Peri-Implantitis: The Infection That Can Destroy Your Dental Implant
By Dr. Jess Liu, Board-Certified Periodontist | Pleasant Dental Associates
Dental implants have a success rate of more than 95% — but that number doesn't mean they're maintenance-free. Peri-implantitis, a bacterial infection around an implant, is the leading cause of implant failure after placement, affecting an estimated 20% of implant patients over time. The good news: caught early, it's highly treatable. Left untreated, it destroys the bone holding the implant in place.
As a periodontist, I treat peri-implantitis regularly. Here's what every implant patient needs to know.
What Is Peri-Implantitis?
Peri-implantitis is an inflammatory condition affecting the gum and bone around a dental implant, caused by bacterial biofilm (plaque) accumulating at the implant surface. It's analogous to periodontitis around natural teeth, but it tends to progress faster because the implant surface doesn't have the natural defense mechanisms teeth do.
It has two stages:
Peri-implant mucositis: inflammation limited to the soft tissue (gum) around the implant. Reversible with professional treatment and improved home care.
Peri-implantitis: infection has spread to the bone, causing progressive bone loss around the implant. Requires active treatment.
Signs and Symptoms
Bleeding when you probe or brush around the implant
Redness, swelling, or pus around the implant gumline
Bone loss visible on X-ray
Implant feels loose or has slight movement
Pain around the implant site (though peri-implantitis is often painless until advanced)
Risk Factors
Who is most at risk? Patients with:
History of periodontitis (gum disease): the same bacteria that caused disease around natural teeth will target implants
Poorly controlled diabetes
Smoking
Poor oral hygiene
Excess cement left around the implant crown after placement
Implants placed in sites with thin or poor-quality bone
How We Diagnose It
We probe around each implant at every maintenance visit, measure pocket depths, assess for bleeding on probing, and compare X-rays over time to detect bone changes. Peri-implantitis is often caught at a maintenance visit before the patient has any symptoms — which is exactly why maintenance every 3 to 4 months matters.
Treatment Options
Non-Surgical Treatment
For early-stage peri-implantitis, we start with mechanical debridement — cleaning the implant surface with specialized instruments that won't scratch the titanium. We also review your home care routine, and may use antimicrobials locally (placed in the pocket) or recommend a prescription antimicrobial rinse.
Surgical Treatment
When bone loss is significant or pockets remain deep after non-surgical care, surgery is needed to access and clean the implant surface directly. Depending on the pattern of bone loss, we may also place a bone graft to attempt to regenerate lost bone. Not all defects can be regenerated — the shape and extent of bone loss determines whether regeneration is feasible.
Implant Removal
In advanced cases where bone loss is severe and the implant is mobile, removal may be the most appropriate option. The site can then be bone grafted and a new implant placed after healing, if conditions allow.
Frequently Asked Questions
Q: Can peri-implantitis be cured?
A: Peri-implant mucositis (soft tissue only) is fully reversible. Peri-implantitis (with bone loss) can be arrested and stabilized, but lost bone may not fully regenerate. Early intervention gives the best outcomes.
Q: How do I prevent peri-implantitis?
A: Brush around your implant twice daily with a soft brush, use interdental brushes or water flossers to clean around the base of the crown, and attend your maintenance appointments every 3 to 4 months. Don't skip recall visits.
Q: My implant is 10 years old — can I still get peri-implantitis?
A: Yes. Peri-implantitis can develop at any point after implant placement. Long-term implants are not immune. Annual X-rays are important to track bone levels even if you have no symptoms.
Q: How is peri-implantitis different from gum disease?
A: Peri-implantitis affects the tissue and bone around an implant; periodontitis affects those structures around natural teeth. They share similar bacterial causes and both require periodontal specialist management, but implant surfaces require different instruments and techniques.
Q: Should I see my regular dentist or a periodontist for peri-implantitis?
A: A periodontist. We specialize in the bone and soft tissue around both teeth and implants and have the training and instrumentation for both non-surgical and surgical implant care.
Ready to Schedule?
Pleasant Dental Associates is a specialist-only practice at 1318 Beacon Street Suite 20, Brookline, MA 02446. Our board-certified periodontists and prosthodontists — all faculty at Boston University and Tufts — offer complete surgical and restorative care under one roof.
New patients: $259 exam, X-rays & cleaning special. Book online at dental4.me/pleasantdental/1 or call 617-975-3399.
