Peri-implant Gum Disease FAQs

What is peri-implant gum disease?

Peri-implant gum disease refers to inflammation around implants presenting as swelling, soreness or infection of the tissues surrounding implants. There are two main forms of peri-implant gum disease: mucositis and peri-implantitis.

What causes it?

It is caused by a number of factors but most commonly it is caused by bacterial plaque on the implants or the crown they hold. Bacterial plaque is a bacterial colony formed by bacteria that live in the mouth normally. It is normally visible as a soft white film that forms on teeth and implants but can turn into a tougher hard deposit called calculus or tartar when left for as little as 24 hours in some patients.

Other causes of peri-implant gum disease include mechanical failure of implant components or crown cement irritation.

What is mucositis?

It is inflammation of the soft tissues around implants that has not resulted in bone loss. It is usually reversible with simple home cleaning methods and professional scaling by a hygienist for example. If left unaddressed it can lead to peri-implantitis.

What is Peri-implantitis?

It is inflammation of the soft tissues around implants that has resulted in bone loss. It is generally painless and continues to progress until it results in complete loss of the implant. It usually initially presents as mucositis which leads to bone loss and the gradual formation of spaces around the implants called pockets when the gums pull away from the implants. These pockets can harbour more bacteria leading to more inflammation. If not treated, the bone and tissues that support the implants are rapidly destroyed. Implanted teeth will eventually become loose and will need to be removed.

Can we predict who will suffer with peri-implantitis?

No reliable methods are available currently to predict if an individual patient will suffer from peri-implantitis.  However, patients belonging to the following groups are at a higher risk of developing peri-implantitis:

  1. Patients with high levels of plaque due to ineffective cleaning regimes
  2. Patients with history of periodontitis commonly called gum disease
  3. Smokers
  4. Poorly controlled diabetic patients
  5. Patients with excessive alcohol consumption

How do I know if I have peri-implant gum disease?

You may have early peri-implant gum disease if:

  • Your gums are red and swollen
  • Your gums bleed easily when you brush or eat hard foods. Bleeding gums are not normal
  • You have bad breath
  • You may a salty or metallic taste in your mouth

With severe disease you may notice that:

  • Your implant becomes wobbly
  • Your gums have receded exposing the metallic portion of the implant

Take action if you notice these signs. Contact your dentist who may provide assistance or refer you to a periodontist. Early intervention will improve the success of any treatment and will help delay or prevent the loss of your implants.

Who is a periodontist?

Dental hygienists, in common with the rest of the dental team, are concerned with your total oral health. Dental hygienists are an essential part of a comprehensive dental team, particularly in a periodontal practice. They work under the supervision of the periodontists.

A dental hygienist is able to:

  • Provide advice on dietary risk factors for tooth sensitivity, tooth decay, or tooth surface erosion
  • Carry out superficial and deep cleaning (with local anaesthesia if required) and personalised oral hygiene instruction.
  • Suggest and provide specific treatments for tooth sensitivity.

What will the periodontist do?

The periodontist will undertake a detailed examination of your teeth and gums and provide you with a treatment plan aiming at providing you with a healthy, comfortable mouth and an aesthetically pleasing smile. This treatment plan may require the involvement of a number of specialists depending on the complexity of your current condition. You will be informed of that should the need arise.

Can peri-implant gum disease be treated?

In most people the treatment aims to prevent the disease from getting worse and cannot reliably replace the bone supporting your implants. Early intervention will improve the success of any treatment.

Treatment is based on controlling the bacterial growth on the implants.

  • The bacterial plaque can be cleaned away from both above and below the gum line to reduce the gum inflammation by a process called implant surface debridement. This is usually done with a local anaesthetic to make sure that this process is completely comfortable for you and will usually involve the neighbouring teeth.
  • Antibiotic drugs are used for some cases to reduce the bacterial levels but the treatment mostly relies on electronic and hand instruments to mechanically remove plaque off the implant surfaces. Lasers have been utilised in some treatment trials but they do not offer a clear advantage to mechanical plaque removal.
  • Effective daily home cleaning is essential for treatment success. Patients are shown best methods for cleaning teeth and gums to remove plaque on a daily basis. It must be noted that exposed implant surfaces are rougher than teeth making them challenging to effectively clean.
  • These cleaning methods will be different for different people and will be reviewed by your periodontist and hygienist on regular intervals. Without effective home cleaning methods and close monitoring, long term predictability of the treatment is reduced and the risk of relapse becomes greater.
  • In moderate to severe peri-implantitis, surgical treatment may be required to remove inflamed gum tissue or to help reduce further bone loss around teeth. This is usually done under local anaesthetic and it is a painless procedure. Please let us know if you are anxious about this treatment and we will consider the use of sedative technique to create a calming and relaxed atmosphere whilst you are having the treatment.
  • In severe cases of peri-implantitis or in cases that are not responding to treatment, removal to the implant(s) may be necessary to limit the destruction of bone in the surrounding area. This can usually be followed by placement of other implant if necessary after a period of healing.
  • Following active treatment, patients will usually require long term monitoring to ensure stability and early management if relapse occurs.

What are the benefits of treatment?

  • Bleeding, swelling and pus associated with the gums around implants should reduce
  • A reduction in the rate at which bone is lost from around the affected implants which ultimately means keeping the implants for a longer period of time.

Healthier gums mean that you should be able to keep your implants longer. The improvement will depend on how good your cleaning becomes, how well your specific risk factors are controlled and how severe your disease was to begin with.

Will the treatment be successful?

Treatment methods for peri-implantitis have only been recently reported in the scientific literature and as such we do not have any long term data on the success of treating these cases. Current evidence suggests that bone loss around implants continues after treatment at a rate dependent on patient risk factors and that a minority of patients will loose implants despite the treatment (11%).

What happens if gum disease is not treated?

Perimplantitis progresses painlessly on the whole and most patients do not notice the damage it is doing. There is strong evidence to show that bone loss is rapid in cases that are not treated. This will lead to recession around implants, exposure of the grey metallic portion of the implant and gaps appearing between the teeth. The longer the condition is left untreated; the more complicated the treatment can become and the higher the risk of total implant failure.