What's the difference between peri-implantitis and peri-implant mucositis?
The difference is how far the inflammation has spread. If it's only in the gums, it's peri-implant mucositis; if the bone around the screw has also been lost, it's peri-implantitis. Even with the same symptom, like “It's swollen next to the screw and bleeds every time I brush,” the treatment is completely different if the stage is different.
| Category | Peri-implant mucositis | Peri-implantitis |
|---|---|---|
| Extent of inflammation | Gums only | Down to the bone around the screw |
| Imaging findings | No change in bone | Bone around the screw is reduced |
| Can it be reversed? | Can recover with care | Lost bone doesn't fill back in |
| Treatment | Cleaning, correcting how you brush | Treating the contaminated screw surface and inflamed tissue; surgery if severe |
What are the symptoms of peri-implantitis?
If the symptoms below keep coming back, the bone needs to be checked as well, even if there's no pain.
- The area around the implant bleeds when you brush
- The gums are red and often swollen
- Pus comes out or there's a bad smell
- Food gets stuck more than before
- The surrounding gums have receded, so the screw or metal shows through
Receded gums don't come back up. By the time it signals with pain, it's often already late, so get a checkup even for just bleeding or swelling.
Why does inflammation reach the bone faster with implants?
Unlike natural teeth, implants have no periodontal ligament (the cushioning tissue between the tooth and the bone) around them, so the path for inflammation to spread to the bone is shorter. That's why, even with the same bleeding, I check the bone earlier than with a natural tooth. People who previously had periodontitis and people who smoke tend to be at higher risk.
How is peri-implantitis treated?
It's treated according to the stage. For early mucositis, I remove the plaque and tartar stuck around the implant, find the spots you can't clean at home, and correct how you clean them. Peri-implantitis with confirmed bone loss isn't resolved with scaling alone; it needs treatment that deals with contamination on the screw surface and the inflamed tissue.
If a lot of bone has been lost, the options are divided into treating it by opening the gums, or, if it's hard to keep, removing the implant and treating it again. Peri-implantitis doesn't mean the implant comes out right away; the decision is based on the remaining bone and how firmly the screw is fixed. Treating according to the stage comes before major treatment.
How do you keep it from swelling again after treatment?
Clearing the inflammation isn't the end. If food keeps getting trapped under the restoration, an interdental brush can't get in because of the structure, or chewing force is concentrated on one side, the same swelling comes back. That's why, during treatment, I also look at the shape of the restoration and the bite (how the upper and lower teeth meet).
At home, along with a toothbrush, clean the line where the screw meets the gum every day with an interdental brush or floss. For help with a water jet, see How to use a Waterpik. If bleeding or swelling is already recurring, don't try to get by by brushing harder at home.
How we do it at Wonjin Dental
I first look at whether bone has been lost, rather than at the spot that's bleeding. I measure bleeding, pus, and the depth of the gum pockets, and check the bone around the screw with imaging. I also check whether the restoration is loose, whether its shape traps food, whether an interdental brush fits, and whether force is concentrated on one side. I don't just apply medication while leaving the cause in place.
Frequently asked questions
If I have peri-implantitis, does the implant have to come out?
Not necessarily. Whether to keep it is decided by how much bone has been lost and whether the screw is firmly fixed. Removal and retreatment are considered only when it has progressed severely.
How often should I get implant checkups?
I usually recommend every 6 months to 1 year. For people with a history of periodontitis, people who smoke, or people with several implants, I set a shorter interval.
Does peri-implantitis need treatment even if it doesn't hurt?
Yes. Bone sends almost no pain signals while it's being lost. If bleeding, swelling, or pus keep coming back, it needs to be checked regardless of pain.
Does smoking make peri-implantitis more likely?
Yes. Smoking is considered a factor that raises the risk of peri-implantitis by reducing blood flow to the gums and slowing healing. On top of that, blood vessels constrict so there seems to be less bleeding, which makes it easy to notice the inflammation late. If you want your implant to last a long time, I recommend quitting smoking.
