You invested time, patience, and trust in a dental implant. You went through the procedure, through the months of healing, and now you smile again without worry. Then, one morning, you notice blood on your toothbrush, right next to the implant. It doesn’t hurt. It seems like a detail. But this could be the first sign of a condition that, left untreated, can lead to the loss of the implant: periimplantitis.
The good news is that periimplantitis can be prevented, and in its early stages it can be treated with very good results. In this article you will find what it is, how to recognize it, what other complications a dental implant can cause, and what treatment options are available.
Author: Dr. Ionel Julea, senior physician of the Oro-Maxillofacial Surgery Department. Updated on October 5, 2026.
In a nutshell: what you need to know about periimplantitis
- Perimplantitis is a chronic inflammation of the gum and bone around a dental implant, which gradually destroys the supporting bone. It is the main cause of implant loss.
- It is preceded by periimplantitis, an inflammation of the gums only, which heals if treated in time.
- The warning signs are bleeding during brushing, swollen or red gums, pus, an unpleasant taste, and the implant starting to show through. Bone loss is painless, which is why regular check-ups are essential.
- The treatment ranges from professional cleaning and decontamination to regenerative surgery with bone grafting. The earlier it begins, the greater the chances of preserving the implant.
What is periimplantitis?
Perimplantitis is an inflammatory disease of the tissues around a dental implant, caused primarily by bacterial plaque. Unlike a simple gingival inflammation, it also affects the bone that supports the implant, which gradually loses its strength. Untreated, perimplantitis can lead to mobility and, ultimately, to the loss of the implant.
The definition used today by dental doctors comes from the 2017 international consensus on the classification of periodontal and periimplant diseases (World Workshop 2017), which established clear criteria for periimplant health, mucositis, and periimplantitis.
How common is periimplantitis?
Periimplantitis is not a rare complication. A meta-analysis published in the Journal of Clinical Periodontology (Derks and Tomasi, 2015) estimated that approximately 22% of the patients with implants develop periimplantitis, and approximately 43% have periimplant mucositis. The figures vary widely between studies depending on the criteria used, but the conclusion is the same: an implant needs lifelong care and monitoring, just like a natural tooth.
What is the difference between periimplantitis and periimplantosis?
Periimplantitis is the initial stage: the inflammation is limited to the gums, and the bone around the implant is intact. It is common and reversible. Periimplantitis occurs when the inflammation descends into the bone and begins bone loss.
| Peri-implant mucositis | Periimplantitis | |
|---|---|---|
| What is affected | Only the gingiva around the implant | Gingia and the bone that supports the implant |
| Signs | Swelling, swelling, bleeding during brushing or probing | Bleeding, pus, deep pocket, gingival recession, bone loss on X-ray |
| Can it be cured? | Yes, it is reversible if treated in time | It can be stopped and, in some cases, bone can be regenerated |
| Treatment | Professional cleaning and proper hygiene at home | Decontamination, laser, sometimes regenerative surgery |
What complications can a dental implant cause?
Like any surgical procedure, dental implant surgery also carries some risks. Fortunately, the success rate is high, over 95%, and the problems that may occur are rare and usually minor and easily treatable. Potential risks include:
- infection at the implant site, in the first days or weeks after the intervention;
- injuries or damage to the surrounding structures, such as other teeth or blood vessels;
- nerve injuries, which can cause pain, numbness or tingling in the teeth, gums, lips or chin;
- sinus problems, when the implants placed in the upper jaw penetrate into the sinus cavity;
- fracture or overload of the implant, usually due to excessive biting forces;
- periimplantitis, which occurs later, sometimes years after treatment, and is the main cause of implant loss.
Careful planning by a specialized surgeon greatly reduces these risks. Did you know that the only clinic in Galați where the dental implant is inserted by a surgeon is Clinica Chiromax? The interventions are performed by Dr. Ionel Julea, a senior physician in the field of oro-maxilo-facial surgery.
What are the symptoms of an infection in the dental implant?
