Gum Disease Around Dental Implants: What an OPG Showed After Years of Home Flossing
The soreness may be the last thing to arrive.
A patient came to us worried about an infection in the gums around her implants. She has been cleaning at home the whole time, threading floss under the bridge the way she wa shown. She had not booked an appointment before because she was not in pain.
Nobody calls an Emergency Dentist Brisbane unless something hurts, so a quiet problem can sit there for years.
After we took an OPG, we noticed that her gums had pulled off the implant, part of the metal was showing, and the bone underneath had changed shape. Brisbane dentists explain that gum disease around dental implants may be hard to catch because what you feel and what the X-ray shows us can be different. Since there is no nerve inside an implant, it cannot ache the way your real tooth does when there is a problem. That’s why you will receive the warning from your gums. If we catch the issue while it is still in your gums, it can usually be reversed, which is why being aware of the early early warning signs is important.
Implants Don’t Decay, But The Gum And Bone Around Them Still Can
Dental implants cannot decay, but the gum and bone holding them in place can become infected. The implant is titanium or zirconia, and neither of those can get a hole in it in the way your natural tooth does. People forget that the implant is doing only half of the job. The rest is the gum wrapped around it, and the bone underneath, and both of those are alive, just like the gum and bone holding your natural teeth. If plaque is not removed from where the implant meets your gum, that tissue can get sore and inflamed. This is what we mean by gum disease around dental implants. If plaque is left there for a long time, the bone may start to shrink back from the implant, and that is how implants get lost.
Mucositis Or Peri-Implantitis: The Difference That Decides Everything
The differece between peri-implant mucositis and peri-implant is the bone. Mucositis is inflammation of the gums on its own, and it can be reversed. Peri-implantitis is the same inflammation after it has spread into the bone, and that bone does not grow back. With mucositis, the gum bleeds when we probe around the implant gently and may look red or puffy, but the bone underneath is still fine and where it should be. Once teh plaque is cleaned away, the gum normally calms down. Treatment for peri-implantitis can stop the loss from progressing. In some case, we can rebuild a little of it surgically, but at that point, we are mostlty trying to protect what is left. Around one in five implant patients end up with peri-implantitis, and it usually starts as mucositis. So if you notice a bit of bleeding, tell us about it even if seems unimportant to you.
Why Implants Are Harder To Keep Clean Than Natural Teeth
Your natural teeth are held in the jaw by thousands of tiny fibres, the periodontal ligament, which carries its own blood supply, while a dental implant does not have any of that. Around your real tooth, the gum is stitched onto it and holds on tightly. However, an implant is joined to the bone underneath, and not your gum. This means there is no attachment and only a soft collar of gum around the metal, making it easier for bacteria to sneak in. Blood flow around an implant is lower, too, so your body is slower to deal with any infection that statrs. Picture a mushroom. The top is wider than the stalk, and there is a shaded gap underneath the rim. A crown on an implant does the same thing. Bacteria live in that gap, and no toothbrush goes in there. By the time you notice anything, bactreia have been in there a while. Once they are below the gum line, no amount of cleaning at home will clear them out.
What Causes Gum Disease Around Dental Implants
Gum disease around dental implants is caused by plaque that stays on the implant near the gum line. Plaque is the soft, sticky layer of bacteria that builds up on teeth and implants every day. If it is not cleaned off by proper brushing, the gum around the implantbecomes inflamed, and over time, the bone underneath can start to disappear.
The Early Signs Of Peri-Implant Disease, And What Usually Gets Noticed First
Bleeding is almost always the first thing people notice, usually a small amount of blood on the floor or the interdental brush.Then poeple typically notice that the gum looks puffier or redder than the one next to it. They may also notice a taste that will not go away, no matter how much you rinse. Later on, your gum shrinks back, and you can see a bit of the implant showing under the crown. If your implant feels loose, that usually means we’ve already lost the bone around it. None of it is painful, and that is the problem. In the case we started with, the damage showed up on an X-ray long before it showed up as pain.
