Most people worry about whether an implant will take. Fewer know that the more common reason implants are lost is what happens years afterwards. Peri-implantitis — inflammation of the gum and bone around an established implant — is the main cause of late implant loss, and it is largely preventable.
Dr. Jin-Ho Cho at Shine Dental Newington — BDS (University of Sydney, 1987), more than 35 years in practice, over 9,000 implant fixtures placed — reviews implants at maintenance visits precisely because early changes are manageable and late ones often are not.
What is peri-implantitis?
There are two related conditions, and the difference matters.
Peri-implant mucositis is inflammation confined to the soft tissue around an implant. The gum is red, swollen and bleeds when brushed or probed, but the supporting bone is unaffected. This stage is generally reversible with proper cleaning and professional attention.
Peri-implantitis is what follows if mucositis is left. Inflammation extends into the bone, and bone around the implant is lost. That bone does not return on its own. Treatment aims to halt progression rather than restore what has gone.
The parallel with natural teeth is close: mucositis is to gingivitis what peri-implantitis is to periodontitis. The practical difference is that implants have no periodontal ligament, so the tissue attachment around them is less robust and problems can progress more quickly once established.
What are the warning signs?
The difficulty is that implants do not ache the way teeth do. There is no nerve inside to signal trouble, so pain arrives late if at all.
Signs worth acting on:
- Bleeding when you brush or floss around the implant. This is the earliest and most useful sign.
- Redness or puffiness of the gum at the implant, compared with elsewhere.
- A bad taste or persistent odour localised to that area.
- Gum receding, or the metal collar of the implant becoming visible.
- Discharge from the gum margin.
- Any looseness of the crown or the implant itself — this warrants prompt attention.
Bleeding is the one people most often dismiss. Healthy gum does not bleed with normal brushing, at an implant or anywhere else.
Who is at higher risk?
Several factors raise susceptibility:
- A history of gum disease. The strongest single predictor. If you lost teeth to periodontitis, the same susceptibility applies around implants.
- Smoking, which affects blood supply and immune response, as covered in our article on smoking and implants.
- Poorly controlled diabetes — see diabetes and implants.
- Inadequate cleaning, particularly where the restoration design makes access awkward.
- Skipping maintenance visits, so early changes go unnoticed.
- Residual cement from cementing a crown, which can sit below the gum and provoke inflammation. Screw-retained restorations avoid this issue where the case allows.
What does treatment involve?
It depends on the stage.
For mucositis, thorough professional cleaning around the implant and a corrected home routine are often enough, with review to confirm the tissue has settled.
For established peri-implantitis, treatment is more involved. Non-surgical debridement of the implant surface may be attempted. Where bone loss is significant, surgical access is often needed to clean the surface directly and, in selected cases, to attempt regeneration of lost bone. Outcomes vary considerably and depend on how much support remains, the shape of the defect and whether the underlying risk factors are addressed.
Where too much bone has been lost, removing the implant may be the sensible course. That is a difficult conversation and one reason early detection matters so much.
How do I prevent it?
The routine is unglamorous and effective.
Clean around the implant daily and properly. Brushing alone does not reach the surfaces between and beneath the restoration. Interdental brushes sized to the space, floss designed for implants, or a water flosser — whichever your dentist recommends for your particular restoration — are the part that actually matters. Our implant aftercare guide covers technique.
Attend maintenance visits at the interval recommended for you. This is not a general check-up. Implants are assessed specifically: probing where appropriate, checking for bleeding, and radiographs at intervals to compare bone levels over time. Comparison against a baseline is how slow changes get caught.
Address the risk factors you can change. Smoking and blood sugar control are the two with the largest effect.
Report changes early rather than waiting for the next visit. Bleeding that persists for a couple of weeks is worth a call.
What about full-arch restorations?
Cleaning under an All-on-X bridge requires specific technique, because the prosthesis sits above the gum with a space beneath it that must be cleaned through rather than around. Our All-on-X cleaning guide sets out the routine, and it is worth following closely — the same biology applies, across more implants at once.
The honest position
Implants do not decay, which leads some people to assume they need less attention than teeth. The opposite is closer to the truth: they need attention of a different and more deliberate kind, indefinitely.
Well-maintained implants in suitable patients frequently serve for many years. Neglected ones can be lost. Individual outcomes vary with health, habits and the specifics of the case.
Arranging a review
If you have implants placed elsewhere and have not had them reviewed recently — or you have noticed bleeding around one — an assessment is straightforward. Bring any records you have, including which implant system was used.
Consultations run in English or Korean. HICAPS on-the-spot claiming is available, and the practice is a CBHS and NIB preferred provider.
Call (02) 9748 4822, mobile 0430 442 018, or send an enquiry.