If the gum around one of your implants is sore, puffy or bleeding, the question on your mind is probably whether you are about to lose it. In most cases the answer is no. Peri-implantitis is treatable, and the earlier we catch it, the less we have to do about it. What matters is not waiting, because this is a condition that gets harder to reverse the longer it runs.
What Peri-Implantitis Is, and What It Isn’t
Peri-implantitis is an inflammatory condition affecting the peri-implant tissues around a dental implant, and its defining feature is loss of supporting bone. Bacteria collect on the implant surface, the body responds with inflammation, and over time that inflammation destroys the bone around the implant. Left alone, it becomes progressive bone loss rather than a one-off episode.
There is an earlier, milder version of the same problem. Peri-implant mucositis is soft tissue inflammation around the implant with no bone loss yet. It looks similar in the mirror, red, swollen, bleeding when you brush, but underneath, the bone is still intact.
The distinction matters more than any other point on this page:
- Peri-implant mucositis is reversible. Treated properly, the tissue returns to health and nothing is permanently lost.
- Peri-implantitis is not fully reversible. Bone that has already gone does not grow back on its own. We can stop the disease and, in some cases, rebuild part of what was lost, but the goal shifts from cure to control.
Together these two are known as peri-implant disease. They follow much the same pattern as periodontal disease around natural teeth, which is why the same specialty treats both.
Signs You Shouldn’t Ignore
Peri-implant disease is quieter than most patients expect. An implant has no nerve, so it does not ache the way a tooth with an infection does. That is exactly why it gets missed.
- Gums around the implant that look red, shiny or swollen
- Bleeding when you brush or floss near the implant
- Pus or discharge at the gum line
- The gum receding, so more of the crown or the metal shows
- A bad taste or persistent bad breath in one spot
- Discomfort when chewing on that side
- The implant feeling loose, which is a late sign and needs attention immediately
Pain is often absent until quite late. If you have noticed bleeding around the implant and nothing else, that is worth a visit rather than a wait. Our page on whether dental implants can get infected goes through the symptoms and what causes them in more detail.
What Causes It
The direct cause is bacterial plaque forming a biofilm on the implant surface, in the same way plaque drives gum disease around natural teeth. Several things make that more likely to progress:
- A history of periodontitis, which is the single strongest risk factor
- Smoking
- Poorly controlled diabetes
- Oral hygiene that cannot reach the area, sometimes because of how the restoration is shaped
- Excess cement left behind when the crown was fitted
- An implant placed in a position that makes cleaning difficult
- No regular maintenance visits after the implant was restored
Two of those are worth dwelling on, because they point at the original implant treatment rather than at the patient. An implant placed at the wrong angle, or a crown contoured so that floss and a brush cannot get underneath it, creates a trap that no amount of diligence at home will clear. When patients come to us with peri-implantitis after treatment elsewhere, this is frequently what we find.
How We Diagnose It
Diagnosis is straightforward and takes one appointment.
We measure probing depths around the implant and record whether there is bleeding on probing, which tells us whether inflammation is active. We then take radiographs, and compare them against your baseline films from when the implant was placed if we can get them, because what we need to know is not just how much bone is there now but how much has changed. Where the picture is unclear, or where we are planning surgical treatment, a CBCT scan gives us the defect in three dimensions.
That combination separates mucositis from peri-implantitis and tells us the stage of peri-implantitis we are dealing with, which is what determines everything that follows.
Can Peri-Implantitis Be Cured?
Not cured in the sense of returning the implant to the state it was in before. Bone loss around the implant is permanent unless we rebuild it surgically, and even then the result is a repair rather than a reset.
What we can do is arrest it. A successful treatment outcome means the inflammation resolves, probing depths reduce, bleeding stops, and the bone level holds steady from that point forward. Plenty of implants treated this way go on to serve for years. What peri-implantitis will not do is resolve on its own, and better brushing alone will not reverse it once bone is involved.
