What is peri-implantitis (and how it differs from peri-implant mucositis)

Peri-implantitis is inflammation of the tissues around a dental implant combined with progressive loss of the bone that holds the implant in place. It is a disease, and it needs professional dental treatment. Left alone, it tends to get worse and can lead to implant failure.

To understand peri-implantitis, it helps to compare it with its milder cousin, peri-implant mucositis. The difference between the two decides how urgent and how involved treatment becomes.

Peri-implant mucositis: reversible inflammation, no bone loss

Peri-implant mucositis is inflammation of the soft tissue (gum) around an implant without any bone loss. The gum may look red, feel tender, and bleed when probed. The good news is that this stage is reversible. With professional cleaning and good home hygiene, the tissue can return to health. Think of it as the early warning before real damage starts.

Peri-implantitis: inflammation plus progressive bone loss

Peri-implantitis is the next step. Here, the inflammation has spread to the bone, and bone around the implant is being lost. This is the key distinction: bone loss has begun. Unlike soft-tissue inflammation, lost bone does not grow back on its own. Treatment can stop the disease and stabilize the implant, but the goal is to arrest the process, not to fully reverse the bone loss that already happened.

Why implants are more vulnerable than natural teeth

Implants face the disease differently than natural teeth. A natural tooth sits in a periodontal ligament, a layer of fibers with its own rich blood supply that helps fight infection and cushions the tooth. An implant has no ligament. It fuses directly to bone, so its blood supply to the surrounding tissue is more limited and its defenses against bacteria are weaker. The threads and rough surface of an implant are also harder to clean once plaque reaches them. These three factors (no ligament, different blood supply, harder-to-clean surface) make implants more vulnerable to infection that progresses.

Warning signs: bleeding on probing, suppuration, deepening pockets, exposed threads

Watch for these signs and report them to your dentist:

• Bleeding when the gum around the implant is touched or probed.
• Pus (suppuration) at the gumline.
• Deepening pockets, meaning the space between gum and implant gets deeper over time.
• Gum recession that exposes the metal threads of the implant.
• Redness, swelling, or a bad taste near the implant.
• In late stages, the implant feels loose.

If you are checking your own implant between visits, our self-check for unhealthy gums around an implant covers what to look for.

Stages of peri-implantitis and how treatment changes at each stage

Peri-implantitis is graded by how much bone has been lost and how deep the pockets are. The stage decides the treatment. The table below maps severity to the usual approach. Your dentist confirms the stage with measurements and imaging.

Stage	Bone loss	Probing depth	Typical treatment approach
Peri-implant mucositis	None	Shallow, bleeding present	Professional cleaning, improved home hygiene (reversible)
Early peri-implantitis	Mild (up to about 25%)	4-6 mm	Non-surgical debridement, antiseptics, close monitoring
Moderate peri-implantitis	About 25-50%	6-8 mm	Non-surgical first, then surgical access if pockets persist
Advanced peri-implantitis	More than 50%	8 mm or more	Surgery (resective or regenerative); removal if failing

Early peri-implantitis (mild bone loss)

In early disease, only a small amount of bone has been lost. Pockets are moderately deep and bleed. Most early cases are managed without surgery: thorough professional cleaning around and below the gumline, plus better daily hygiene at home. The aim is to halt the disease before it advances.

Moderate peri-implantitis

With moderate disease, more bone is gone and pockets are deeper. Non-surgical treatment is still the first step. If the pockets and bleeding do not resolve at re-evaluation, surgery is often needed to clean the implant surface directly and reduce the pocket.

Advanced peri-implantitis (severe bone loss / failing implant)

In advanced disease, more than half of the supporting bone may be lost. Surgery is usually required. When bone loss is extensive (around 80% or more) or the implant is mobile, saving it is unlikely, and removal becomes the realistic option.

How your dentist measures severity: probing depth, bleeding, and CBCT bone loss

Three measurements define the stage. Probing depth records how deep the pocket is around the implant. Bleeding on probing shows active inflammation. A CBCT scan (a 3D X-ray) shows the actual bone level around the implant. Together these tell your dentist how far the disease has gone and what treatment matches it. Understanding the underlying healing also helps; you can read more about dental implant healing stages to see how the bone normally integrates with an implant.

How to treat peri-implantitis without surgery (non-surgical protocol)

Non-surgical care is the backbone of peri-implantitis treatment. The single most important step is professional mechanical removal of the bacterial film (biofilm) from the implant and the pocket. Everything else is an adjunct. Official UK guidance (SDCEP) is clear that mechanical debridement is the core, and that several popular add-ons are not recommended as routine adjuncts.

Mechanical and ultrasonic debridement

This is the foundation. Using hand instruments and ultrasonic tips designed not to scratch the implant, the dentist removes plaque and calculus from the implant surface and inside the pocket. This is sometimes called professional mechanical plaque removal (PMPR). The goal is a clean surface so the tissue can settle.