An infection in the dental implant can occur immediately after the procedure or much later, in the form of periimplantitis. The signs you can notice on your own are:
- bleeding during brushing or using the toothbrush, around the implant;
- red, swollen or sensitive to touch;
- a purulent or persistent unpleasant taste in the implant area;
- bad-smelling breath that does not go away after brushing;
- the retraction of the gum, which makes the implant or the metallic edge visible;
- discomfort when chewing or the feeling that the work has moved;
- in the case of an acute infection after the intervention: pain that increases after the third day, a large swelling or fever.
An important detail: the loss of bone in periimplantitis is, most often, painless. Many patients do not realize they have a problem until the implant starts to move. Therefore, periodic check-ups are the only reliable method of early detection.
When should you go to the doctor urgently?
Go to the doctor the same day or the next day if you notice any of these signs:
- fever after the implant procedure;
- pain that increases after the third day, instead of decreasing;
- large swelling that extends to the face or under the chin;
- pockets around the implant;
- The implant or the work on the implant is moving.
Bleeding during brushing, red gums or the retraction of the gums around an older implant are not emergencies, but they require follow-up in the coming days. These are the first signs of mucositis or periimplantitis, and the treatment is much simpler when it starts early.
What causes periimplantitis?
The main cause is the bacterial plaque that accumulates around the implant and is not removed properly. The bacteria trigger gum inflammation, and if the inflammation persists, it reaches the bone. Other factors that can contribute include:
- excessive biting forces on the implant, for example in bruxism;
- cement residues left under the gum after the crown is fixed;
- a prosthetic work that is difficult to clean around the implant;
- the unfavorable positioning of the implant or a poor quantity or quality of the bone.
Who is at higher risk of periimplantitis? Contraindications and risk factors
Some conditions and habits do not necessarily preclude the implantation, but they increase the risk of complications, including the risk of periimplantitis. Therefore, the doctor assesses them before the intervention. The strongest scientific evidence exists for:
- The historian of periodontal disease (periodontitis);
- poor oral hygiene;
- The lack of controls and periodic hygiene after the implant is installed.
They are also taken into account:
- smoking;
- diabetes, especially when it is not well controlled;
- the long-term administration of corticosteroids;
- radiotherapy or chemotherapy;
- nighttime bruxism (grinding of the teeth during sleep).
Bleeding problems, infections, allergies, and the medications you take must be discussed with the doctor before starting treatment with dental implants.
How is the diagnosis of periimplantitis made?
The diagnosis is made by the doctor, through clinical and radiological examination. The doctor checks whether the gum around the implant is bleeding or if pus is being drained from it during a gentle probing, measures the depth of the pocket between the gum and the implant and compares the bone level with previous X-rays.
According to the 2017 international consensus, periimplantitis means bleeding or pus at the time of probing, increased probing depth and progressive bone loss, over and above the normal remodeling after the implant is placed. When there are no older radiographs for comparison, the signs indicating periimplantitis are: a bone level of at least 3 mm below the upper part of the implant, a probing depth of at least 6 mm and abundant bleeding.
Therefore, it is useful to keep the X-ray taken when the crown is fitted on the implant. It becomes the reference point for all subsequent examinations. At Chiromax, the investigations are performed on the spot, in its own dental imaging center, including 3D tomography (CBCT), which shows exactly the shape and extent of the bone defect.
How is periimplantitis treated?
The treatment depends on the stage. The goal is to stop the inflammation, completely clean the surface of the implant and, where possible, rebuild the lost bone. At Chiromax Clinic, all the treatment stages described below are available.
Treatment of peri-implant mucositis
In the stage of mucositis, the treatment is simple and effective: professional hygiene around the implant with special instruments that do not scratch the surface, and correction of the hygiene technique at home. The inflammation usually subsides within a few weeks.
Non-surgical treatment of periimplantitis
In the early stages, the doctor thoroughly cleans the pouch around the implant and disinfects its surface. Dedicated implant tools, air-polishing systems, lasers, and antiseptic solutions are used. When necessary, antibiotics applied locally or administered systemically are added. The result is reassessed after a few weeks.
