Symptoms, examination and treatment choices.
Bleeding or swollen gums around the implant should not become a common occurrence. Although the implant itself does not get cavities, the surrounding tissues can become inflamed. If the bone supporting the implant also resorbs, this condition is called peri-implantitis.
The disease can develop without severe pain, so implant care does not end after the crown is placed. Daily cleaning and regular check-ups help detect changes before they cause more significant tissue damage. Treatment depends on the extent of inflammation, bone loss, and the possibility to properly clean the implant area.
Peri-implant mucositis is inflammation of the soft tissues around the implant without detectable progressive bone loss characteristic of peri-implantitis. The gums may appear red and bleed. Removing plaque and improving oral hygiene often allows controlling this inflammation.
Peri-implantitis involves both the soft tissues and the bone supporting the implant. Its treatment is more complex. Not every mucositis progresses, but bleeding should not be ignored or tolerated until pain develops. These conditions are differentiated through dental examination and, if needed, comparison of X-ray images. Gum color alone or a photo taken by phone cannot reliably determine the diagnosis.
Commonly noticed signs include bleeding when brushing teeth or cleaning between teeth, swollen gums, unpleasant taste, and sometimes pus discharge. Gums may recede and expose more of the implant or its abutment surface. Some people experience tenderness when chewing, while others feel almost nothing.
If you notice a crown, bridge, or the entire implant is moving, contact your dentist. Different parts of the structure may move: a loosened screw is not the same as an implant that has lost bone support. You do not need to check this difference at home by twisting the structure. Until the examination, avoid putting stress on it with hard foods.
Bacterial plaque accumulates on the implant and its prosthetic part, just like on natural teeth. It is important to clean not only the visible surface of the crown but also its junction with the gums and the harder-to-reach spaces. If the shape of the structure hinders maintenance, simply advising “clean better” is not enough – the doctor must evaluate the structure itself.
Risk is increased by past or current periodontitis, insufficient plaque control, smoking, and irregular supportive care. General health, including diabetes control, is also assessed. Inflammation may be sustained by cement remaining under the gums. No single factor alone determines the prognosis for a particular patient, but discussing them enables a more accurate maintenance plan to be developed.
The gums are examined, plaque amount, bleeding, and pus discharge are assessed, and the depth of tissue pockets around the implant is measured. The condition of the prosthesis, its stability, and cleanability are checked. It is important to find out if periodontitis was previously treated, when the last professional hygiene session occurred, and what hygiene methods you use at home.
X-ray examination helps assess the bone level. Previous images and recorded measurements allow evaluation of whether the condition is changing. Initial bone remodeling processes after implantation are not automatically peri-implantitis. Diagnosis depends on a combination of inflammation and bone changes, rather than a single number or image.
If treatment was done at another clinic, it is useful to have implant system data and previous records. They can help plan maintenance or adjustment of the prosthetic part.
First, bacterial plaque quantity is reduced and causes that hinder daily care are removed. Professional cleaning is performed using instruments suitable for implants, interdental brushes or other cleaning aids are selected. If cement residues or defects in the structure are detected, they are evaluated and removed as appropriate.
After initial treatment, a follow-up evaluation is planned. The doctor checks whether bleeding has decreased, whether there is no longer pus discharge, and whether the pockets remain deep. Simply having fresher breath or less sensitivity does not yet indicate that the disease is controlled. In the case of mucositis, such treatment may be sufficient, but peri-implantitis often requires additional procedures.
If active inflammation persists after non-surgical treatment, surgery may be necessary to access and clean the affected implant surface. Factors considered include the shape of the bone defect, implant position, soft tissues, and the patient’s ability to clean the area after treatment. In some cases, tissue regeneration procedures are considered.
It is not always possible to restore all lost bone. Sometimes a safer option is to remove the implant, especially when it has lost stability or the damage is extensive. Before the procedure, alternatives, treatment scope, possible changes in gum appearance, and options for later tooth restoration are discussed. Choosing a specific method based solely on descriptions found online is not advisable.
Rinse solutions do not remove all deposits accumulated on the implant surface and do not correct structural issues that prevent effective cleaning. They may be a short-term part of treatment if prescribed by a specialist. Prolonged self-use of antiseptics should not delay professional examination.
Antibiotics are also not a typical self-treatment for peri-implantitis. The need for them is determined by the doctor based on the clinical situation. Treatment should not be chosen solely based on buzzwords like “laser” or “bone regeneration”: it is first necessary to establish the extent of the disease and understand what a particular procedure can achieve.
Brush your teeth twice a day and clean between implants and under bridges daily. It is worthwhile to practically test the size and use of tools with an oral hygienist. A brush that is too large can cause trauma, too small may not reach deposits. An oral irrigator may be useful as an additional tool in some cases but does not replace the full cleaning prescribed by the doctor.
The frequency of follow-up visits is determined individually; in case of peri-implantitis, the usual infrequent check-ups may not be sufficient. During visits, not only cleanliness but also the condition of the tissues is evaluated. If bleeding, pus formation, or mobility of the structure occurs between visits, do not wait for the scheduled date.
No. Inflammation and bone loss can progress with little or no pain. Therefore, control measurements, assessment of bleeding, and X-ray examinations as needed are important.
Repeated bleeding needs to be evaluated. It may be caused by inflammation or trauma from cleaning. Do not stop cleaning, but use a gentle technique and discuss appropriate measures with a specialist.
Treatment usually begins with non-surgical measures. Whether these will suffice becomes clear after assessing the damage and response to treatment. Deeper lesions may require surgical assistance.
Not necessarily. The prosthetic part or its screw may be loose. The cause must be determined by a doctor; do not twist or attempt to tighten the structure yourself.
This cannot be promised. The possibilities for tissue regeneration depend on the type of damage, implant position, and other factors. The primary goal is to control the inflammation and preserve function.
Yes. Plaque accumulates even without pain. Implants and teeth attached to them require daily and professional care.
When scheduling an appointment, specify what problem has arisen and when the implant placement was performed. Bring any existing reports, images, and implant data; after examination, further care can be discussed.
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This information is for patient education and does not replace an individual examination, diagnosis or treatment plan.
