Peri-implantitis is an inflammatory disease characterized by inflammation and bone loss around a dental implant, which can lead to implant failure.


Peri-implantitis is an inflammatory disease characterized by inflammation and bone loss around a dental implant, which can lead to implant failure.

Table of Contents

What is Peri-Implantitis?

Peri-implantitis is periodontal disease/periodontitis, but instead of around natural teeth, it is around dental implants. They have similar bacteria and disease process, but can be more difficult to manage. With the popularity of dental implants booming, so are its complications, with peri-implantitis being the most common and most severe. Patients who have a history of periodontal disease, especially in the sites where dental implants are being placed, are significantly higher risk to getting peri-implantitis.

The structure of dental implants makes peri-implantitis more unique and difficult to manage compared to run of the mill periodontal disease. Natural teeth have a ligament that attaches between the entire root and bone. It acts as a barrier to help prevent bacterial infiltration. Dental implants lack this connection – they fuse directly with the bone. There is only a small weak attachment at the top of the bone where the gums are. Once bacteria get past this junction, they have access to the bone and the dental implant surface. The dental implant surface is very different than a tooth root. The implant has a sandblasted, extremely rough surface with a very high surface area. Once a biofilm develops on top, it is impossible to keep clean normally. Imagine trying to clean peanut butter or chocolate off of sandpaper – everything just gets stuck on the rough texture. Dental implants have threads and grooves that make it difficult to access. These characteristics of dental implants are why studies have shown time and time again that non-surgical treatment for periimplantitis is ineffective. 

What you should know before your Peri-Implantitis Treatment in Orange County

The first thing you will need is a consultation. We will evaluate the gums and bone around the ailing implant. We will take a dental radiograph (x-ray) of the implant to evaluate the position and angulation of the implant, the length and the bone around the implant. Sometimes we may need a 3D or CBCT scan (cone beam computed tomography) to evaluate the in 3-dimension the surrounding bone and anatomical structures. We will discuss the findings and treatment options and decide together the best treatment to pursue.

What happens during your Peri-Implantitis Treatment?

What kind of anesthesia is used?

Most of the time, we do peri-implantitis treatment under local anesthesia. The area is numbed just like any other dental procedure. We also offer two additional sedative options. An oral sedative or anxiolytic can be prescribed for you to take an hour before the procedure, which will help calm you down and make you drowsy during the procedure. You may or may not remember the procedure afterward. Another sedation option we offer is “twilight” anesthesia. A board-certified dental anesthesiologist will administer medication through an IV line to make sure you are safely sedated and asleep during the entire procedure.

The surgical procedure

After local anesthesia, an incision will be made and the gums carefully separated from the bone. There will usually be cystic-like tissue where the bone has been lost by the disease. This tissue is carefully separated from the healthy tissue and bone and removed. 

The most challenging part of treating implants is to fully disinfect the rough implant surface. The outer exposed rough surface is removed with high speed burs, and then polished smooth. Remember the analogy earlier about trying to remove chocolate or peanut butter from sandpaper? If we remove that rough outer layer and smoothen the surface, it makes it much easier to clean. A titanium brush is then used on a rotary with saline irrigation to mechanically debride the surface and finish the surface so it is shiny and smooth to minimize future plaque formation and to help facilitate hygiene so it can be kept clean. After mechanical debridement, chemical disinfection of the surface and surrounding is performed with antimicrobial and antibiotic scrubs, with chlorhexidine, peroxide, and minocycline. 

The next part of the surgery depends on the specific case and what the bone and tissue looks like. In some cases, if we cannot regenerate the lost bone, then the bone architecture will be smoothed out and the tissue positioned to expose some of the implant surface so it can be kept clean with everyday brushing and flossing. If we can regenerate the bone, then bone grafting is usually performed, mixed with biologic agents and growth factors and covered with a barrier membrane similar to around natural teeth (guided tissue regeneration). If the tissue is thin and not conducive to bone stability, health, and hygiene, then a gum graft may be performed by the implant before we suture the tissue together. Quite often, a combination of all three will happen. 

How long is the Peri-Implantitis Treatment appointment?

Peri-implantitis treatment is usually around 1.5 hours for a single implant, but it is very case- and patient-specific. Depending on how complex the case is, such as multiple implants being placed or bone grafting, then the appointment may be longer in duration.

Peri-Implantitis Treatment recovery and results: what to expect

After the surgical procedure, you will have dissolvable stitches in the area. Depending exactly what stitches are used, they may fall off in around a week or we will remove them at your post-operative appointment. After the local anesthesia wears off, you may be sore or experience some aching in the surgical area. Any discomfort can usually be resolved with ibuprofen (Advil) or acetaminophen (Tylenol). Stronger pain medications are rarely needed but can be prescribed depending on your pain sensitivity. You will usually be given a course of antibiotics to take for 5-10 days. 

During the first two weeks of healing, it is important that the surgical site remains undisturbed. That means you will avoid chewing food or brushing the site. Except for specific cases, there are no real dietary restrictions – you don’t need a liquid diet or soft diet and can eat whatever you want as long as you chew on the other side. 

You will be instructed not to brush or floss the surgical sites until we see you for the post-operative appointment as to not disturb the initial healing. We will give you a special toothbrush to use at your post-operative appointment. Afterwards, it is imperative that you keep the areas as clean as possible. If bone grafting was done, we will wait around 3-4 months for the graft to heal and mature before we fake further X-rays and evaluate the healing. 

Our team of periodontists specialize in peri-implantitis treatment, and serve the communities of Orange County, including Orange, Anaheim, Fullerton, Anaheim Hills, Tustin, Placentia, Yorba Linda, Santa Ana, Villa Park and Garden Grove. Book your consultation today!