Peri-implantitis is an inflammatory disease of the tissues around a dental implant associated with progressive loss of supporting bone. It shares important features with periodontitis, but the anatomy and tissue attachment around implants differ from natural teeth. Disease progression can vary considerably between patients.
If peri-implantitis progresses untreated, inflammation and bone loss can compromise function and may ultimately result in loss of the implant. Early diagnosis, biofilm control and appropriate treatment can often help stabilise the condition, although outcomes depend on the defect and individual risk factors.
What is peri-implantitis and how does it develop?
Peri-implant diseases are generally divided into:
Peri-implant mucositis: inflammation of the soft tissue without progressive supporting-bone loss beyond initial remodelling
Peri-implantitis: inflammation with progressive loss of supporting bone
Relevant risk indicators and local factors include:
bacterial biofilm accumulation
insufficient access for daily cleaning
prosthetic or positional factors that make hygiene difficult
restoration contours or residual cement in selected cases
smoking
a history of periodontitis
systemic risk modifiers such as poorly controlled diabetes
Patients with previous periodontitis have a higher risk of peri-implant disease and therefore require particularly careful maintenance.
Signs of peri-implantitis
Early disease may cause few symptoms. Findings can include:
bleeding on probing around the implant
redness or swelling
tenderness or discomfort in some cases
increased probing depths compared with previous records
suppuration
visible recession or exposure of the implant surface
radiographic evidence of progressive bone loss
implant mobility in an advanced case usually indicates loss of osseointegration and requires prompt assessment
Earlier diagnosis generally offers more options for controlling disease and preserving the implant.
How is peri-implantitis diagnosed?
Assessment at our practice may include:
probing to assess pocket depth, bleeding and suppuration
radiographs to compare supporting bone levels when clinically indicated
assessment of the implant restoration, contour and cleansability
functional assessment where mechanical complications or overload are suspected
risk assessment including smoking, periodontal history and diabetes
Regular implant reviews are important because peri-implant disease may progress with few symptoms.
Treatment of peri-implantitis
1. Initial anti-infective treatment
Aim: disrupt and control the biofilm and improve cleansability
mechanical cleaning of the implant and surrounding tissues
adjunctive antiseptic measures in selected situations
selected use of powered or other decontamination methods according to the implant surface and defect
optimisation of daily and professional cleaning around the restoration
2. Surgical treatment
May be considered for more advanced or persistent lesions:
access surgery for direct debridement
implant-surface decontamination using an appropriate technique
resective approaches in selected defects to improve access and reduce pocket depth
regenerative procedures with bone grafting and/or membranes in suitable defect morphologies
3. Modification of the suprastructure
If overcontouring or poor access for cleaning contributes to disease, the restoration may need to be modified or replaced.
4. Management of mechanical factors
This may include:
adjustment of clearly excessive contacts where clinically indicated
an occlusal splint when bruxism threatens teeth or implant restorations
assessment of static and dynamic contacts as part of the overall prosthetic review
5. Long-term supportive care
Maintenance is central to long-term implant health:
individualised recall intervals, often every 3–6 months in higher-risk patients
professional implant and periodontal maintenance
consistent daily plaque control with suitable interdental aids
Scientific background on peri-implantitis
Large reviews consistently identify a history of periodontitis as an important risk indicator for peri-implantitis. The magnitude of risk varies between studies and patient populations.¹
Reported prevalence varies widely because studies use different definitions, follow-up periods and patient populations; peri-implantitis is therefore better understood as a clinically significant complication rather than assigned one universal percentage.²
Supportive maintenance and effective plaque control are associated with lower rates of peri-implant disease and are important after implant treatment.³
Regenerative treatment is more likely to be useful in contained or favourable intrabony defects than in non-contained horizontal bone loss, although outcomes remain variable.¹
Biofilm is a central aetiological factor in peri-implant mucositis and peri-implantitis, while patient susceptibility and local implant/prosthetic factors influence progression.⁴
Frequently asked questions (FAQ) about peri-implantitis
Can peri-implantitis be cured?
It can often be controlled or stabilised, but lost bone does not automatically regenerate and recurrence is possible. Early diagnosis and long-term maintenance are important.
How can I recognise peri-implantitis?
Bleeding, swelling, suppuration, recession or increasing pocket depths can be warning signs. Radiographs may show bone loss, but early disease can be asymptomatic.
Does an implant with peri-implantitis always need surgery?
No. Peri-implant mucositis is treated non-surgically, and initial peri-implantitis therapy also starts with biofilm control. Surgery is considered when residual disease or defect anatomy requires direct access.
Can an implant affected by peri-implantitis be saved?
Sometimes. Prognosis depends on the amount and pattern of bone loss, implant position and surface, cleansability, smoking, periodontal risk and response to treatment.
Is peri-implantitis contagious?
Peri-implantitis is not treated as a simple contagious infection. Oral bacteria can be shared between people, but disease develops through an interaction between biofilm, local conditions and individual susceptibility.
What can I do myself?
Daily plaque control, cleaning between implants, smoking cessation, management of diabetes where relevant and regular professional maintenance are the most important modifiable factors.
References
Zitzmann NU, Berglundh T. Definition and prevalence of peri-implant diseases. J Clin Periodontol. 2008. PMID: 18724857.
Derks J, Tomasi C. Peri-implant health and disease. J Clin Periodontol. 2012. PMID: 22533948.
Roccuzzo M, et al. Maintenance therapy for patients with peri-implant disease. Clin Oral Implants Res. 2010. PMID: 20584081.
Berglundh T, et al. Peri-implant diseases: consensus report from the 2017 World Workshop. J Clin Periodontol. 2018. PMID: 29926491.