Treatment Options for Peri-Implantitis
Treatment of peri-implantitis follows a sequence rather than a single procedure. We start with the least invasive step that has a realistic chance of resolving it, re-evaluate once the tissue has healed, and escalate only if the disease is still active. That staged protocol is the approach supported by current periodontal guidance, and it exists because the treatment options available differ enormously in how invasive they are.
In practice, management of peri-implant diseases draws on three levels: non-surgical debridement and hygiene control, laser-assisted therapy, and open surgery with or without grafting. Which of these applies to you is decided by how much bone has been lost and the shape of the defect, not by preference.
Non-Surgical Treatment
Initial treatment is always the least invasive option that stands a reasonable chance of working. That means mechanical debridement, cleaning the implant surface and the pocket around it with instruments designed not to scratch titanium, along with a thorough reset of oral hygiene, including whatever adjustments are needed to make the area cleanable day to day.
Antiseptics such as chlorhexidine are sometimes used alongside debridement. On antibiotics, I want to be clear, because this is one of the most common questions we get and the answer is not what most people expect: systemic antibiotics are not a treatment for peri-implantitis. They may reduce symptoms briefly, but they do not remove the biofilm from the implant surface, and the problem returns once the course finishes. The European Federation of Periodontology’s guidance does not support routine antibiotic treatment for this condition. The same goes for mouthwash, which is a useful adjunct and not a solution.
Non-surgical treatment on its own reliably works for peri-implant mucositis. For established peri-implantitis with bone loss, it often does not go far enough, and we re-evaluate after healing to decide whether surgical treatment is needed.
LAPIP: Laser Treatment for a Failing Implant
We treat peri-implantitis with LAPIP, the Laser-Assisted Peri-Implantitis Procedure, performed with the PerioLase® MVP-7, the same Nd:YAG laser platform we use for LANAP.
If you have been researching this and mostly found LANAP, that is not a different treatment: LANAP is the protocol for natural teeth, LAPIP is the protocol adapted for implants. The instrument is the same, the sequence and the settings differ, because the surface being decontaminated is titanium rather than root cementum, and the tissue attachment we are trying to preserve behaves differently. Practices often say LANAP for both because it is the name patients recognize.
What the laser does here is remove diseased tissue and decontaminate the implant surface without cutting and lifting a large flap, which means less recession afterwards. That last point carries real weight in the front of the mouth: conventional surgical therapy of peri-implantitis tends to leave the gum line lower than it was, and on a visible implant that is a cosmetic problem layered on top of a biological one.
We have documented cases showing bone filling back in around implants treated this way, tracked on radiographs over a period of months. Laser treatment is not the right answer for every defect, and I will tell you when it isn’t, but for the right case it does something conventional debridement cannot.
Surgical Treatment
In advanced peri-implantitis, where the defect is beyond non-surgical or laser therapy alone, surgical intervention gives us direct access to the implant surface.
Broadly, surgical approaches fall into two groups. Resective treatment reshapes the bone and gum to eliminate the pocket, which is predictable but lowers the gum line. Regenerative treatment uses a bone graft, often with a membrane, to rebuild peri-implantitis defects and encourage bone to reattach, which preserves appearance and is more technique-sensitive. Which one suits your case depends on the shape of the defect, not on preference: contained, crater-shaped defects respond well to reconstructive techniques, while broader horizontal loss usually does not.
How We Decontaminate the Implant Surface
Every surgical approach depends on implant surface decontamination, because leaving biofilm behind guarantees the disease returns. This is the step where competitor pages tend to go vague, so here is what we actually use.
Our approach combines glycine powder air-polishing and titanium brushes. Glycine powder is fine and low-abrasive enough to clean threads and micro-textured surfaces without damaging them, and it reaches areas an instrument tip cannot. Titanium brushes mechanically strip biofilm from the exposed threads themselves. Both are recent additions to peri-implantitis treatment and, in our view, among the more promising developments in managing this condition.
