Yes — an implant cannot decay, but the gum and bone around it can become infected, and that condition is called peri-implantitis. It is one of the three most common preventable emergencies seen at this practice. The implant itself is titanium or ceramic and is chemically indifferent to acid or bacteria. Everything holding it in place is living tissue, and living tissue can be lost.
If you have an implant and the gum around it has changed, it is worth having it assessed rather than watched.
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This article deals only with the periodontal side of implants. Cost, planning and the procedure itself are covered separately in implant costs in Sydney, implants where there is existing bone loss, implants compared with bridges and dentures, and on the implants service page.
What is the difference between peri-implant mucositis and peri-implantitis?
They are two stages of the same process, and the distinction between them is the part worth understanding.
Peri-implant mucositis
Inflammation confined to the soft tissue around the implant. The gum is red, swollen or bleeds when cleaned or probed, but the bone level has not changed.
This stage is reversible. With plaque removal, professional debridement and improved daily cleaning around the implant, the tissue can return to health. It is roughly the implant equivalent of gingivitis, which is discussed in the stage that is still fully reversible.
Peri-implantitis
Inflammation that has extended beyond the soft tissue and is causing loss of the bone supporting the implant fixture.
This stage is not reversible in the sense that matters: bone that has been lost does not return. Treatment aims to stop further loss and stabilise what remains. That is a worthwhile goal, but it is a smaller goal than reversal, which is why the mucositis stage is the one to catch.
Why is an implant in some ways more vulnerable than a natural tooth?
This surprises people, because implants are often presented as the durable option. In terms of the material, they are. In terms of the tissue seal around them, a natural tooth has advantages an implant does not.
- No periodontal ligament. A natural tooth is suspended in its socket by a ligament with its own blood supply and its own cellular defences. An implant is fused directly to bone. That connection is strong, but it removes a layer of biological defence and a route for immune cells to reach the site.
- No fibre attachment into the root surface. Around a natural tooth, collagen fibres insert into the cementum of the root and run outward, forming a physical barrier. Around an implant, the fibres tend to run parallel to the surface rather than inserting into it.
- A different and less resilient seal. The soft tissue cuff around an implant is a weaker barrier to bacterial ingress than the natural attachment it replaced. Once inflammation gets past it, it can reach bone more readily.
- No nerve to warn you. A natural tooth can ache, throb or become sensitive. An implant has no pulp and no nerve, so peri-implantitis can advance a long way without producing pain.
That last point is the one that costs people implants. The absence of symptoms is not the absence of disease, and around an implant there is less chance of a symptom appearing at all.
Who is most at risk?
A history of periodontitis
This is one of the consistently recognised risk factors. Someone who has lost a tooth to periodontal disease has demonstrated both a bacterial profile and an immune response capable of causing bone loss. Placing an implant does not change either of those things.
That is why active gum disease should be stabilised before an implant is placed, not afterwards. Placing a fixture into a mouth with ongoing periodontal infection puts it into the environment that caused the original problem.
Smoking
Smoking impairs blood supply and healing in the same tissues that have to hold the implant. It is a recognised risk factor both for early failure and for later peri-implantitis. The general background is in smoking and your gums.
Poor plaque control around the implant
Implant restorations can be harder to clean than natural teeth, particularly where the crown emerges from the gum at an awkward contour or where several units are joined. Plaque that sits undisturbed at that margin is the direct driver of the process.
Other contributors
Poorly controlled diabetes, residual cement left under the gum at the time the crown was fitted, and an implant restoration that is difficult to access with interdental brushes all feature in the literature.
If you are not sure how to clean around your implant, that is a normal question and worth asking at your next visit.
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How is peri-implantitis assessed?
Assessment is measurement, not inspection.
- Probing around the implant. Gentle probing at multiple points records the depth of the sulcus around the fixture and whether it bleeds. Bleeding on probing is the earliest reliable indicator, and it is often the only sign present at the mucositis stage.
- Suppuration. Any pus expressed from around an implant is a significant finding.
- Radiographs compared against a baseline. This is the part that separates mucositis from peri-implantitis. A radiograph taken at or shortly after placement records where the bone sat at the start. Later films are compared against it. Without that baseline, bone loss has to be inferred rather than measured, which is far less useful.
- Mobility. A mobile implant is a late and serious finding, because integration is either present or lost — there is no gradual loosening the way a natural tooth loosens.
If you had an implant placed elsewhere, it is worth asking for a copy of the film taken at placement. It makes every future assessment more precise.
General background on gum infection and when to seek care is available from healthdirect.
How is peri-implantitis managed?
Management depends on the stage.
At the mucositis stage, treatment is debridement of the implant surface and the surrounding tissue using instruments appropriate to the implant material, removal of any retained cement, correction of anything making the area hard to clean, and a revised home-care routine with the right interdental tools. Recall is then shortened so the response can be checked rather than assumed.
Where bone loss is present, the same non-surgical steps are the starting point, combined with closer monitoring and control of the contributing risk factors. The aim is to arrest progression and stabilise the bone level that remains.
Advanced cases — substantial bone loss, persistent suppuration, or a site that does not respond — are referred. Berala Dental is a general dental practice with no specialist on site. Dentists and oral health therapists here manage most periodontal and peri-implant maintenance, and refer when a case genuinely needs a specialist. That is a question of who is right for your case.
Why do implants need maintenance visits for life?
Because the risk does not expire and the warning system is missing.
A natural tooth in trouble often produces a symptom. An implant in trouble usually does not, until the change is large. Regular measured review is the substitute for the nerve the implant does not have.
Maintenance visits check the probing depths around the implant, check bleeding and suppuration, check the restoration and its access for cleaning, and periodically compare a radiograph against the baseline. People routinely carry gum infection for years without knowing, and around an implant that silence is even more complete.
What does this cost, and what is maintenance worth against it?
An implant at Berala Dental is $4,500, or $5,000 where a bone graft is required. A check-up, X-rays and clean is $250, and periodontal maintenance where periodontal disease has been treated is $400 every three months.
The arithmetic is worth doing plainly. A maintenance visit is a small fraction of the cost of the implant it is protecting, and a lost implant is not simply replaced — the bone loss that caused the failure also complicates whatever comes next.
All of these figures assume no health-fund contribution. A fund may contribute, and what it contributes depends on your policy, so check with your fund directly. A written quotation is provided before treatment begins. The full list is on the fees page.
Quick answers
Can an implant get a cavity?
No. The implant and its crown are not living tissue and cannot decay. The gum and bone around it can still become infected, and adjacent natural teeth can still decay.
Does peri-implantitis hurt?
Often not, or not until it is advanced. There is no nerve in an implant. Bleeding when cleaning, swelling, a bad taste or pus are more common early signs than pain.
Can lost bone around an implant grow back?
Bone lost to peri-implantitis does not simply return. Treatment aims to stop further loss and stabilise the remaining support, which is why the earlier soft-tissue-only stage is the one to catch.
Should gum disease be treated before getting an implant?
Yes. Active periodontal disease should be stabilised first. A history of periodontitis is one of the recognised risk factors for peri-implantitis, so placing a fixture into an untreated mouth carries avoidable risk.
Where to go from here
If you have an implant, the useful step is a measured review with a baseline radiograph on file. You can read about periodontal treatment, check the fees page, or read the non-periodontal side of implants in implant costs in Sydney and implants compared with bridges and dentures.
Bringing your placement radiograph to that appointment makes the assessment considerably more accurate.
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Written and reviewed by Humzah Aly, Oral Health Therapist. This article is general information only and is not a substitute for personalised dental advice. Please see a dental practitioner to discuss what is right for you.
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