Studio Calesini · Via della Croce 77, Rome
Inflammation and bone loss around dental implants, what it is, when it is treatable, and when the implant cannot be saved.
Peri-implantitis is a bacterial infection of the tissues surrounding a dental implant that results in progressive bone loss. It is the implant equivalent of periodontitis around natural teeth. Unlike mucositis, reversible soft-tissue inflammation without bone destruction, peri-implantitis involves irreversible loss of the bone that anchors the implant. Detected early and managed correctly, the implant can often be preserved; allowed to progress without treatment, implant removal becomes the only remaining option.
Inflammation of the soft tissue surrounding the implant, characterised by bleeding on probing and possible swelling. No bone destruction. Fully reversible with correct hygiene and professional debridement. The window in which intervention has the best return on effort.
Bone loss of 1–3 mm beyond the initial remodelling expected after implant placement, with associated probing depths and bleeding. Treatable with a combination of mechanical debridement, surface decontamination, and improved home care. Outcome is generally predictable at this stage.
Bone loss of 3–5 mm. Surgical intervention is typically required: open flap debridement with surface decontamination, and regenerative procedures where the bone defect geometry is favourable. Outcomes are less predictable than at the early stage, but significant proportion of cases can be stabilised.
Bone loss exceeding 5 mm, or loss involving more than half the implant length. Salvage is possible in selected cases with favourable defect morphology, but the prognosis is poor. In most cases of advanced disease, implant removal and site reconstruction before re-implantation is the more predictable long-term option.
Bacterial plaque accumulation on the implant surface is the primary aetiological factor. Plaque accumulation is accelerated by prosthesis design that makes effective cleaning difficult or impossible: crowns with inadequate emergence profiles, full-arch restorations placed too close to the bone, or screw-access channels in positions that trap debris.
Inadequate soft tissue thickness around the implant reduces the biological seal against bacterial ingress. Implants placed in sites with insufficient keratinised tissue are at higher risk.
Smoking is associated with increased peri-implantitis risk and reduced treatment response. Uncontrolled diabetes affects healing and immune response. A history of treated periodontitis increases susceptibility, independent of implant brand or technique.
Occlusal overload, excessive or non-physiological forces on the implant, is a secondary contributor rather than a primary cause, but it accelerates bone loss in the presence of existing infection.
Treatment selection is based on the stage of disease, the morphology of the bone defect, the patient’s systemic profile, and the design of the prosthesis above the affected implant. There is no single protocol that applies to all cases.
Assessment at Studio Calesini
Assessment of a peri-implantitis case at Studio Calesini includes clinical probing, CBCT imaging for bone level evaluation, review of original treatment records, and an honest analysis of prognosis for each option. A treatment plan is not recommended without documentation; the patient receives a written assessment with the clinical rationale behind each option presented. Italian, English, and any language via AI-assisted communication.
The most common signs are: bleeding or discharge around the implant, swelling of the gum, discomfort or pain on pressure, and visible gum recession around the implant crown. In many cases, particularly at early stages, the patient notices nothing: peri-implantitis is asymptomatic until bone loss is significant. Regular probing and radiographic monitoring at implant maintenance appointments is the only reliable way to detect it before it becomes advanced.
In many cases, yes. At the mucositis and early peri-implantitis stage, non-surgical and surgical management can arrest the condition and preserve the implant. At the moderate stage, surgical intervention with surface decontamination and, where defect morphology permits, regeneration can stabilise the situation. At the advanced stage, preservation becomes significantly less predictable, and the risk-benefit balance shifts toward implant removal in the majority of cases.
Bacterial plaque accumulation on the implant surface is the primary cause, the same mechanism as periodontitis around natural teeth. Factors that predispose to peri-implantitis include: prosthesis design that prevents effective cleaning, insufficient keratinised tissue around the implant, smoking, uncontrolled diabetes, a previous history of periodontitis, and inadequate or absent maintenance care after implant placement.
Peri-implantitis can develop at any point after osseointegration. It is most commonly diagnosed at three to five years after placement, but cases have been documented within the first year and more than fifteen years post-placement. The rate of progression varies by patient and case. This is why ongoing maintenance is not optional for patients with implants: a single assessment of implant health at annual recall detects the majority of early cases.
In most cases, yes, but not immediately. After implant removal in a peri-implantitis site, the area requires debridement, decontamination, and in most cases bone reconstruction before re-implantation is possible. The waiting period is typically six to twelve months depending on the extent of bone loss and the regenerative procedure performed. Re-implantation in a previously infected site carries a higher failure risk than primary implant placement in a healthy site, and this must be acknowledged in the treatment plan and prognosis.
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Studio Calesini · Via della Croce 77, Rome
Italian, English, and any language via AI-assisted communication. By appointment only.
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