You have had implants for several years. You have noticed that the gum around them bleeds a little, sometimes swells. "But implants don't go wrong" — you think. And that thought is precisely the problem.
Myth: "Implants don't go wrong"
This is one of the most frequently repeated untruths about implants. Implants are made of titanium and ceramic — materials that indeed do not "develop caries" like natural teeth. However, the tissues around the implant — the gum and the bone — are living and susceptible to infection.
In the materials of the 2017 World Workshop on Classification of Periodontal and Peri-Implant Diseases and Conditions, two main pathological states around implants were distinguished: peri-implant mucositis and peri-implantitis.
In everyday practice we see that patients with implants attend check-ups less frequently than patients with natural teeth — precisely because they believe "there is nothing to check". Unfortunately, this is a mistake.
How to recognise peri-implantitis — early and late symptoms
Early symptoms (peri-implant mucositis)
- Red, swollen gum around the implant
- Bleeding during brushing or flossing in this area
- Mild pain or discomfort on touching the gum
- No bone loss (not visible on radiograph)
Mucositis is reversible. Proper professional cleaning, intensified home hygiene and often a short antiseptic course are enough for the condition to resolve.
Late symptoms (peri-implantitis)
- Deep pockets around the implant (probing 5 mm or more)
- Discharge of pus or exudate on pressing the gum
- Visible bone loss on the radiograph around the implant
- Exposure of the upper implant threads
- A feeling that the implant is "getting longer" — as if it protrudes more than before
- An unpleasant smell from the mouth associated with the implant area
- In advanced stages — implant mobility (this is already critical)
Peri-implantitis requires decisive treatment. It will not resolve on its own. The earlier treatment is initiated, the greater the chance of saving the implant.
Risk factors — who deserves particular attention
The literature has identified factors that increase the risk of peri-implantitis. Knowing them allows patients and clinicians to tailor prevention accordingly.
- A history of periodontitis before implant placement — patients who previously had advanced periodontal disease have a significantly higher risk of peri-implantitis.
- Smoking — one of the strongest risk factors.
- Poorly controlled diabetes (HbA1c above 7%).
- Incorrect implant loading — a crown that is too high, lack of contact, bruxism without splint protection.
- Lack of regular follow-up visits (every 6 months minimum).
- Poor home hygiene — especially difficulty flossing around implants.
- Residual cement left after crown cementation on the implant — this has become a significant risk factor that has been increasingly recognised in recent years.
Treatment — from antiseptics to surgery
The 2023 European EFP guidelines (Herrera et al.) describe the treatment of peri-implantitis as sequential: we start with less invasive methods and escalate if necessary.
Level 1 — non-surgical treatment (mucositis and early peri-implantitis)
Professional cleaning of the implant surface (mechanical instrumentation — curettes, ultrasonics with special titanium-safe tips, air-abrasion with glycine powder). Combined with intensified home hygiene and a short course of chlorhexidine.
Level 2 — resective surgical treatment
For deep pockets and bone loss of up to 30–50% of implant length, a surgical procedure is performed with exposure of the implant surface. We clean the surface mechanically and chemically and recontour the bone and soft tissues.
Level 3 — regenerative treatment
For selected types of defects (narrow, deep, surrounded by bone on several sides) regeneration similar to GTR/GBR can be attempted — with bone graft material and a membrane.
Level 4 — implant removal
In advanced peri-implantitis (bone loss above 50%, implant mobility, continuously recurring infections) removal is a sensible decision. Attempting to save a critically compromised implant exposes the patient to further bone loss.
Prevention — check-up schedule for patients with implants
Prevention is considerably less expensive and more effective than treatment. Below is the schedule we recommend to implant patients at Modern Dental & Orthodontics.
| Period | What to do | With whom |
|---|---|---|
| First 72 hours after the procedure | Gentle brushing, chlorhexidine, home care instructions | Independently + clinic check-up |
| 1–2 weeks | Healing check, suture removal | Oral surgeon |
| 3 months | First implant check-up | Implantologist |
| 6 months | Soft-tissue assessment, pocket depth measurement | Implantologistist or periodontist |
| Every 6 months (years 1–3) | Professional hygiene + measurement | Hygienist + periodontist |
| Every 6–12 months (after year 3) | Check-up + X-ray once a year | Periodontist |
| At any symptom | Do NOT wait for the scheduled check-up | Contact the clinic |
Red flags — when to call immediately
| SYMPTOMS REQUIRING AN APPOINTMENT WITHIN A WEEK: persistent bleeding around the implant (>2 weeks), discharge of pus from the gum on pressing, swelling around the implant that does not subside, visible exposure of the implant threads, worsening bad breath localised to the implant area. |
All of these symptoms suggest active inflammation. The sooner the report, the greater the chance of successful non-surgical treatment. Postponing the visit "until the scheduled check-up" can cost months of healing.