Where threads are exposed and cannot be covered again, implantoplasty — smoothing the exposed thread surface so plaque has less to hold onto — is an option we use as a last resort rather than routinely, because it removes implant material permanently.
Whether the defect is grafted at the same visit is decided once we can see it. Some defects hold a graft well and some do not, and that is a judgment made with the site open rather than beforehand.
What Affects the Cost
Peri-implantitis treatment costs vary widely, because the range runs from a single debridement appointment to surgery with grafting. The factors that drive it:
- Whether treatment is non-surgical, laser-assisted or surgical
- How many implants are affected
- Whether a bone graft and membrane are needed
- Whether the existing crown or bridge has to be removed and refitted
- Whether the implant needs replacing rather than treating
- Ongoing maintenance visits after active treatment
Insurance coverage for this varies, and treatment is sometimes partly covered under periodontal rather than implant benefits. I’ll give you an exact cost as part of your treatment plan at your consultation.
How to Prevent Peri-Implantitis
What you do to prevent peri-implantitis matters more than anything we can do once it starts. Most of it is unglamorous, and it is also the part of implant care patients are least often told about at the time their implants are placed.
The best prevention starts before the implant goes in. A large share of the peri-implantitis we treat traces back to how the case was planned. Two details do most of the work:
- Proper contact between the crowns. Where a restoration does not contact its neighbors correctly, food packs into the gap every time you eat. That food impaction is a mechanical cause of inflammation, and it is entirely preventable at the planning stage.
- An implant placed where it can be cleaned. Angle and depth decide whether a brush and floss can reach the area for the next twenty years.
After that, the routine matters:
- Clean around implants daily, including under the restoration where the brush doesn’t reach
- See your dentist at least twice a year so probing depths get measured rather than guessed at
- Have x-rays taken once a year, since bone loss shows on a radiograph long before you feel anything
- Stop smoking, which affects both the risk and how well treatment holds
- Keep diabetes well controlled
- Treat existing gum disease before implants go in, not after
Schedule a Consultation
If an implant is sore, bleeding or feels different, have it looked at rather than waiting to see whether it settles. Our periodontists will measure what’s actually happening around the implant, show you the radiographs, and tell you honestly whether it can be saved and what that would involve. We see plenty of patients whose implants were placed elsewhere, and a second opinion costs you nothing but the appointment.
Call our office at (347) 493-2439 or schedule your consultation online.
Frequently Asked Questions
Does peri-implantitis go away on its own?
No. Peri-implant mucositis can resolve with better hygiene and a professional clean because no bone has been lost. Once bone loss has started, the condition progresses until it is treated.
Can a dental implant get infected years later?
Yes, and that is the more common pattern. Problems in the first few months usually relate to healing, while peri-implantitis develops slowly around an implant that has been stable for years. It is the reason maintenance visits matter long after the implant feels settled.
What antibiotic treats peri-implantitis?
None of them treat it on their own. Antibiotics may be used as an adjunct in specific cases, but they don’t remove the biofilm from the implant surface, and current guidance doesn’t support systemic antibiotics as a routine part of treatment.
What mouthwash is good for peri-implantitis?
Chlorhexidine is the one most often prescribed, used short-term alongside professional treatment. It reduces bacteria but doesn’t reach the implant surface where the problem sits, so it supports treatment rather than replacing it.
What is the early stage of peri-implantitis?
Peri-implant mucositis, which is inflammation of the soft tissue with no bone loss. This is the stage you want it caught at, and it’s reversible.
Is peri-implantitis painful?
Often not, which is the difficulty. Bleeding gums around an implant may be the only sign until the condition is advanced.
How common is peri-implantitis?
Reported rates vary considerably between studies depending on how it’s defined, but it’s the most common biological complication in implant dentistry. Patients with a history of periodontitis are at meaningfully higher risk.
Can a failing implant be saved?
Frequently, yes, if it still has enough supporting bone and the disease can be arrested. The determining factor is how much bone remains, which is why an eearly assessment matters so much.
