Peri-implantitis: how to tell an implant is inflamed, why it happens, and how it is treated

Bleeding gum near an implant, an unpleasant smell, discomfort — signs of mucositis and peri-implantitis. Why bone around an implant becomes inflamed, at which stage it is still reversible, how Tursunov Clinic treats it, and how to prevent it. Astana.

Key points

  • Peri-implantitis is inflammation of the bone around an implant. It starts as mucositis (only the gum is inflamed) — that is reversible; left untreated, it spreads into the bone, and the implant can then be lost.
  • Signs: bleeding near the implant when brushing, redness and swelling of the gum, odour, an unpleasant taste, and later a loose crown or exposed threads.
  • Causes: plaque (the main one), smoking, diabetes, leftover cement under the crown, overload from a poorly fitting denture, and untreated periodontitis.
  • Treatment depends on the stage: cleaning and the Vector device at an early stage, open debridement and bone augmentation at a middle stage, implant removal at a late stage.
  • Prevention is easier than treatment: professional cleaning at the clinic every six months, and a water flosser plus interdental brushes at home.

Two stages: the gum and the bone

Mucositis: only the gum around the implant is inflamed. The gum is red, bleeds when brushed, and can ache under pressure. The bone is untouched. At this stage everything is reversible: professional cleaning and correct home care return the gum to normal within 2–3 weeks.

Peri-implantitis: the inflammation has reached the bone, and the bone around the implant has started to shrink. On a scan a "bowl" shows around the upper threads. The gum can recede, exposing the threads; an odour and sometimes pus appear; at a late stage the implant becomes loose. Lost bone does not come back on its own — it can only be stopped and partly rebuilt.

The difference between the stages is time. Mucositis turns into peri-implantitis over months if left untreated.

Why this happens

Plaque. There is no ligament around an implant to hold the gum tight the way there is with a natural tooth, so bacteria find it easier to work their way in. Poor hygiene is cause number one.

Smoking — the risk is 1.5–2 times higher.

Uncontrolled diabetes — weaker immunity means inflammation progresses faster.

Cement under the gum. If a crown was cemented and residual cement got under the gum, it irritates the tissue for years. That is why the clinic fixes multi-implant dentures with screws instead.

Overload. A denture that sits on the implants with tension, or a crown that interferes with the bite, puts constant pressure on the bone.

Thin gum and little bone from the start, if this was not accounted for in planning.

Periodontitis on natural teeth. Bacteria spread from them to the implants.

How it is treated

Mucositis: professional cleaning (25,000 ₸) with treatment around the implant, and, if needed, the Vector device (70,000 ₸) — ultrasound with a fine suspension that cleans the implant surface without scratching the titanium. An antiseptic, care instructions, and a check-up after 3–4 weeks.

Early peri-implantitis (minor bone loss): the same, plus pocket debridement and, sometimes, removing the crown for access (10,000 ₸) and refitting it afterwards. An erbium laser, where used, is helpful here specifically because it removes the bacterial film from the threads without contact or heat [use at the clinic to be confirmed].

Moderate peri-implantitis: surgical debridement — the gum is lifted, the implant surface is cleaned, and the bone defect is filled with bone material and a membrane (augmentation 60,000 ₸, membrane 60,000–80,000 ₸). The prognosis depends on the shape of the defect.

Late peri-implantitis: a mobile implant is removed (50,000 ₸), the bone is given 3–4 months to heal, and then a new implant is placed, often with a graft.

If you notice the signs, here's what to do

Don't wait for a scheduled check-up. Bleeding near an implant when brushing is already a reason to come in: at the mucositis stage treatment takes one or two visits and costs about the same as a cleaning; at the peri-implantitis stage it means surgery. Book a check-up: a CBCT segment (4,500 ₸) will show whether there is bone loss.

How to prevent it

At home: a medium-bristle brush, interdental brushes around the implant, a water flosser in the evening. Floss near an implant — gently, without "sawing" at the gum.

At the clinic: professional cleaning every 6 months (every 4 for smokers and diabetics). With an All-on denture, it is removed and fully cleaned when needed.

An annual check-up scan — it shows bone loss before you would feel it.

A precise denture fit and screw retention instead of cement — decisions made at the prosthetic stage that pay off here.

Related services and guides

Frequently asked questions

My implant has been in for 3 years and the gum bleeds — is that peri-implantitis?

Possibly mucositis. You need an exam and a scan; at an early stage everything is reversible.

Does peri-implantitis hurt?

Often not — which is why it tends to be noticed late. Watch for bleeding, swelling and odour rather than pain.

Can it be cured with antibiotics?

An antibiotic is only a supplement to cleaning; on its own it does not remove plaque from an implant.

If an implant is removed, can a new one be placed?

Yes, once the bone has healed, usually with a graft; the survival rate for a second implant is lower than for the first but still high.