Surgical treatment of periimplantitis
If the inflammation does not stop or the bone loss is greater, surgical intervention is needed. The surgeon removes the gum to have direct access to the implant, cleans and disinfects the surface completely, and then, depending on the shape of the defect:
- removes the bone and gum, so that the area can be easily cleaned in the future;
- smooths the exposed portion of the implant (implantoplasty) to reduce the accumulation of bacteria;
- replaces the bone lost through regenerative surgery, with bone and membrane addition.
These are interventions by Oronomic-Maxillofacial Surgery, These are performed by the surgeon at Chiromax.
When should the implant be removed?
When the implant has mobility or the bone loss is very advanced, the implant can no longer be saved and must be removed. After healing and, if necessary, after bone reconstruction, a new implant can be inserted. That is why early detection makes the difference between a professional cleaning and a reintervention.
How can you prevent periimplantitis?
Prevention is much simpler than treatment. The steps that have the greatest effect are:
- flossing twice a day and daily cleaning around the implant with interdental brushes or a mouthwash;
- checkups at the dentist at least once every 6 months;
- professional cleaning of the implant once every 6 months, for example by Guided Biofilm Therapy (GBT), Available at Chiromax;
- Quitting smoking;
- a protective guard if you clench your teeth during sleep;
- treating periodontal disease before the implantation of the implant;
- the preservation of the reference radiograph from the fitting of the crown.
Where is periimplant treatment performed in Galați?
Chiromax Clinic has been operating in Galați since 2004 and started out in surgery. The implants are inserted by a surgeon, and the diagnosis is made on the spot with 3D tomography. For patients with implants fitted at our clinic or at another clinic, the evaluation begins with a clinical examination and an X-ray, after which you receive a treatment plan adapted to the stage of inflammation.
For more information about dental implants, read our page Implantology. The updated rates are on the page prices. We are waiting for you at our office on Domnească Street no. 82, from Monday to Friday, between 8:00 and 20:00. Appointments can be made at 0236 491 112.
Sources:
- Berglundh T. et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of Clinical Periodontology, 2018. doi.org/10.1111/jcpe.12957
- Derks J., Tomasi C. Peri-implant health and disease. A systematic review of current epidemiology. Journal of Clinical Periodontology, 2015. doi.org/10.1111/jcpe.12334
Frequently asked questions about periimplantitis
How long does it take for the inflamed gums to heal after an implant?
After the implant is inserted, the swelling and sensitivity usually subside within 3-7 days, and the gums heal in approximately two weeks. If the inflammation persists after this period or appears later with bleeding or pus, a checkup is necessary because it may be an infection or periimplant mucositis.
What is the white plaque on the gums after a dental implant?
In the first few days after the intervention, a whitish-yellow fibrin layer often forms on the wound. It is part of normal healing and should not be removed. If the white layer is accompanied by increasing pain, swelling, pus, or fever, it may be a sign of infection and you should go for an examination.
Why do I see my dental implant?
Its implant or metallic edge becomes visible when the gum recedes. The causes can be thin gums, too aggressive brushing, or loss of bone from periimplantitis. The gum recession is one of the recognized signs of periimplantitis, so it is worth checking with an X-ray, even if it does not hurt.
What are the symptoms of an infection in the dental implant?
The most common signs are bleeding during brushing, red and swollen gums, pus, an unpleasant taste and an unpleasant-smelling breath in the implant area. Later, gum recession and implant mobility can occur. After the procedure, pain that increases after the third day and fever are signs of acute infection.
Does periimplantitis heal?
Periimplantitis can be stopped with treatment, and in many cases the lost bone can be partially restored through regenerative surgery. The results are even better the earlier treatment begins, which is why regular check-ups are essential.
Can an implant be saved with periimplantitis?
Yes, in most cases detected in time, the implant can be saved through decontamination and, if necessary, through regenerative surgery. The implant must only be removed when it is mobile or when the bone loss is very advanced. After healing, a new implant can be inserted.
Book an appointment
Are you experiencing bleeding or inflammation around a dental implant? Schedule an appointment at the Chiromax Clinic in Galați. The diagnosis is made on the spot, including with 3D tomography, and the treatment is adapted to the stage of the inflammation.
