What is peri-implantitis, and can a failing implant be saved?

What is peri-implantitis?

Peri-implantitis is an inflammatory condition affecting the soft tissue and bone around a dental implant, in which the bacterial biofilm on the implant surface drives progressive loss of the bone that supports the implant. It is the implant equivalent of periodontitis around a natural tooth.

It helps to separate two related conditions, because they are managed very differently (Berglundh et al., 2018):³

• Peri-implant mucositis is inflammation confined to the soft tissue around the implant, with no loss of supporting bone. It is reversible: if the area is cleaned thoroughly and kept clean, the gum can return to health.
• Peri-implantitis is inflammation plus progressive bone loss around the implant. Once bone is lost, it does not grow back on its own — so the goal of treatment shifts from reversal to stopping the disease and stabilising what remains.

Peri-implant disease is common, not rare. In a large Swedish population study, 45% of patients had peri-implantitis nine years after implant therapy, and 14.5% had moderate-to-severe peri-implantitis with bone loss greater than 2 mm (Derks et al., 2016).² Peri-implantitis is the most common reason an implant fails late, after the first year.

What are the signs of peri-implantitis?

The warning signs include:

• Bleeding when the area around the implant is brushed or gently probed.
• Suppuration — pus from the gum margin around the implant.
• Deepening pockets — the space between gum and implant measured by the clinician gets deeper over time.
• Bone loss visible on an x-ray taken around the implant.
• Mobility — the implant becomes loose. This is a late sign and usually means the implant can no longer be saved.

A point that catches many patients out: early peri-implantitis is often painless. An implant has no nerve of its own, so it does not warn you with sensitivity the way a decaying tooth would. Disease can progress silently, which is exactly why scheduled reviews and x-rays matter — the problem is frequently found by the clinician before the patient notices anything.

Can a failing implant be saved?

Sometimes — and the earlier it is caught, the better the odds. Whether an implant can be saved depends mainly on how much bone has already been lost and whether the implant is still firmly held.

Treatment follows a staged approach set out in the 2023 EFP S3 clinical practice guideline (Herrera et al., 2023):¹

1. Non-surgical phase. The implant surface is cleaned and decontaminated, oral-hygiene technique is corrected, and risk factors such as smoking are addressed. For peri-implant mucositis this is often enough. For established peri-implantitis, non-surgical treatment alone is usually not sufficient but is a necessary first step.
2. Surgical phase, where needed. The gum is reflected to give direct access to the implant surface, which is thoroughly decontaminated. Depending on the shape of the bone defect, the surgeon may reshape the bone and gum to make the area cleanable (resective surgery) or attempt to rebuild lost bone (regenerative surgery).
3. Removal, when the implant cannot be saved. An implant with extensive bone loss, or one that has become mobile, is generally removed. After healing — and after the underlying cause is addressed — a new implant can often be considered for the same site.

Outcomes after peri-implantitis treatment are less predictable than treating gum disease around natural teeth, which is part of why catching it early matters so much. Both Dr Leande Kotze and Dr Christa Blignaut assess and manage peri-implant disease, whether the implant was placed at this practice or elsewhere.

How is peri-implantitis prevented?

Prevention is far more reliable than treatment. The two strongest levers are:

• Structured maintenance. Regular professional reviews with cleaning around the implant and periodic x-rays catch peri-implant mucositis while it is still reversible, before bone is lost.
• Not smoking. Smoking is a major risk factor for peri-implantitis; stopping meaningfully lowers the risk.

Keeping a history of gum disease under control and cleaning thoroughly at home — usually with an interdental brush around the implant — round out a prevention routine.

Common questions

Is peri-implantitis the same as gum disease? It is closely related. Peri-implantitis is the implant equivalent of periodontitis: the same kind of bacterial inflammation, but around an implant rather than a natural tooth.

Does peri-implantitis hurt? Often not in the early stages, which is why it is easy to miss without regular checks. Pain, swelling, or a loose implant tend to be later signs.

Can lost bone around an implant grow back? Bone does not regrow on its own. Regenerative surgery can sometimes rebuild some bone in suitable cases, but the main aim of treatment is to stop further loss and stabilise the implant.

Will my implant definitely be removed? No. Many implants caught early are stabilised and kept. Removal is reserved for implants with extensive bone loss or that have become mobile.

This article is general educational content. Whether your implant can be saved depends on how much bone has been lost, whether it is still stable, your medical and smoking history, and an examination with x-rays — a consultation gives a clinical answer for your specific implant. For the service itself, see our peri-implantitis treatment page.