Approach: Non-surgical wherever possible
Treatment time: 30-60 minutes per session
Anaesthetic required: Yes, local anaesthetic. (Sedation available from £450)
Downtime: None for non-surgical treatment
Cost: Non-surgical treatment from £450 (or £37.50 per month*)
Peri-implantitis is an infection around a dental implant that destroys the bone holding it in place, in the same way gum disease destroys the bone around a natural tooth. Left untreated, it loosens the implant, and eventually the implant fails. A natural tooth is better defended against this: the tissue attaching a tooth to the jawbone resists infection better than the tissue around an implant does. It is one of the reasons we work hard to save teeth where saving it is possible, and why an implant needs more maintenance rather than less.
There are two stages. In peri-implant mucositis, the gum around the implant is inflamed and bleeds, but no bone has been lost. At this stage, it can be reversed. In peri-implantitis, bone has started to deteriorate. That bone does not grow back on its own, but the loss can be stopped.
Signs to look for are bleeding or pus around the implant, gum that looks red or swollen, and an implant that feels different when you bite. A loose implant is a late sign rather than an early one.
Our approach is to manage peri-implantitis without surgery wherever possible, and in our experience surgery or removal is needed far less often than patients expect. Non-surgical treatment cleans the implant surface below the gum to remove the bacteria driving the infection, without cutting or lifting the gum.
It is carried out under local anaesthetic, using specialist ultrasonic and hand instruments. Each session takes 30 to 60 minutes, and the pocket depths and bleeding around the implant are measured again at least two months later to check the response. How your own implant is treated is discussed with you at your assessment.
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Dr Yogesh Wadher, Specialist Periodontist & Implant Surgeon, GDC No. 114971
BDS (Lond), MJDF RCS (Eng), MClinDent Perio (Lond), MPerio RCS (Ed). Trained in periodontology and implant dentistry at King’s College London, and has placed dental implants for over 10 years.
Dr Shu Yang Ker, Specialist Periodontist, GDC No. 271709
BDS(London), MPerio RCS(Eng). Trained at King’s College London and the UCL Eastman Dental Institute, and holds the Diploma of Membership in Periodontics from the Royal College of Surgeons of England. She treats peri-implant disease surgically and non-surgically.
Yes, that is not a problem. Most of the implants we treat for peri-implantitis were placed at other practices. You do not need a referral, and you do not need to have been a patient here before. At your assessment, we measure the pocket depths and bleeding around the implant and take X-rays to check the bone level. Please bring any records you have, as knowing which implant system was used and when it was placed is useful, but we can assess and treat you without them.
Where the pocket around the implant is still deep after non-surgical treatment, surgery gives direct access to the implant surface. The gum is lifted, the surface is cleaned under direct vision, and then, depending on the case, it may need to be reshaped or rebuilt. Sometimes a connective tissue graft is completed to thicken the gum around the implant, or the crown may need to be remade so the area can be kept clean.
Sometimes too much bone has been lost for treatment to hold the implant in place. Where that is the case, we will say so at the assessment, before any treatment is paid for. An implant that cannot be saved will need to be removed, from £300. What happens afterwards is a separate decision, made once the site has healed: a replacement implant, a bridge, or leaving the space.
Peri-implant mucositis, the early stage where no bone has been lost, can be reversed. Peri-implantitis cannot be cured, but it can be stopped and kept stable with regular maintenance. Unfortunately, bone already lost does not come back on its own.
Not necessarily, and that is what the assessment establishes. Many implants are saved, particularly where the problem is caught early. Where one cannot be saved, we will tell you at the assessment, before any treatment commences.
Peri-implantitis is caused by bacteria building up around the implant, in much the same way gum disease is caused by bacteria building up around a tooth. The risk is higher if you have had gum disease before, if you smoke, or if you have diabetes that is not well controlled. It is a recognised complication of implant treatment rather than a sign that something went wrong.
Non-surgical treatment is carried out under local anaesthetic, so you should not feel the cleaning itself, and there is a short recovery time afterwards. Where surgery is needed, recovery is two to five days. Sedation is available from £450.
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