Home hygiene around implants — what patients do wrong
Implants require slightly different hygiene from natural teeth. Here are the most common mistakes we see in practice:
- Using ordinary dental floss around implants. Better options are specialist implant floss (wider, without cutting edges), superfloss or interdental brushes.
- Skipping the implant area "so as not to injure the gum". The implant gum has a lower blood supply than natural gum, but it must be cleaned regularly — without cleaning, bacterial plaque accumulates and mucositis develops.
- Using an electric toothbrush with too much pressure. An implant has no periodontal ligament to cushion force — excessive pressure can damage the surrounding tissues.
- Skipping the water flosser. For implant patients a water flosser (especially with an orthodontic or implant-specific tip) is a very useful addition to daily hygiene.
- Ignoring bleeding. "A little bleeding" around an implant is always a signal for an appointment, not "something that will pass on its own".
At Modern Dental & Orthodontics, during follow-up visits, the hygienist or clinician checks the patient's hygiene technique and adjusts the instructions accordingly.
The most frequently asked questions from patients
Is peri-implantitis painful?
Paradoxically — often it is not, especially in the early stages. This is because an implant has no dental nerves (no pulp) and pain comes only from the surrounding soft tissues. This makes peri-implantitis "silent" — the patient does not feel it until it is already advanced.
If I lose the implant, can I have a new one?
Yes, in most cases. After removal we allow the site to heal (usually 3–6 months), assess the bone (augmentation may sometimes be necessary) and plan a new implant. Each case is assessed individually.
Can bone lost around an implant be regenerated?
Partially and in selected cases. Regenerative techniques (similar to GTR/GBR for natural teeth) have a lower success rate around implants than around natural teeth, but in favourable defect morphology they can halt disease progression and partially rebuild the bone.
Read more:
- Periodontist Warsaw — Klinika MDO services
- Bone regeneration around teeth (GTR/GBR) — when a tooth can be saved instead of extracted
- Closed vs open curettage — a comparison of methods for treating advanced periodontitis
- Surgical crown lengthening — when is it necessary and how is it performed
Sources
Source 1
Links
https://pubmed.ncbi.nlm.nih.gov/37271498
https://doi.org/10.1111/jcpe.13823
Opis: Herrera D, Berglundh T, Schwarz F, Chapple I, Jepsen S, Sculean A, Kebschull M, Papapanou PN, Tonetti MS, Sanz M; EFP workshop participants and methodological consultant. „Prevention and treatment of peri-implant diseases—The EFP S3 level clinical practice guideline.” Journal of Clinical Periodontology. 2023;50(Suppl 26):4–76.
Source 2
Links
https://pubmed.ncbi.nlm.nih.gov/36261829
https://doi.org/10.1186/s12903-022-02493-8
Opis: Diaz P, Gonzalo E, Gil Villagra LJ, Miegimolle B, Suarez MJ. „What is the prevalence of peri-implantitis? A systematic review and meta-analysis.” BMC Oral Health. 2022;22(1):449.
Source 3
Links
https://pubmed.ncbi.nlm.nih.gov/37076816
https://doi.org/10.1186/s12903-023-02956-6
Opis: Cheng J, Chen L, Tao X, Qiang X, Li R, Ma J, Shi D, Qiu Z. „Efficacy of surgical methods for peri-implantitis: a systematic review and network meta-analysis.” BMC Oral Health. 2023;23(1):227.
Source 4
Links
https://pubmed.ncbi.nlm.nih.gov/38112108
https://doi.org/10.1111/clr.14228
Opis: Romandini M, Bougas K, Alibegovic L, Hosseini S, Carcuac O, Berglundh T, Derks J. „Long-term outcomes and prognostic factors of surgical treatment of peri-implantitis—A retrospective study.” Clinical Oral Implants Research. 2024;35(3):321–329.