Peri-Implantitis Treatment
Peri-implantitis is gum disease around a dental implant: inflammation with loss of the bone that holds it. It is treated in steps. First a thorough non-surgical cleaning and removal of whatever is trapping plaque, then a re-check, then surgery for the sites that have not healed, and afterward regular maintenance. Caught while bone loss is limited, the implant can usually be kept.
“Several doctors told me a new implant was out of the question because the bone loss was too severe to be grafted. … He performed masterful bone/tissue graft and now my new implant is firmed anchored. Dr Verrett is awesome! I highly recommend him!!”
“The staff at Austin Periodontal Associates are thorough and careful. I have an implant and they are very good with regular cleaning, alternating with my dentist. I have had good experiences with their doctors and professional staff.”
What Peri-Implantitis Is
The 2017 World Workshop, run jointly by the American Academy of Periodontology and the European Federation of Periodontology, defines peri-implantitis as a plaque-associated condition in the tissues around a dental implant, with inflammation of the gum and progressive loss of the supporting bone. Its milder relative, peri-implant mucositis, is inflammation of the gum alone, and it is reversible. Once bone is involved, it needs treatment.
It is common. A meta-analysis by Derks and Tomasi in the Journal of Clinical Periodontology found peri-implantitis in roughly 22 percent of patients with implants. The strongest risk factors in the World Workshop review were a history of periodontitis, poor plaque control, and no regular maintenance after the implant was placed.
How It Is Diagnosed
Peri-implantitis rarely hurts until it is advanced, so it is found by measuring rather than by symptoms. The exam records the depth of the pocket around the implant, whether it bleeds or produces pus when gently probed, whether the gum has pulled back, and whether the implant moves. X-rays and a cone-beam CT scan (a 3D X-ray) show the bone level, which is compared with the earliest image available, ideally one taken when the crown was placed.
The exam also looks for the reason. A crown shaped so that it cannot be cleaned, cement left under the gum, thin or missing firm gum around the implant, a history of gum disease elsewhere in the mouth, and gaps in maintenance all change the plan.
Treatment, Step by Step
The sequence below follows the European Federation of Periodontology’s S3 clinical practice guideline for peri-implant diseases, published in 2023 from thirteen commissioned systematic reviews. As the first line of treatment, it recommends trying to keep an implant that is still acceptable to the patient.
- Non-surgical treatment. Cleaning above and below the gumline around the implant with instruments designed not to damage its surface, instruction and practice in cleaning it at home, control of risk factors such as smoking, and adjustment or removal of anything that traps plaque, including an over-contoured crown or leftover cement. Gum disease around the natural teeth is treated alongside it where needed.
- Re-evaluation. The guideline’s endpoints for this step are pockets of 5 mm or less, bleeding at no more than one spot, and no pus. Implants that reach them go straight to maintenance.
- Surgery, where the endpoints are not met. The gum is opened so the implant surface can be seen and decontaminated directly. Depending on the shape of the bone loss, the area is either reshaped so it can be kept clean or, where there is a contained crater at least 3 mm deep, grafted to rebuild bone. The guideline suggests removing the crown or bridge for the surgery where that is feasible, and recommends adjusting any restoration that does not allow cleaning beforehand.
- Removal, when the implant cannot be kept. An implant that is mobile, or has lost too much bone to be treated predictably, is removed. The site is grafted and, after healing, a new implant can often be placed.
- Maintenance. Every treated implant is checked every three to six months, alternating with your dentist. The guideline recommends recording the clinical measurements six months after surgery and taking an X-ray at twelve months.
The guideline recommends against surgery for patients who are not keeping the area adequately clean at home. That is a conversation had before surgery is scheduled, not after.
What the Guideline Advises Against
Some treatments are widely advertised for peri-implantitis and not supported by the evidence reviewed for the guideline. It does not suggest lasers, used alone or added to cleaning, in the non-surgical step, and does not suggest the Er:YAG laser, air polishing, chlorhexidine or photodynamic therapy for cleaning the implant surface during surgery. It recommends against the routine use of antibiotic pills as an add-on to either non-surgical or surgical treatment.
Austin Periodontal Associates does not use lasers or antimicrobials. Peri-implantitis treatment: what the evidence shows goes through the trials behind each of these recommendations.
How Well It Works
Treatment reliably reduces pocket depth and bleeding. How often an implant meets every strict criterion for success is lower, and it varies with how advanced the disease was and with the implant surface. In a randomized trial of 100 patients with severe peri-implantitis by Carcuac and colleagues, surgical treatment was successful at one year in 45 percent of implants overall: 79 percent of implants with a smooth, unmodified surface and 34 percent of those with a roughened surface. In a five-year follow-up of surgically treated patients in regular maintenance by Heitz-Mayfield and colleagues, 63 percent of patients still met the success criteria, some had the disease return, and some lost an implant.
The practical reading is that early treatment keeps more implants, and that maintenance afterward is part of the treatment rather than an optional extra.
Implants Placed Elsewhere and Second Opinions
Where the implant was placed makes no difference to whether we will see you. The brand and the original X-rays help; nothing needs to be arranged in advance. If you have been told an implant is failing, or that the answer is to remove several and start over, a second opinion is an exam, a scan, and a written summary for you and, with your permission, your dentist. An implant placed here that has a problem is covered by the practice’s replacement policy.
Cost and Insurance
The cost depends on which steps are needed, how many implants are involved, whether bone grafting is part of the surgery, and whether the crown has to be removed or remade. Every step is estimated in writing before it is scheduled. We are an out-of-network provider, but we file your dental insurance claim on your behalf so the reimbursement comes to you directly, and monthly payment plans are available. Insurance and financing.
For referring dentists, bleeding on probing around an implant together with any bone change on the radiograph is reason enough to refer. Peri-implantitis at the hygiene visit sets out the thresholds.
Request a consult in North Austin, or call (512) 346-6097.
Frequently Asked Questions
Can peri-implantitis be cured?
It can be stopped, and the tissue can return to health, but bone that has been lost does not reliably come back in full, and the condition can return. That is why treatment is judged against specific endpoints and followed by maintenance for as long as the implant is in place.
Do you use a laser?
No. The European Federation of Periodontology's 2023 clinical practice guideline does not suggest lasers for peri-implantitis, either on their own or added to cleaning, and does not suggest the Er:YAG laser for cleaning the implant surface during surgery. Austin Periodontal Associates does not use lasers or antimicrobials. What the evidence shows sets out why.
Will I need surgery?
Not always. Treatment starts without surgery. If the pockets around the implant are 5 mm or less, with no bleeding at more than one spot and no pus, when they are re-checked, the next step is maintenance rather than surgery. Deeper sites that are still bleeding usually need surgery to reach the implant surface.
Can the lost bone be rebuilt?
Sometimes. Where the bone loss forms a contained crater around the implant, a bone graft can be placed during surgery; the guideline suggests reserving this for defects at least 3 mm deep. In a multicenter randomized trial by Derks and colleagues, adding a bone substitute did not improve pocket depth or bleeding over surgery alone, but the gum receded less on the visible side. Whether a graft is worth it is decided site by site.
My implant was placed at another office. Will you treat it?
Yes. We regularly treat implants placed elsewhere, including at implant centers. Bring whatever records you have, particularly the implant brand and any X-rays from when the crown went on; with your permission we request the rest.
What if the implant cannot be saved?
It is removed, the site is grafted and allowed to heal, and a new implant can often be placed in sound bone later. When an implant has failed covers that path.