Air-polishing (glycine/erythritol powder)

Air-polishing uses a fine, low-abrasive powder (glycine or erythritol) sprayed under pressure to clean the implant surface, including the threads, without damaging it. It is used as an adjunct to debridement, not a replacement for it.

Er:YAG laser decontamination

An Er:YAG laser can be used to decontaminate the implant surface. Evidence for routine laser use is limited. UK guidance advises against routinely using lasers as an adjunct, so it is a case-by-case clinical decision, not a standard step.

Antiseptics: chlorhexidine rinses and gels

Chlorhexidine, an antiseptic, can be used as a rinse or gel around the implant. It is a supporting measure, not a cure. A common misconception in clinic blogs is that chlorhexidine or antibiotics are the main treatment. They are not. The mechanical cleaning is the main treatment, and antiseptics are conditional adjuncts with low-certainty evidence.

When local antibiotics (minocycline) are used and why routine systemic antibiotics are not recommended

A local antibiotic (such as minocycline placed directly into the pocket) may be used in selected cases. Routine systemic antibiotics (pills) are not recommended for peri-implantitis. This is a conditional recommendation based on low-certainty evidence in SDCEP guidance. The reasoning is simple: the benefit is unproven for routine use, and overusing antibiotics drives resistance. Your dentist decides if antibiotics are justified in your specific situation.

The 3-month re-evaluation with CBCT

Non-surgical treatment is not judged on the day it is done. Your dentist re-evaluates around 3 months later, often with a fresh CBCT scan, to compare bone level, pocket depth, and bleeding against the starting point. If the disease has stabilized, you move into maintenance. If pockets and bleeding persist, surgery is considered.

Surgical treatment for peri-implantitis

When non-surgical care does not control the disease, surgery gives the dentist direct access to the implant surface. Decontaminating that surface thoroughly is the essential first step of any peri-implant surgery, before any pocket reduction or bone rebuilding.

Access flap surgery and implant-surface decontamination

The gum is gently lifted (an access flap) to expose the implant and the bone defect. The dentist then cleans and decontaminates the implant surface directly, removing biofilm that instruments could not reach through the pocket. This access and decontamination is the common starting point for both resective and regenerative surgery.

Resective surgery and implantoplasty (pocket reduction)

Resective surgery reshapes the bone and gum to reduce the pocket so it is easier to keep clean. Implantoplasty means smoothing and polishing the exposed implant threads so plaque cannot cling to them. This approach trades some appearance for a more cleanable, more stable result, and is often chosen when the bone defect is shallow or broad.

Regenerative surgery: bone grafts and membranes

Regenerative surgery tries to rebuild lost bone using a bone graft, often covered with a barrier membrane. It is usually chosen when the defect is contained (a deep, walled crater that holds graft material well). Be aware that regeneration around implants is less predictable than around natural teeth. Defect shape drives the choice between resective and regenerative surgery. If a graft is part of your plan, the sequence of recovery is worth understanding; see dental bone graft healing stages.

Soft-tissue grafting to rebuild keratinized gum

Some implants lack a firm band of attached, keratinized gum, which makes them harder to clean and more prone to inflammation. A soft-tissue graft can rebuild that protective gum. The recovery is similar to other gum procedures; our guide to gum graft recovery walks through what to expect.

When the implant must be removed (explantation)

Not every implant can be saved. When the disease is too advanced, removing the implant (explantation) protects the remaining bone and lets the area heal for a future replacement.

Signs the implant cannot be saved (80%+ bone loss, mobility)

An implant that has lost roughly 80% or more of its supporting bone is likely to fail in the short term. A mobile (loose) implant has lost its bond with the bone and cannot be re-stabilized. In these situations, removal is usually the right call rather than repeated attempts to rescue it.

What removal and replacement involves

Removal is often straightforward when the implant is already loose. After removal, the site is cleaned and frequently grafted to preserve or rebuild bone volume. Healing takes several months before a new implant can be considered, and your dentist may address the original cause (hygiene, smoking, bite forces) before placing another.

What success looks like: peri-implantitis treatment goals

Success is defined by measurable targets, not by how the implant looks. These numeric goals come from clinical consensus and give you a clear way to judge whether treatment is working.

Residual probing depth 5 mm or less

After treatment, the pocket around the implant should be 5 mm or shallower. Shallow pockets are easier to keep clean, which lowers the chance of the disease returning.

No bleeding on probing or suppuration

Healthy peri-implant tissue does not bleed when probed and has no pus. Minimal or no bleeding and the absence of suppuration are key signs the inflammation is controlled.

Stable bone level on follow-up imaging

The bone around the implant should hold steady on follow-up X-rays or CBCT. Stable bone, not regrown bone, is the realistic marker of arrested disease.

