Peri-implantitis: Causes, Symptoms and Treatment of Inflammation Around a Dental Implant

A dental implant is among the most durable solutions modern dentistry has to offer — but even it has its Achilles heel. That weak spot is peri-implantitis, an inflammation of the tissues around the implant that, left untreated, leads to its loss. According to the systematic review by Derks and Tomasi in the Journal of Clinical Periodontology (2015), peri-implantitis affects roughly 22 % of patients with implants; mucositis (the milder, reversible stage) affects more than half of them.

If you feel pressure in the gum or have noticed bleeding around an implant, there is no reason to panic. Nor to delay. In the guide below we explain what peri-implantitis is, how to recognise it, what modern treatment looks like and how to prevent it.

What peri-implantitis is and why it occurs

Peri-implantitis is an inflammatory disease that affects both the soft tissues and the bone around a dental implant. It is characterised by loss of the surrounding bone and bleeding of the gum. Without treatment, it leads to loosening and eventual loss of the implant.

It is important to distinguish two stages. Peri-implant mucositis is inflammation limited to the soft tissues only. Caught early, it is fully reversible and is usually resolved by professional dental hygiene and an adjustment of home care. Peri-implantitis is a more advanced state where the inflammation has reached the bone and is causing its irreversible loss. Mucositis is not as harmless as it looks — if neglected, it almost always progresses into peri-implantitis.

The main trigger is bacterial plaque, which builds up around an implant much as it does around natural teeth. The risk is increased by smoking, a history of periodontitis, uncontrolled diabetes, poorly fitted prosthetic work or missed check-ups. From our practice in České Budějovice we know that most of the cases we treat are linked to underestimated home hygiene around the implant or to the patient having stopped attending regular check-ups.

How to recognise peri-implantitis — symptoms and stages

Peri-implantitis is silent at the start. Pain only arrives in the advanced stage, so you have to look for the early signals yourself. The most common symptoms are:

1. Bleeding of the gum around the implant when brushing
2. Redness and swelling of the gum next to the crown
3. Receding gum — the implant appears “longer”
4. Purulent discharge from the gum margin
5. Bad breath that does not disappear even after thorough hygiene
6. Pressure or sensitivity when biting
7. In an advanced stage, looseness of the implant — an alarming signal

The disease progresses through three stages: mucositis (reversible), early peri-implantitis (with beginning bone loss) and advanced peri-implantitis (extensive bone loss, risk of losing the implant). In the clinic we confirm the diagnosis by probing around the implant, an X-ray and, in unclear cases, a 3D scan (CBCT). The disease often has an early onset — not infrequently within the first three years after implantation — and a non-linear course. That is another argument for not skipping regular check-ups.

The sooner we catch the problem, the better. Mucositis is fully reversible. With peri-implantitis we are already fighting to preserve the remaining bone.

Causes: why peri-implantitis appears

The causes usually combine. We divide them into two groups depending on whether you can influence them yourself.

Factors you can influence:

Home hygiene. The bacterial biofilm around an implant is the main trigger of inflammation. A classic toothbrush is not enough here — interdental brushes or a special floss (superfloss) are essential.

Smoking. Epidemiological data show that smokers have a significantly higher risk of losing an implant and of developing peri-implantitis.

Diabetes. Poorly controlled diabetes (high HbA1c) impairs healing and supports inflammation.

Regularity of check-ups. Missing one or two check-ups can, in a high-risk patient, mean the difference between mucositis and a surgical procedure.

Factors you cannot influence:

• A history of periodontitis — the tissues of these patients react more sensitively to bacterial load.
• Genetic predispositions in the immune system’s response.
• The quality of bone at the implant site.
• The design of the prosthetic work — inaccessible margins, overhanging crowns or a poorly designed bridge make home cleaning considerably more difficult.

Bacterial plaque always plays the primary role. Everything else consists of modifying factors that amplify its impact.

Treatment of peri-implantitis in 2026

Treatment differs by stage. The aim is to decontaminate the implant surface, halt bone loss and, where possible, restore what has been lost.

Non-surgical treatment (mucositis and early peri-implantitis)

• Professional dental hygiene using ultrasonic tips that are gentle to titanium and an air-flow system
• Local antiseptics — rinses or gels with chlorhexidine
• Targeted patient education — home care, interdental brushes, brushing technique
• Systemic antibiotics only in indicated cases, never routinely

The treatment of first choice depends on the stage of the disease. Mucositis is fully reversible — hygiene and patient education are enough. Early peri-implantitis is treated non-surgically with local antiseptics, with an 80–90 % chance of saving the implant. Advanced peri-implantitis requires surgical treatment with regeneration, and the success rate falls to 60–70 %. In the terminal stage (more than 50 % bone loss, implant mobility), the implant is removed and a new plan is drawn up, with reimplantation possible after the tissue has healed.

Surgical treatment (advanced peri-implantitis)

When non-surgical therapy is not enough or the bone loss is extensive, open flap debridement comes into play — the implant is surgically exposed, mechanically cleaned and its surface chemically or laser-decontaminated. Depending on the type of defect, we then choose either a resective approach (reshaping the bone) or a regenerative one (bone augmentation, membranes).

The systematic review by Monje et al. (Periodontology 2000, 2025) evaluated the long-term outcomes of surgical treatment of peri-implantitis. Over at least five years of follow-up, treatment achieved disease resolution in 58.6 % of cases and arrested progressive bone loss in 69.6 % of cases. Modern treatment works, but success is never one-hundred-percent — all the more reason to prevent the disease in the first place.

When the implant cannot be saved

When more than 50 % of the surrounding bone has been lost, the implant is mobile or treatment repeatedly fails, the best solution is extraction, healing of the tissue and a plan for a new reconstruction. Trying to save an implant at all costs often means that, once it is lost, there is less bone left for a new implant.

In our practice a simple rule applies: a patient who comes in at the first sign of bleeding around the implant has, in 80–90 % of cases, a chance of saving the restoration without surgery. A patient who postpones the visit by a year is usually facing a surgical procedure with an uncertain outcome.

How to prevent peri-implantitis

Prevention is exceptionally effective with peri-implantitis. It rests on three pillars:

Home hygiene. A soft brush twice a day, interdental brushes or superfloss around every implant. For fixed prosthetic work, consider an oral irrigator (water flosser).

Professional dental hygiene twice a year — and three to four times a year for high-risk patients (smokers, diabetics, patients with a history of periodontitis). The hygienist has specialised tools that cannot be replaced at home.

A check-up with the dentist once a year, with an X-ray of the implant every one to two years. Probing reveals mucositis before you notice it yourself.

If you spot bleeding, swelling or an unusual smell around an implant, do not postpone your visit. Two weeks make a decisive difference with this disease. In our clinic in České Budějovice we have a dedicated specialised dental hygiene protocol for patients with implants.

Conclusion

Peri-implantitis is not the inevitable fate of every patient with implants. It is a disease whose course is largely shaped by home hygiene and the regularity of check-ups. Most patients who come in at the first signs of mucositis leave the clinic with a fully saved implant and a clear care plan.

Have you noticed bleeding, or do you feel pressure around an implant? Do not hesitate. Book a check-up or specialised hygiene appointment at our clinic in České Budějovice online. The sooner you come in, the less there will be to address.