Peri-implantitis: What It Is, Symptoms, Causes, Treatment and Prevention

Peri-implantitis is an inflammation of the tissues around a dental implant, associated with bacterial plaque: over time it leads to progressive loss of the bone that supports the implant. It is common: a 2025 review found it in about one patient with implants in five (Galarraga-Vinueza et al., 2025). It can be treated, but a complete cure is not guaranteed and the disease can come back.

If you already have an implant or are thinking about one, including abroad, this guide sets out what guidelines and recent studies say about warning signs, causes, treatment and prevention. The text is informational: it does not replace an appointment and is not meant for self-diagnosis.

In brief

• Peri-implant mucositis is inflammation of the gum around the implant, without bone loss and potentially reversible; peri-implantitis involves progressive bone loss.
• Peri-implantitis affects about one patient in five, mucositis between 46% and 63%; the estimates depend on the criteria used.
• Signs: bleeding, red and swollen gum, pus. Pain is often absent, so check-ups matter.
• It can be treated, but relapses are common and sometimes the implant has to be removed.
• What helps: treating periodontitis before the implant, daily hygiene and regular professional check-ups.

What Is Peri-implantitis and How Does It Differ From Mucositis?

In peri-implantitis the mucosa around the implant becomes inflamed and then the bone that supports it is progressively resorbed (Berglundh et al., 2018). Peri-implant mucositis is the earlier stage: inflammation is present, but no bone is lost. It arises from plaque build-up and, if plaque is brought back under control, it is biologically reversible, although the visible signs can take more than three weeks to disappear (Heitz-Mayfield and Salvi, 2018).

To tell them apart, the dentist probes the gum and checks the bone on an X-ray. The table summarises the 2017 consensus definitions (Renvert et al., 2018; Berglundh et al., 2018).

If earlier X-rays are not available, the consensus treats the combination of bleeding, a probing depth of 6 mm or more and a radiographic bone level of at least 3 mm as indicative of peri-implantitis (Renvert et al., 2018). These are measurements only a dentist can assess.

How Common Is Peri-implantitis?

About one patient with implants in five has peri-implantitis, and mucositis is even more common. A 2025 systematic review of 102 studies and more than 13,000 patients estimates a prevalence (the share of patients who have the condition) of 46% for mucositis and 21% for peri-implantitis. The incidence (the share who develop it over time) is 53% and 22% within 20 years of the implant going into function (Galarraga-Vinueza et al., 2025). A meta-analysis from the same year (which pools the data of several studies), limited to studies using the 2017 criteria, gives 63% and 25% (Reis et al., 2025).

The figures differ because the definitions differ: in a Swedish study of 588 patients after 9 years, peri-implantitis was present in 45% using a bone-loss threshold above 0.5 mm and in 14.5% using a threshold above 2 mm (Derks et al., 2016).

Peri-implantitis Symptoms: Signs of an Inflamed Dental Implant

The main clinical sign is bleeding of the gum when the area is probed gently. An inflamed dental implant can also show (Berglundh et al., 2018):

• red, swollen gum;
• pus (suppuration);
• gum recession and pockets deeper than at earlier check-ups, measured with a probe;
• bone loss, visible only on an X-ray;
• implant mobility: this is a serious sign, because mobility is one of the situations in which removal is considered (Wang et al., 2025).

Pain is not a reliable indicator: according to a literature review, in most cases peri-implant diseases are asymptomatic and the patient does not feel them (Kwon et al., 2022). If you notice bleeding, swelling or pus around an implant, book an appointment without waiting: peri-implantitis can progress in a non-linear and accelerated way (Schwarz et al., 2018).

Peri-implantitis Causes and Risk Factors

The main associated factor is bacterial plaque that builds up on the implant and along the gum margin: for mucositis, the evidence for a causal link is strong (Berglundh et al., 2018). How and when mucositis turns into peri-implantitis is not fully understood (Schwarz et al., 2018). Studies therefore speak of risk indicators: associations, not proven causes.

To read the numbers: the odds ratio compares the odds of disease in people who have the factor with those in people who do not. A value of 2 means odds about twice as high; for a common condition the actual risk rises a little less.

• Periodontitis. Evidence is strong for previous chronic periodontitis (Schwarz et al., 2018). In the 2025 AO/AAP meta-analysis (Academy of Osseointegration and American Academy of Periodontology) the odds ratio for peri-implantitis is 2.92 with previous periodontitis and 4.05 with current periodontitis (Galarraga-Vinueza et al., 2025).
• Poor hygiene and no check-ups. Evidence is also strong for poor plaque control and a lack of regular maintenance (Schwarz et al., 2018). In a small 5-year study of 80 people with mucositis, peri-implantitis appeared in 43.9% of those who had no preventive maintenance and in 18.0% of those who did (Costa et al., 2012).
• Smoking and diabetes. The odds ratio is 2.27 in smokers and 2.31 in people with diabetes (Galarraga-Vinueza et al., 2025). The 2025 consensus lists uncontrolled diabetes as a risk factor (Wang et al., 2025).
• Local factors. Excess cement under the gum in cemented crowns is a possible risk indicator (Staubli et al., 2017); a poorly positioned implant and unfavourable prostheses are named as relevant local factors (Wang et al., 2025).

