaces are skipped, the gum may look inflamed and bleed, even though the patient brushes their teeth regularly.

This is why it is useful for the dentist or dental hygienist to demonstrate cleaning directly in the surgery. General instructions are often not enough. Only when the patient sees where the aid is placed and how it is used does home care become more precise and effective.

How often should dental implants be checked?

The frequency of check-ups after implant placement should not be the same for every patient. Someone with one implant, good hygiene and healthy surrounding tissues may have a different schedule from a person who has previously had periodontitis, smokes or has a more complex prosthetic restoration on several implants. Check-ups are planned according to risk, not only according to how much time has passed since placement.

An implant check-up does not simply mean checking whether the implant is stable. During the examination, the condition of the gum, bleeding, the depth of the spaces around the implant, hygiene, the bite and the prosthetic restoration are assessed. When necessary, an X-ray is taken to assess the bone around the implant.

In patients with increased risk, check-ups may be more frequent. This applies particularly to people who:

have a history of periodontal disease
smoke
have bruxism
have bridges or larger prosthetic restorations on implants
find it difficult to maintain hygiene around implants
have already had inflammation around an implant

This individual approach helps detect changes early. In practice, this can mean the difference between simple professional cleaning and more complex treatment of peri-implantitis.

At Esthea Polyclinic, assessment of implant condition may include examination of the soft tissues, hygiene assessment, inspection of the prosthetic restoration and, when necessary, X-ray analysis. Based on the findings, the patient receives a recommendation for further maintenance, the frequency of check-ups and any necessary treatment steps. This approach is especially important in patients who already have implants and want to preserve their stability in the long term. – If you do not offer this, we will remove this section.

Can peri-implantitis be prevented?

Peri-implantitis cannot be prevented in absolutely every case, but the risk can be significantly reduced. The most important thing is to understand that an implant still requires active care after placement. Successful placement is the beginning of treatment, but long-term success depends on maintenance.

Prevention is based on several simple but consistent habits:

thorough daily cleaning of the implant and surrounding tissues
use of interdental aids as recommended
regular professional cleaning
control of periodontal disease before and after implant therapy
reducing or stopping smoking
control of bruxism and an unfavourable bite
early response to bleeding, swelling or an unpleasant taste

The biggest mistake is waiting for the implant to hurt. With peri-implantitis, pain is often not the first sign. Bleeding, a change in the colour of the gum or an unpleasant taste may be much earlier signals. If action is taken in time, treatment options are better and the risk of implant loss is lower.

Prevention is not complicated, but it must be consistent. An implant does not require fear, but routine: proper cleaning at home, professional maintenance and check-ups according to individual risk.

A dental implant needs regular care, not only successful placement

Dental implants can significantly improve chewing function, smile aesthetics and quality of life, but they are not a solution that can be forgotten once treatment is completed. The tissues around the implant need to remain healthy for the implant to be stable in the long term. Peri-implantitis is a reminder that maintenance has a role just as important as placement itself.

Inflammation around an implant often begins quietly, without severe pain or dramatic symptoms. Bleeding during cleaning, swelling, an unpleasant taste, gum recession or a change in the feeling when chewing are sufficient reasons to have the condition checked. The earlier the problem is recognised, the greater the chances of stopping it.

If you have a dental implant and notice changes around it, a dental examination is recommended to assess the condition of the soft tissues and bone. Timely assessment helps distinguish milder inflammation from peri-implantitis and allows a maintenance or treatment plan to be created according to the actual condition of the implant.

Peri-implantitis: how to recognise inflammation around a dental implant and prevent implant loss