What do we need to know about peri-implantitis?

Last updated on: 5 Aug, 2026

Peri-implantitis is a serious complication in implant treatment. This condition affects patients with dental implants. Early recognition and appropriate treatment can save the implant and prevent more serious complications.

What is peri-implantitis?

Peri-implantitis is an inflammatory condition that leads to progressive and irreversible bone loss around the dental implant. However, early and appropriate treatment can halt the process and save the implant, preventing further bone loss around it. 

Inflammation usually begins around the implant in the soft tissues. Gradually, the process spreads to the bone tissue. The condition is similar to periodontitis in natural teeth. The difference is that peri-implantitis progresses more aggressively and rapidly.

As the scope of conventional dental implantology expands, the challenges facing patients who have chosen two-piece, classic dental implants as replacements for missing teeth are growing. 

The problems faced by implantologists are also varied when it comes to a relatively new and unpleasant condition associated with the placement of two-piece dental implants – peri-implantitis.

According to various international dental studies, in recent years between 10% and 35% of implants have been affected by this condition within 5 to 10 years of placement. 

This makes a detailed preliminary consultation before choosing implant treatment extremely important, as implants are not suitable for every clinical case.

The initial form of inflammation around the implant is called perimucositis. In this condition, only the soft tissues are inflamed, which can be reversed with timely treatment. 

If left untreated, perimucositis can progress to peri-implantitis and mucositis, as the inflammation of the soft tissues persists but spreads to the bone. At this advanced stage, irreversible bone loss around the implant is observed.

Key symptoms

Recognising the symptoms of peri-implantitis is essential for early diagnosis.

Main symptoms:

• Redness and swelling of the gums around the implant;
• Bleeding on contact or when brushing;
• Pus discharge around the implant;
• Looseness of the implant in advanced stages;
• Unpleasant taste or smell in the mouth;
• A feeling that the crown is loose.

If any of these symptoms appear, it is important to consult a dentist in Sofia or in your area immediately. Early treatment significantly improves the prognosis.

Stages of peri-implantitis

There are 4 main stages of peri-implantitis, depending on the depth of the bone pocket and the extent of bone loss around the implant.

Stage 1 – Early peri-implantitis

At this initial stage, minimal bone loss is observed – up to 3 mm from the original bone margin. Symptoms are mild and are often underestimated by patients. There is slight redness of the gums and sometimes minor bleeding. Bacterial plaque begins to accumulate around the implant.

Stage 2 – Moderate peri-implantitis

Bone resorption is between 3 and 5 mm. The inflammation around the implant worsens. More pronounced bleeding occurs and pockets begin to form around the implant. The patient may experience discomfort or mild pain.

Stage 3 – Advanced peri-implantitis

Bone loss exceeds 5 mm. Symptoms become more evident. Purulent discharge appears and deep peri-implant pockets form. The stability of the implant begins to be compromised.

Stage 4 – Severe peri-implantitis

Bone loss exceeds more than half the length of the implant and it becomes mobile. Significant pus discharge is possible. At this stage, removal of the implant is often necessary, and the clinical outcomes of treatment are poor.

Causes and risk factors

There are various causes of peri-implantitis. The main factor is the accumulation of bacterial plaque, and inadequate oral hygiene leads to the proliferation of pathogenic bacteria.

The main risk factors that can lead to this condition are as follows:

• Smoking and peri-implantitis: Smoking reduces blood flow to the gums, which impairs healing and increases the risk of infection.
• Diabetes and peri-implantitis: Uncontrolled diabetes disrupts healing processes, and diabetics have a compromised immune system.
• Osteoporosis and dental implants: Reduced bone density may affect integration.
• Rough surface of the two-piece implant: Prone to plaque and bacterial retention.
• Poor oral hygiene following implantation.
• Previous periodontal disease.
• Bruxism.

All these factors can lead to the development of the condition.

How is the diagnosis made?

Diagnosis is carried out in a dental surgery by a specialist. The process involves a clinical examination and X-rays, with the depth of the peri-implant pockets being measured. 

Regular dental check-ups help with the early detection of the condition. The specialist assesses the condition of the soft tissues and checks for bleeding on probing.

X-rays show bone loss around the implant. Images from different periods are compared, which helps to track the progression of the disease.

Prevention 

The most effective approach is the prevention of peri-implantitis. Proper oral hygiene is the foundation of prevention, and daily cleaning with a toothbrush and dental floss is essential. 

Standard recommendations for oral hygiene also include the use of special implant brushes, interdental brushes and regular rinsing with an antibacterial mouthwash.

A professional cleaning to remove tartar and plaque should be carried out every 3–6 months. During the visit to the dental surgery, the specialist checks the condition of the implants. 

Adhering to a healthy diet, consuming foods rich in vitamins C and D, and avoiding refined sugars reduces the risk.

What are the treatment methods?

The treatment of peri-implantitis itself is a complex process. The approach depends on the stage of the disease, with the aim being to eliminate the infection and preserve the implant.

Conservative treatment

Non-surgical methods are used in the early stages. Professional cleaning is the first step, using special instruments to clean the surface of the implants. Antibiotics are prescribed for peri-implantitis if an infection is present. The local application of antimicrobial agents is also effective.

Laser treatment

Laser treatment is a modern approach in which the laser destroys bacteria in the peri-implant pockets. The procedure is less invasive than traditional surgery. Laser therapy improves healing, reduces inflammation and stimulates regeneration. Clinical results show good efficacy.

Surgical treatment

In advanced cases, surgical intervention is required to reach the affected areas. The infected tissues are cleaned.

In some cases, regenerative techniques are used. Bone substitutes and membranes are employed, with the aim of restoring lost bone.

In the most severe cases, it may be necessary to remove the implant; re-implantation is possible once healing has taken place.

Maintenance therapy

Comprehensive professional dental care does not end after active treatment. Regular check-ups are necessary, with their frequency depending on the specific risk of peri-implantitis.

The presence of peri-implant biological complications requires long-term monitoring, and so-called inflammation prevention is of crucial importance.

Conclusion

Peri-implantitis in patients with dental implants is a serious condition that requires early diagnosis and appropriate treatment. That is why, if symptoms appear, do not forget to seek professional dental care. 

It is important to understand that this condition is not simply an ‘infection’, but a complex biological process that can compromise the long-term success of the implant. In addition to home care, maintenance therapy with a dental specialist plays a key role. 

Regular check-ups and professional scaling are essential, particularly for patients with risk factors such as smoking or diabetes. Choosing the right specialist and a clinic with suitable, modern equipment is of vital importance.

Peri-implantitis is a condition that can be prevented. The patient’s active role in maintaining excellent oral hygiene, regular check-ups and good cooperation with the dental team ensure the long-term health of the implants and a beautiful smile.