How Do We Know If The Bone Is Affected?
An X-ray is the only way to tell. Looking at the gum shows us whethere it is red, puffy or bleeding, but the bone sits underneath all of that, and teh bone is hidden underneath, so we cannot see what is happening to it. Someone can have gum that looks mildly irritated and still have lost a noticeable amount of bone around the implant, which is exactly what the OPG showed in the case above. We keep the X-ray too. One picture on its own does not tell us much. What we really want to know is how much the bone has changed since last time.
How Gum Disease Around Implants Is Treated
For the patient we mentioned earlier, our dentists began treatment the same day she came in. What happnes next depends on whether the bone is involved.
- If the problem is still per-implant mucositis: cleaning the implant surface below the gum with instruments that will not scratch the titanium, followed by an antiseptic rinse for a few weeks, is usually enough for the gum to settle.
- Once it has become peri-implantitis: as it had in this case, the cleaning is paired with a short course of antibiotics, commonly five days of metronidazole, and a chlorhexidine rinse two or three times a day while the tissue calms down.
- Results vary from person to person: some implants stay stable for years, some are given a guarded prognosis and watched closely, and a few have to be removed.
Bone that has already gone does not return by itself, which is why we always recommend regular chechups.
What Happens When Your Dentist Refers You To A Gum Specialist
The referral letter goes out the same day the problem is found. It asks the specialist for three things: to clean thoroughly around the implant, to tell us if the implant can be saved, and to let us know whether a bone graft or further surgery is worth doing.
It asks the specialist for three things: to clean thoroughly around the implant, to tell us if the implant can be saved, and to let us know whether a bone graft or further surgery would help.
What “Guarded Prognosis” Means
It means we are not sure how things will go, not that the implant is finished. A dentist writes it when there is enough damage that we cannot promise the implant will last, but not enough for us to say it has to come out.
Why Floss Threaders Alone Are Not Enough Around Implants
A floss threader gets floss under a bridge, and that is all it does. Once it is there, the floss has to do the actual cleaning, and floss is just a thin string you pull along the surface. The space around an implant is wider than that. The crown is broader than the implant underneath, so there is a small ledge and a gap beneath it, and floss just slides across the top without reaching in. An interdental brush (the right size), fills that gap and actually cleans it. The patient we talked about before, had been threading floss under her bridge for years, exactly the way she was taught, but the plaque never moved.
Keeping Implants Healthy At Home And In The Chair
Your dental imlants need both everyday cleaning at home and professional cleaning in the clinic.
What You Can Do At Home
- Interdental brush: This is the important one. It has to be the right size for your gap because a brush that is too small just slides past the plaque. Ask us to help you pick the right size next time you are in.
- Superfloss or a floss threader: These get under a bridge where a brush cannot reach, but they will not clean a wide gap on their own.
- Water flosser: While they are nice to have and easyto use, they will not do the job of the other two.
What Happens In The Chair
- Probing around every implant: we gently check around each implant with a small probe, to check for bleeding and to measure how deep the gap underneath is, then we compare it with your last visit.
- Bleeding when we probe: this is the first sign of trouble we can actually measure because a healthy gum does not bleed.
- X-rays: we take these regularly, because nobody can tell what the bone is doing just by looking.
- How often you come in: there is no set rule, and it depends on your dental health, so ask us what suits you.
Key Takeaways
Dental implants cannot decay, but the gum and bone holding them in place can still become infected. It starts as mucositis, which affects the gum only and can be reversed, and if it is left it becomes peri-implantitis, where bone is lost and does not grow back. Most people feel nothing early on, so a bit of bleeding when you clean is usually the first sign, and only an X-ray can show what the bone is doing. Cleaning with an interdental brush sized to your gap, along with regular check-ups, is what keeps implants healthy.
