Peri-implantitis: the seven signs an implant is failing

The signs, in the order they usually appear

An implant almost never fails without warning, and the earliest sign is bleeding when you clean around it. After that, in rough order: redness at the collar, a bad taste or smell that returns soon after brushing, a deepening pocket the dentist measures, gum recession exposing metal, a mild ache on chewing, and finally movement of the crown. Only the last is an emergency, and the first is the point at which treatment is easy and almost always works.

Mucositis versus peri-implantitis

Bleeding gum around an implant with no bone loss on the X-ray is peri-implant mucositis, and it reverses with cleaning and better home technique, exactly like gingivitis around a natural tooth. Once the X-ray shows bone loss along the fixture it is peri-implantitis, and that bone does not come back on its own. This distinction is the entire reason for an annual X-ray on an implant that feels perfectly fine: the two look identical without one.

What treatment actually involves

Early cases are treated without surgery: mechanical debridement using instruments that will not scratch titanium, decontamination of the exposed threads, a short antiseptic course and a review at six to eight weeks. Advanced cases need a flap raised to clean under direct vision and sometimes regenerative grafting; our gum treatment programme starts at €250. When more than half the fixture has lost its bone support, removal and a fresh implant after healing gives a better long-term result than rescue.

Who is at risk, and what genuinely prevents it

Three groups account for most cases: smokers, people who lost their own teeth to periodontitis in the first place, and patients whose crown was cemented with excess cement left behind in the sulcus. The first is a choice, the second requires three-monthly maintenance for life, and the third is a technical error avoided by screw-retained crowns or careful cementation. Prevention is dull and effective, an interdental brush daily and a professional check every six months.

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