Peri-implantitis is an inflammation of the tissue around a dental implant. The gums and jawbone adjacent to the implant show various signs of inflammation such as swelling, redness and pain. If peri-implantitis is not treated, implant loss usually occurs.


Causes of peri-implantitis

Bacterial flora in the oral cavity

If pathological bacteria that are capable of damaging the gums and bone are present in the oral cavity, peri-implantitis can develop quickly. Such pathogenic bacteria produce enzymes that degrade adjacent tissue and destroy the implant anchorage.

If the number of harmful bacteria increases and forms biofilm and coating on the dental implant, peri-implantitis is inevitable.

Elevated levels of a-MMP8

a-MMP8 stands for activated matrix metalloproteinase-8, an enzyme produced by immune cells (mainly granulocytes) when they come into contact with bacterial biofilms.

a-MMP8 is able to degrade peri-implant tissue by enzymatically cleaving the collagen of gingiva and jawbone. Thus, it ensures that more immune cells can get to the biofilm and plaque to increase the defense mechanism.

Many people produce excessive amounts of a-MMP8 which makes the destructive process very aggressive.

The worse the oral bacterial flora, the more a-MMP8 is produced by immune cells and the higher the destruction of gums and bone.

Interestingly, the a-MMP8 level is a marker for periodontitis or peri-implantitis. By testing the level of a-MMP8, effective measures can be taken before the first signs of periodontiis or peri-implantitis become apparent.


Our dental practice specializes in effectively optimizing the oral bacterial flora. Only harmful germs are eliminated and the healthy and important bacteria stay alive.

A patient’s aMMP8 level can be tested within a few minutes. This way, the risk of future periodontitis or periimplantitis can be determined even before the first symptoms appear.


Effects on health

Peri-implantitis has the same negative impact on health as periodontitis. Through the inflamed tissue, bacteria can enter the bone and blood vessels in large numbers and lead to various diseases. Thus, peri-implantitis is associated with diseases such as arteriosclerosis (heart attack, stroke), diabetes, osteoporosis, arthritis or rheumatism.

Patients who have periodontitis or peri-implantitis often have fatigue and lack of energy. The reason for this is the continuous activation of the immune system, which uses a lot of energy to fight off the bacterial infection.

Since periodontitis has similar effects, please read more in the article Holistic dentistry.

Treating peri-implantitis

In general, the treatment of peri-implantitis should always be based on improving the bacterial flora, as this is the main cause. By eliminating pathogenic bateria, the distruction process stops and production of a-MMP8 decreases.

Cleaning of the surface of the affected dental implants can help. It is essential to ensure that no titanium particles are released into the surrounding area. The more titanium particles there are in the peri-implant tissue, the stronger the inflammatory reaction.

If the degradation of the peri-implant tissue is too advanced, complete healing can no longer take place. If the condition is advanced, the implant should be removed.

Peri-implantitis and periodontitis

Peri-implantitis is inflammation that is localized around the implants, periodontitis is inflammation of the tissue around the teeth.

Both are the symptoms of the same cause. In both peri-implantitis and periodontitis, the main cause is pathogenic bacterial flora in the mouth. Therefore, the therapy is also the same: improving the oral bacterial flora.

Existing periodontitis increases the risk developing peri-implantitis after implant placement. Patients with periodontitis should improve their oral bacterial flora and complete periodontitis treatment before having implants placed.

Peri-implantitis and titanium implants

Titanium implants are able to heal properly even if inflammation is present. Titanium implants are able to remain in the jawbone without loosening for a long time despite peri-implantitis.

As a result, massive inflammation can form around the titanium implant while the implant remains immobile and stable.

Since peri-implantitis can remain undetected for a long time, it can be a massive burden on the body.

Titanium implants may promote peri-implantitis due to the following factors:

  • There is usually a gap between titanium implants and the edge of the bone. This gap can harbor bacterial biofilms and increase local inflammation.
  • Titanium is able to deform. While chewing, microscopic movements are transmitted to the jawbone, in the form of pressure. Pressure always causes tissue to breakdown, which automatically leads to an inflammatory process.
  • When titanium implants are placed, titanium particles are always released into the surrounding area. The particles are taken up (phagocytosed) by macrophages in the peri-implant tissue, which then release immune messengers. If the macrophages react by increasing the immune response, a titanium stimulation test is positive.

When macrophages come in contact with titanium aprticles, there is always an inflammatory response. To find out whether this is mild or severe, a titanium stimulation test can be done.

Since titanium also contains elements such as nickel, aluminum or vanadium, these substances can be tests for allergies. A lymphocyte transformation test (LTT) can diagnose metal sensitivites and allergies.

Peri-implantitis and ceramic implants

Peri-implantitis can also occur with ceramic implants. If an implant is not placed properly and inflammation is not completely removed from the tissue, peri-implantitis will occur and the ceramic implant will not be able to heal. The implant will have no stability because it cannot heal into the bone. Consequently, it must be removed and replaced.

Provided a ceramic implant is inserted properly and the wound is completely cleaned and disinfected, ceramic implants heal in the jawbone without inflammation.

Reasons why ceramic implants are rarely affected by peri-implantitis:

  • Due to their design, most ceramic implants do not have gaps. Therefore, bacteria is not able to settle there.
  • Both gum and bone readily bond with the zirconia ceramic.
  • Masticatory (chewing) forces cannot move ceramic implants due to their infexibility. Consequently, there are no pressure peaks that deteriorate the jawbone.
  • Ceramics are neutral and hypoallergenic. This material does not cause an immune response.

If a healthy oral bacterial flora is maintained and daily oral hygiene is carried out correctly, ceramic implants can remain in the jaw for many decades, without any complications.

FAQ about periimplantitis

What are the symptoms of peri-implantitis?

Symptoms of peri-implantitis:

  • Bleeding gums and pocket formation around the implant
  • Gum and bone recession
  • Bad breath
  • Pain or discomfort originating from the implant
  • Implant loosening and implant loss in the final stage
How can peri-implantitis be diagnosed?

A radiological evaluation with an X-ray is the ideal way to diagnose peri-implantitis. Intraoral dental films, panoramic dental X-rays or 3D digital volume tomographies (DVT) can show bone loss very well.

Is there an early diagnostic method for peri-implantitis?

Even before peri-implantitis is visible on X-ray, a-MMP8 testing can provide prognosis for peri-implantitis.

How can the production of a-MMP8 be reduced?

The most effective way is to improve the bacterial flora in the mouth.

How often does peri-implantitis occur?

In our practice we rarely see peri-implantitis, provided the patient follows the oral hygiene instructions and has regular check-ups and dental prophylaxis.

According to research, the incidence of inflammation around implants ranges from 10 to 65%.

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