For the equivalent picture around natural teeth, see our guide on before and after periodontitis treatment.

What to expect: peri-implantitis treatment timeline

There is no fixed calendar, because treatment depends on your stage and response. The table below lays out a typical path so you know roughly what comes next and when.

Phase	Typical timing	What happens
Diagnosis	Day 0	Probing, bleeding check, CBCT to stage the disease
Non-surgical treatment	Weeks 0-2	Debridement, air-polishing, antiseptics, hygiene coaching
Re-evaluation	Around 3 months	Re-measure pockets and bone; decide on surgery or maintenance
Surgery (if needed)	3-6 months	Access flap, decontamination, resective or regenerative steps
Surgical healing	6-12 months	Soft-tissue and bone healing; staged follow-up visits
Maintenance	Ongoing	Recall visits every 3 to 6 months for life of the implant

From diagnosis to re-evaluation to surgery

After diagnosis, you start with non-surgical treatment. The pivotal checkpoint is the re-evaluation around 3 months. Only then does your dentist know whether non-surgical care was enough or whether surgery is the next step. Rushing to surgery before this checkpoint is not the standard path.

Healing and follow-up after surgical treatment

After surgery, soft tissue heals over a few weeks, while bone changes take many months. Expect several follow-up visits across 6 to 12 months to confirm pockets stay shallow, bleeding stays low, and bone stays stable. Soft-food periods during recovery are common; our guide on what to eat after wisdom teeth removal has gentle, practical food ideas that apply after many oral surgeries.

Peri-implantitis treatment cost and what affects it

Cost varies widely because treatment varies widely. Non-surgical care is the least expensive option, and the price climbs as the disease becomes more complex and surgical.

Why non-surgical is cheaper than regenerative surgery

Non-surgical debridement and maintenance involve fewer appointments, no operating time, and no graft materials, so they cost the least. Surgery adds the cost of the procedure itself, and regenerative surgery adds bone graft material and membranes on top of that, which is why it sits at the high end.

Factors that change the price (number of implants, defect type, grafting)

• Number of implants affected (more implants, more cost).
• Severity and defect type (a contained defect needing a graft costs more than simple cleaning).
• Whether bone or soft-tissue grafting is required.
• Use of lasers or other technology.
• Specialist (periodontist) versus general dentist fees, and your region.

Ask your dentist for a written treatment plan with itemized costs before you start, and check what your dental insurance covers.

How to prevent peri-implantitis and protect treated implants

Prevention is not a footnote. After treatment, what you and your dentist do next decides whether the disease stays away. Supportive maintenance is directly tied to long-term success and lower recurrence.

Supportive peri-implant maintenance (recall schedule)

Plan on professional maintenance visits every 3 to 6 months. At each visit your dentist cleans around the implant, checks pockets and bleeding, and catches any early relapse before it becomes serious. Skipping maintenance is one of the strongest predictors of recurrence.

Daily home hygiene around implants

Brush twice a day, and clean between and around implants with the tools your dentist recommends (interdental brushes, floss designed for implants, or a water flosser). Consistent plaque control at home is the day-to-day defense that keeps the implant surface clean.

Smoking cessation and diabetes control

Smokers are more than twice as likely to have implant failure, so quitting smoking is one of the highest-impact things you can do. Controlling diabetes also matters, because high blood sugar impairs healing and raises infection risk. Addressing these systemic factors, along with a history of gum disease and removing any residual cement, tackles the root causes of peri-implantitis rather than only its symptoms.

A nutrition note: ch-OSA® is a food supplement, not a treatment for peri-implantitis, and never replaces your dentist's care. Silicon is thought to support the body's own collagen formation; the evidence here is preliminary. Discuss any supplement with your clinician.

New to this molecule? What is ch-OSA®?

Supplements are a separate question from treatment, and they are not a treatment for peri-implantitis. If you are weighing them anyway, our review of what the evidence does and does not show on periodontal supplements sets out the limits of the research.

Sources

• Prathapachandran J, Janardhanam N. Management of peri-implantitis. Dent Res J. 2012. View source
• Teughels W, et al. The effect of choline-stabilized orthosilicic acid in patients with peri-implantitis: an exploratory randomized, double-blind, placebo-controlled study. BMC Oral Health. 2021. View source
• Spector TD, et al. Choline-stabilized orthosilicic acid supplementation as an adjunct to Calcium/Vitamin D3 stimulates markers of bone formation in osteopenic females: a randomized, placebo-controlled trial. BMC Musculoskelet Disord. 2008;9:85. View source
• Reffitt DM, et al. Orthosilicic acid stimulates collagen type 1 synthesis and osteoblastic differentiation in human osteoblast-like cells in vitro. Bone. 2003. View source
• Tomasi C, et al. (Smeets R, et al.) Peri-implantitis Update: Risk Indicators, Diagnosis, and Treatment. Eur J Dent. 2020. View source