Treating Peri-Implantitis in Shepperton: When Non-Surgical Care Isn't Enough

Dental implants are, for many patients, one of the most transformative treatments in modern dentistry. Once healed and settled, an implant can look, feel and function so much like a natural tooth that patients often forget which one it is. But implants — like natural teeth — need looking after, and they can develop their own version of gum disease.

That version is called peri-implantitis, and if you have implants, it's worth understanding what it is, how to spot it early, and what treatment involves. Caught early, it's very manageable. Left too long, it puts the implant itself at risk.

What Peri-Implantitis Actually Is

To understand peri-implantitis, it helps to think about how a dental implant sits in the jaw. An implant is a small titanium (or occasionally ceramic) post that's placed into the jawbone and, over the following weeks and months, fuses with the bone in a process called osseointegration. On top of the implant sits an abutment and a crown — the visible "tooth" part.

Around every implant, there's a small collar of gum tissue and a specific region of bone that holds the implant firmly in place. When bacterial plaque is allowed to accumulate at the gumline around an implant — just as it would around a natural tooth — the surrounding tissue can become inflamed.

There are two stages:

• Peri-implant mucositis is inflammation of the gum tissue around an implant, without any loss of the surrounding bone. Think of it as the implant equivalent of gingivitis: reversible, but a warning sign.
• Peri-implantitis is the more serious progression, where the inflammation has extended to involve the bone that supports the implant, and bone loss has started to occur. This is the implant equivalent of periodontitis — the same disease process our periodontics team treats around natural teeth, but centred around an implant instead.

The important difference: an implant doesn't have a periodontal ligament between it and the bone the way a natural tooth does, so once bone loss around an implant starts, it can progress faster and be harder to reverse than gum disease around a tooth. That's why early detection matters so much.

The Warning Signs You Shouldn't Ignore

Peri-implantitis is often quiet in its early stages, which is part of what makes it dangerous. But there are signs worth taking seriously — please don't wait to see if they'll pass:

• Bleeding when brushing or flossing around an implant. Healthy gum tissue around an implant should not bleed. Bleeding is the earliest and most reliable warning sign.
• Redness or puffiness of the gum at the base of the implant crown, compared to the tissue around your natural teeth.
• Discomfort, tenderness, or aching in the area — either during eating or spontaneously. Implants themselves have no nerve, so any sensation from an implant area comes from the surrounding tissues and warrants attention.
• Bad taste or a bad smell localised to the area around a specific implant.
• Pus or discharge at the gumline (this is more advanced and needs prompt attention).
• A feeling that the implant is loose or has moved, or that your bite around that implant has changed.

If you notice any of these, please get in touch — we'd much rather see you sooner and find nothing serious than see you later, when treatment options are narrower.

Why It Matters If Untreated

Here's the honest truth about peri-implantitis: the biggest risk of leaving it untreated is losing the implant.

Because peri-implantitis progressively destroys the bone that anchors the implant, an implant with advanced disease around it eventually loses enough support that it becomes mobile and, ultimately, fails. Once an implant has been lost to peri-implantitis, replacing it is often more complex than the original placement was, because the bone in that area has been reduced — sometimes requiring bone grafting before a new implant can be considered.

Beyond the implant itself, chronic peri-implantitis is a persistent bacterial infection in the mouth, with the same general health implications as untreated gum disease anywhere else. It's not something to shrug off.

The good news, again, is that this is very much a manageable condition when addressed early.

Non-Surgical Treatment First

Just as with gum disease around natural teeth, treatment for peri-implantitis is staged. The first line of treatment is almost always non-surgical, and for peri-implant mucositis and early peri-implantitis this is often all that's needed.

A non-surgical peri-implantitis appointment typically includes:

Assessment. Your clinician will measure the pocket depths around the affected implant, check for bleeding, review X-rays, and compare current measurements against any baseline records from when the implant was placed. This establishes exactly what's going on and how far it's progressed.

Deep cleaning around the implant. Removing plaque, tartar and bacterial biofilm from the implant surface and the surrounding gum tissue is the core of treatment. Because the implant surface is different from a natural tooth root, specific instruments — often titanium or plastic curettes and, in some cases, air-polishing devices with fine glycine or erythritol powders — are used to clean the implant surface without damaging it.

Antimicrobial rinses or localised antibiotics. For more inflamed sites, your clinician may recommend a course of chlorhexidine mouthwash, or place a small amount of localised antibiotic gel into the affected pocket to support healing.

Home-care instruction. This is not a nice-to-have; it's central to whether treatment holds. You'll be shown exactly how to clean around your specific implant — often with interdental brushes sized to fit the space, a floss designed for implants, or a water flosser — and the recommended schedule for professional maintenance visits.

Close follow-up. After non-surgical treatment, more frequent hygiene appointments (often every three months for a period of time) allow us to monitor healing and step in early if inflammation returns.

For many cases of early peri-implantitis and virtually all cases of peri-implant mucositis, this staged, non-surgical approach is enough to stabilise the situation and preserve the implant long-term.

When More Advanced Treatment Is Needed

Non-surgical treatment doesn't work for every case. If pocket depths remain elevated, bleeding continues, or X-rays show ongoing bone loss despite thorough non-surgical care, the situation warrants more advanced treatment.

Options at this stage may include:

• Surgical access. Lifting the gum around the implant under local anaesthetic to allow direct visualisation and thorough cleaning of the implant surface that isn't reachable non-surgically.
• Regenerative procedures. In selected cases with the right pattern of bone loss, bone graft material and a barrier membrane may be used to encourage the body to regenerate some of the lost bone around the implant.
• Resective procedures. Reshaping the surrounding bone and gum to eliminate deep pockets that would otherwise continue to harbour bacteria.
• Referral to a specialist. More complex peri-implantitis cases are sometimes best managed by a periodontist with specific implant expertise.
• Removal of the implant. In advanced cases where too much bone has been lost, removing the affected implant may be the most predictable option, followed by a healing period before considering replacement.

Which option is right depends on the specifics of your case, and your clinician will walk you through it fully — there is no one-size-fits-all answer, and there should never be a rush to the most invasive step first.

Frequently Asked Questions

How common is peri-implantitis? Some degree of inflammation around implants (peri-implant mucositis) is fairly common over the lifetime of an implant. True peri-implantitis with bone loss is less common but not rare, and its likelihood increases with smoking, poor oral hygiene, uncontrolled diabetes, and a history of severe gum disease. Regular hygiene visits and good home care are the single most important protective factors.

Can I look after my implants at home to prevent this? Yes — daily cleaning around implants is essential. Brush twice a day, clean between the teeth and around each implant with an appropriately sized interdental brush or floss designed for implants, and don't skip your professional hygiene visits. Prevention is dramatically more effective than treatment.

Will treatment save my implant? In early stages, very often yes. The earlier peri-implantitis is caught, the higher the chance of stabilising it and preserving the implant. This is why we take even small warning signs seriously.

Does treatment hurt? Non-surgical treatment is generally comfortable, often with local anaesthetic for deeper cleaning. Surgical treatment is also done under local anaesthetic and, as with any minor oral surgery, is followed by a healing period with mild swelling and tenderness.

Please Don't Wait

If you have implants and you've noticed any bleeding, tenderness, or change around one of them — even a subtle one — please book an assessment. Early peri-implant disease is one of the most treatable situations in implant dentistry; advanced peri-implantitis is one of the hardest. The gap between the two is usually a matter of months, not years.

Contact Confident Smile in Shepperton to arrange a check, and read more about our approach to dental implants and periodontics while you're here.