In practice, the factors with the most evidence (periodontitis, poor plaque control, no check-ups) are also the ones you can act on.

Can Peri-implantitis Be Treated?

It can be treated, but there is no guarantee of a complete cure: only a small share of cases, with any technique, reached resolution of the disease (Donos et al., 2023) and relapses are common (Karlsson et al., 2023). Treatment can reduce inflammation and probing depth, and regular check-ups are needed after therapy (Stiesch et al., 2023).

Mucositis: The Potentially Reversible Stage

Mucositis is managed with non-surgical professional cleaning and control of risk factors (Wang et al., 2025). Results are only partial, though: in five randomised trials the share of implants with no more bleeding after instrumentation (mechanical cleaning) ranged, depending on the study, from 31% to 35% at 3 months and from 8% to 17% at 6 months (Verket et al., 2023).

Peri-implantitis: From Cleaning to Surgery

For peri-implantitis the path depends on severity (Wang et al., 2025). Non-surgical cleaning can be a first step; for lasers and other systems for decontaminating the implant surface, the clinical benefits remain to be shown (Cosgarea et al., 2023). In more advanced cases a tailored surgical procedure is needed: with an access flap (the gum is lifted to reach and clean the implant), with resective techniques (the tissues are reshaped) or regenerative techniques (an attempt to rebuild the lost bone). In the studies:

• Access surgery. In a 2023 meta-analysis, probing depth and bleeding dropped markedly, but within 1 to 5 years the disease often came back and implant loss was not uncommon; outcomes depended on the starting conditions (Karlsson et al., 2023).
• Regenerative techniques. At 12 months the reduction in probing depth was not significantly different from that of access surgery (Donos et al., 2023).

Can You Lose the Implant?

Yes, in some cases. The 2025 AO/AAP consensus advises considering implant removal when bone loss is extensive and the shape of the bone is unfavourable, when peri-implantitis recurs, or when the implant is mobile (Wang et al., 2025). The same authors note that the criteria for choosing between keeping and removing still need to be better defined. There is no percentage that applies to everyone: the decision, and any replacement, is assessed case by case with your dentist.

How to Prevent Peri-implantitis

Prevention starts before the implant and continues for its whole life: the European guideline of the European Federation of Periodontology (EFP) recommends measures at the planning, placement and prosthetic loading stages, then a supportive care programme with regular check-ups (Herrera et al., 2023). In practice:

1. Before the implant: identify and manage risk factors, namely periodontitis, smoking and uncontrolled diabetes (Wang et al., 2025).
2. A restoration that can be cleaned: for cemented crowns, an accessible margin and no cement left under the gum (Staubli et al., 2017).
3. Daily hygiene: toothbrush (electric too), interdental brushes and floss, as your dentist advises (Wang et al., 2025). The first weeks after surgery have specific rules: you will find them in our guide to recovery after a dental implant.
4. Check-ups and professional cleaning: people at high risk, for example because of previous periodontitis or poorly controlled diabetes, should be seen every 3 to 4 months; people at low risk with stable tissues, every 5 to 6 months (Wang et al., 2025). These are expert recommendations: after peri-implantitis treatment, the evidence is not enough to set a single protocol or an ideal frequency (Stiesch et al., 2023). See the 7 steps of a professional dental cleaning.

Implant Placed Abroad: What to Keep

If you had your implant done far from home, keep an X-ray taken once the restoration is finished, the brand and model of the implant, the date of surgery and the type of restoration (cemented or screwed). The 2017 consensus recommends recording baseline radiographic and probing measurements when the restoration is completed (Berglundh et al., 2018): they help show whether anything changes over time. Have check-ups after you return home too, with a dentist near where you live.

If You Want an Opinion on an Implant

If you notice any of the signs described, the first step is an appointment: diagnosis requires probing and an X-ray. At Trio Dental Center in Tirana the first consultation is free, the written quote arrives within 24 hours, and a patient coordinator who speaks Italian answers questions and handles follow-up after you return home. Professional cleaning costs €60.

Dr. Elian Dylgjeri, implantologist and oral surgeon, speaks Italian and has placed more than 2,000 implants. For costs and the treatment path: dental implants in Albania and the price list. Contact: +355 69 747 4695, info@dentaltrio.com.

Related reading: periodontitis and implants: what to consider first, why check-ups and cleanings after dental implants are important and managing dental implant follow-up care after returning home.

Informational article by Trio Dental Center; it does not replace the opinion of a dentist. Medically reviewed by Dr. Elian Dylgjeri, Implantologist & Oral Surgeon.

Sources

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