Peri-implantitis: Warning Signs, Prevention and Treatment

Mucositis and peri-implantitis: what is the difference?

Peri-implantitis is a bacterial inflammation of the tissues around an implant, combined with progressive loss of the supporting bone. It is almost always preceded by peri-implant mucositis, an inflammation limited to the gum, without bone loss, which is reversible if treated in time. Put simply: mucositis is the warning light, peri-implantitis is the established disease.

These definitions come from the 2017 classification of the EFP and the AAP (European Federation and American Academy of Periodontology), which describes three conditions around an implant:

• peri-implant health: firm gum, no bleeding on gentle probing;
• mucositis: redness, swelling and bleeding on probing, with no bone loss beyond the initial remodelling that follows placement;
• peri-implantitis: inflammation plus bone loss visible on X-rays, often with a deeper pocket around the implant.

The parallel with natural teeth is direct: mucositis corresponds to gingivitis, peri-implantitis to periodontitis.

Signs that should alert you

What makes peri-implantitis tricky is that it is often painless for a long time. You cannot wait for pain before acting. Signs to watch for:

• bleeding around the implant when brushing or using an interdental brush;
• gum that is red, swollen or tender to the touch;
• pus or a persistent unpleasant taste;
• localised bad breath;
• gum that recedes, revealing metal or implant threads;
• later on, a feeling that the crown moves.

A word on that last point: a loose crown may simply be due to a loosened screw, which is easy to fix. A loose implant, on the other hand, usually means the bone no longer holds it, and by then it is too late to keep it.

At the practice, the dentist measures probing depth around the implant, checks for bleeding or pus, and compares X-rays with those taken after the crown was fitted. That comparison is what shows whether bone has been lost.

Why some implants become infected: risk factors

The cause is dental plaque (biofilm) building up around the neck of the implant. But not everyone reacts to it the same way. Recognised risk factors include:

• a history of periodontitis: one of the most consistent factors. People who lost teeth to gum disease remain particularly susceptible;
• inadequate daily plaque control;
• no regular professional follow-up after placement;
• smoking and poorly controlled diabetes, which weaken tissue defences;
• excess cement left under the gum after a crown is cemented;
• a restoration that is hard to clean (overhangs, over-bulky contours, no access for interdental brushes);
• a poorly positioned implant, too deep or too close to a neighbouring tooth;
• thin or mobile gum around the implant that makes brushing uncomfortable (its exact role is still debated).

Some of these factors can be managed when the treatment is designed: treating gum disease first, planning implant position, choosing a screw-retained crown or carefully controlled cementation, and designing a restoration that can be cleaned.

Daily prevention: your part

The best treatment for peri-implantitis is never letting it start. Your hygiene around an implant matters as much as, if not more than, around a natural tooth.

• Brush twice a day with a soft manual or electric brush, focusing on the junction between gum and crown.
• Interdental brushes sized for each space, ideally with a coated wire so they do not scratch surfaces. Our guide to floss and interdental brushes explains how to choose the right size.
• Special floss (such as superfloss) to clean under a bridge or implant-supported restoration.
• Water flosser as an extra, useful around fixed full-arch restorations, but not a substitute for mechanical cleaning.
• Stopping or cutting down smoking, still one of the most effective measures.

If you have just had an implant placed, our aftercare advice after implant surgery covers the first weeks. After that, what counts is consistency over the years.

Professional follow-up: peri-implant maintenance

The EFP's European guideline on the prevention and treatment of peri-implant diseases stresses one point: a structured maintenance programme after placement. It usually includes:

• a baseline X-ray when the crown is fitted, used as a reference for later comparison;
• check-ups at intervals set according to your risk profile (more frequent if you have had periodontitis, smoke or find cleaning difficult);
• gentle probing around the implant and checking for bleeding;
• professional cleaning with instruments that are safe for implant surfaces, sometimes complemented by fine-powder air polishing where indicated;
• a check of the restoration: screws, bite and access for cleaning.

These visits are also the moment to treat mucositis as soon as it appears, while it is still reversible.

Treatment: from mucositis to advanced peri-implantitis

Treatment follows a step-by-step logic.

Mucositis: thorough professional cleaning around the implant, correcting whatever traps plaque (excess cement, crown contour) and improving home care are usually enough. The area is then reassessed to confirm that bleeding has stopped.

Peri-implantitis:

1. Non-surgical phase: mechanical decontamination of the implant surface under local anaesthetic, sometimes combined with antiseptics or, in certain cases, local or systemic antibiotics decided by the clinician. Adjunctive techniques such as lasers or air polishing exist; your dentist will tell you whether they are appropriate.
2. Reassessment after a few weeks: if inflammation persists and pockets remain deep, the next phase is considered.
3. Surgical phase: the gum is opened to reach and decontaminate the affected surface. Depending on the shape of the bone loss, the approach is resective (reshaping bone and gum, sometimes smoothing exposed threads, known as implantoplasty) or reconstructive (filling a crater-shaped defect with bone substitute).
4. Implant removal when bone loss is too advanced or the implant is mobile. A new implant can often be considered later, after healing and possibly reconstruction.

After treatment, close maintenance is essential: without it, recurrence is common.

Having your implants checked in Rabat

Whether your implant was placed in Morocco or abroad, a check-up is worthwhile if you notice bleeding, swelling or receding gum, or simply if you have not had a follow-up visit for a long time. If possible, bring details of your implant (brand, date of placement) and previous X-rays: they make comparison much easier.

At German Dental Clinic in Agdal, an implant check combines a gum examination, probing, digital radiography and a review of the restoration. The practice provides gum treatment and follow-up of dental implants. If you are in Rabat, book an appointment to have your implants assessed.