Peri-implantitis is inflammation with loss of the bone supporting an implant. We assess the cause and plan treatment to control it, aiming to keep the implant where possible.
Private care with Dr. Sergi Rivas Frau and/or Dr. Sahand Shirzadi Maryan, according to your treatment plan.
The same simplified bone-level implant is used throughout. In the intact-support example, the threaded body sits within bone and the gum meets the crown at its emergence.
Stable tissues
A healthy implant
Educational schematic · not to scaleSimplified anatomy for explanation; not a patient image or a predicted result.
The tissues are free of clinical inflammation and the supporting bone is stable.
No clinical signs of inflammation
Bone levels assessed against earlier records
Inflammation + bone loss
An implant with peri-implantitis
Educational schematic · not to scaleSimplified anatomy for explanation; not a patient image or a predicted result.
Inflammation is present alongside progressive loss of the bone supporting the implant.
Bleeding and/or discharge may be found on examination
Bone loss and tissue measurements guide the diagnosis
Educational schematic · not to scaleBone support is unchanged from the healthy example; the difference is in the gum tissue.
A different diagnosis
Mucositis: inflammation without additional bone loss.
Mucositis affects the soft tissues. Peri-implantitis also involves disease-related bone loss. Examination and comparison with earlier records help distinguish them.[1]
These are different conditions, not inevitable stages. Health can also exist with reduced bone support; a low bone level alone does not establish active disease.
Peri-implantitis is associated with bacterial plaque around an implant; cleaning access, previous gum disease and individual health factors also matter.[1][4]
Bleeding, swelling, discharge or changes around an implant deserve assessment. Seek advice promptly if the implant feels loose or symptoms worsen. The extent of bone loss cannot be judged from symptoms alone.
From diagnosis to a treatment decision
Control infection. Reassess. Choose the next step.
The aim is to control disease and retain an implant where feasible. Initial care and the response to it guide further treatment.[3][4]
Step 01
Find out what is happening
Educational schematic · not to scale
We examine the tissues, measure around the implant and assess appropriate X-rays and earlier records. We also review your health, previous gum disease and the restoration.
Understand the implant, its support and the factors affecting care.
Step 02
Start with infection control
Educational schematic · not to scale
Professional cleaning around the implant is combined with support for cleaning at home. Access beneath the crown or bridge and relevant risk factors are addressed.
Initial care prepares the tissues for reassessment and any further treatment.
Step 03
Check how the tissues respond
Educational schematic · not to scale
We review inflammation, tissue measurements, cleaning access and bone stability where appropriate. If control is adequate, continue cleaning and regular reviews. Persistent disease may need a surgical approach.
The response to initial care helps determine the next step.
Bone loss can have different configurations. These anatomical patterns describe the defect; they do not prescribe treatment or represent a sequence of stages.[2]
Class I · infra-osseous
Loss within the bone
Educational schematic · not to scaleA cross-section cannot show every remaining bone wall.
A defect extends into the remaining bone. The number and shape of the bone walls vary.
Class II · horizontal
A lower bone level
Educational schematic · not to scaleA cross-section cannot show every remaining bone wall.
Bone support is reduced across the crest, leaving more of the implant above the remaining bone.
Class III · combined
A mixed pattern
Educational schematic · not to scaleA cross-section cannot show every remaining bone wall.
A lower crest and a deeper defect are present together. Different approaches may be combined.
We also assess remaining bone walls, open-sided defects and how the implant sits within the bone. Containment may matter when considering reconstruction, alongside inflammation control, tissue conditions and the restoration.
Different options for different needs
What might further treatment involve?
Surgery can provide access to affected areas. The approach depends on the defect, cleaning access and treatment goals; techniques may be combined.[3][4][5]
Option A · selected after assessment
Access and surface cleaning
Educational schematic · not to scaleThis explains a possible procedure, not the result you should expect.
The gum is gently opened to reach affected areas, remove inflamed tissue and clean the implant surface.
When considered: When deeper access is needed to address persistent disease.
Discuss the limits: The gum position can change after surgery; some implant surface may become more visible.
Option B · selected after assessment
Pocket reduction
Educational schematic · not to scaleThis explains a possible procedure, not the result you should expect.
Selected gum tissue and bone may be reshaped or removed to improve cleaning access and reduce difficult-to-maintain pockets.
When considered: When the anatomy and restoration make this approach appropriate.
Discuss the limits: Recession, exposed metal and changes in appearance need discussion, especially in a visible area.
Option C · selected after assessment
Bone reconstruction when suitable
Educational schematic · not to scaleThis explains a possible procedure, not the result you should expect.
Graft material, sometimes with a membrane, may be used to support reconstruction of a suitable defect after cleaning.
When considered: Defect depth, remaining bone walls and tissue conditions help guide suitability.
Discuss the limits: A graft does not guarantee new bone attachment or implant rescue. Further care may still be needed.
Option D · selected after assessment
When keeping the implant is unsuitable
Educational schematic · not to scaleRemoval is shown schematically; the implant and crown are not necessarily removed together.
If keeping the implant is no longer a reasonable option, removal and a separate replacement plan may be discussed.
When considered: The decision considers support, stability, persistent disease and the overall restoration.
Discuss the limits: There is no single bone-loss percentage that decides this for every patient.
Cleaning methods and materials are selected for the case. No single device guarantees disease resolution. Radiographic bone fill does not by itself prove new bone attachment to the implant or lasting disease control.[3][4]
Educational schematic · not to scaleMaintenance and review continue after active care. This is not a post-treatment result.
Long-term care is part of treatment
Improvement needs continued attention.
Peri-implantitis can recur. Clear cleaning advice and regular professional reviews help identify changes and guide further care. Follow-up is normally with our periodontist team.
Ask how tissue measurements and bone levels will be monitored, what changes to report, and how reviews will be arranged if you live abroad.
Patient understanding and realistic expectations matter. [6]
Your questions
Before you decide on treatment.
Ask for the proposed sequence, alternatives, costs and follow-up in your written treatment plan.
Does bleeding mean I have peri-implantitis?
Bleeding needs assessment. Gum inflammation alone can be mucositis; peri-implantitis also involves disease-related bone loss. Examination and records help distinguish the conditions.[1]
Will every implant need a bone graft?
No. The response to initial care, the defect, cleaning access and other findings determine whether surgery or reconstruction is appropriate.[2][3]
Can my implant always be saved?
Our aim is disease control and implant preservation where feasible. Retaining an implant is not possible or appropriate in every case.[4]
Can peri-implantitis return after treatment?
Yes. Improvement needs ongoing review. Home care, professional maintenance and checking for recurrent inflammation are part of the long-term plan.[6]
Will antibiotics or a particular device solve the problem?
Treatment is planned around the diagnosis and contributing factors. Antibiotics are not a routine substitute for cleaning and appropriate further care; no single device guarantees disease resolution.[3][4]
Can I enquire from outside Spain?
Yes. Contact us with a brief description and any available records. Suitability and the sequence of visits need assessment before you arrange treatment or travel.
The evidence behind this guide
Scientific references.
Patient explanations are informed by consensus guidance and peer-reviewed research, including Monje’s work on defects, combined treatment and patient understanding. Research findings do not predict an individual outcome.
Tell us briefly what you have noticed, what you have been advised and whether previous records are available. An assessment establishes the diagnosis and a plan for your case.
