Why implants are more vulnerable than teeth

Around a natural tooth, collagen fibres insert directly into the root and form a tight seal. Around an implant there are no inserting fibres; the collagen runs parallel to the surface and the connective-tissue zone is only 1–2 mm deep, so the seal is weaker and bacteria reach bone more easily (Hupp et al., 2014; Resnik & Misch, 2018). The periodontal literature describes peri-implantitis as progressing differently from periodontitis for this reason (Heitz-Mayfield & Lang, 2009). The consequence for patients is simple: an implant needs at least as much daily care as a tooth, and professional checks that look for inflammation before bone is lost.

Mucositis and peri-implantitis: definitions and how common they are

Peri-implant mucositis is inflammation confined to the soft tissue, the implant equivalent of gingivitis, and it is reversible. Peri-implantitis is inflammation accompanied by loss of the bone that supports the implant (Resnik & Misch, 2018). The 2017 World Workshop classification adopted these definitions for clinical use (Caton et al., 2018).

Prevalence figures vary with the definition used, so we give ranges. Mucositis has been reported in up to 80% of patients; peri-implantitis in anywhere from under 7% to 37% of implants, with two systematic reviews settling on about 10% of implants and 20% of patients at 5–10 years (Newman et al., 2019; Derks & Tomasi, 2015). A large Swedish population study found moderate to severe peri-implantitis in a meaningful minority of patients nine years after treatment (Derks et al., 2016). The lesson is not that implants are unreliable but that maintenance is part of the treatment, not an optional extra.

Signs to watch for

• Bleeding on brushing or on gentle probing.
• Redness, swelling or tenderness of the gum around the implant.
• Pus or a bad taste at the implant.
• A pocket that deepens from one visit to the next.
• Bone loss on an X-ray compared with the baseline.
• Usually no pain; mobility appears only very late (Resnik & Misch, 2018).

Risk factors

Consensus statements list poor plaque control, a history of periodontitis, smoking, retained cement and occlusal disharmony as the main risk factors, with diabetes and cardiovascular disease as systemic contributors; alcohol and implant surface have been added as indicators (Resnik & Misch, 2018; Newman et al., 2019). Two deserve emphasis.

Smoking: smokers show almost twice the implant failures and a strong association with peri-implantitis, most marked in the loose bone of the upper back jaw (Resnik & Misch, 2018; Newman et al., 2019). The risk continues after healing.

Cement: in one series, excess cement was found in 81% of implants showing signs of peri-implant disease when examined with an endoscope, and some cements are poorly visible on X-rays (Newman et al., 2019). This is why we favour screw-retained restorations where possible and, when cementing, keep margins shallow and remove every trace. The topic is covered on our implant zirconia page.

Home care

• Brush twice daily with a soft brush, angling the bristles into the gum line around the implant.
• Clean between implant and neighbouring teeth daily with floss, superfloss or an interdental brush of the right size; under a bridge use a floss threader or a water flosser.
• Avoid abrasive pastes that roughen the restoration; roughened zirconia and porcelain retain biofilm more readily (Sakaguchi & Powers, 2012).
• Wear your night guard if you clench or grind; bite overload is a listed risk factor.
• Stop smoking, or at least reduce it; the benefit is largest exactly where implants are most at risk.

Professional maintenance: what we do and how often

At the fitting of the crown or bridge we record a baseline: an X-ray and probing depths measured with a light force of about 0.25 N, which is safe for the tissues (Newman et al., 2019). Healthy implant sulci may measure 2.5–5 mm, deeper than around teeth, so the absolute number matters less than whether it increases over time (Resnik & Misch, 2018). Visits are scheduled every three months in the first year, then by risk; a radiograph is compared with baseline at 6–8 months and thereafter as indicated (Newman et al., 2019; Resnik & Misch, 2018). A meta-analysis found that patients who adhere to supportive therapy have markedly lower rates of peri-implant disease (Monje et al., 2016). Each visit includes checking the restoration for loose screws or chipping, cleaning with instruments that do not scratch the implant surface, and reinforcing home care. Patients with treated periodontitis, diabetes or a smoking habit are seen more often.

Maintenance for patients who live abroad

Treatment: what can be done, and its limits

Mucositis responds well to professional cleaning, removal of any cement or plaque-retentive overhang, and improved home care. Peri-implantitis is more difficult. Non-surgical mechanical cleaning tends to be insufficient once bone has been lost, and the outcomes of surgical treatment, which may include open cleaning, bone reshaping or regenerative grafting, are described as not predictable (Newman et al., 2019). In advanced cases the implant is removed and the site is rebuilt before a new implant is considered. This is the honest reason our emphasis lies on prevention and early detection, and why our head physician, who works in periodontology, is involved in the maintenance of every implant placed at the clinic (see periodontal treatment).

What determines the cost of implant maintenance?

• Frequency of visits set by your risk profile.
• Whether the restoration must be removed for cleaning (screw-retained bridges).
• X-rays at the intervals described.
• Treatment of mucositis or peri-implantitis if present, from non-surgical cleaning to surgery.

Our prices and campaigns page explains how fees are structured.

Searching for the “best implant maintenance in Istanbul”: what to check

• Were baseline probing values and an X-ray recorded when your teeth were fitted?
• Is a recall interval stated, and is it adjusted to smoking, diabetes or a gum-disease history?
• Does the clinic look for cement remnants and check the bite at each visit?
• Is there a written protocol for sharing maintenance with a dentist in your home country?
• Does a clinician with periodontal training review signs of peri-implant disease?

Frequently asked questions

Related guides

Medical content review: Dr. Dt. Mehmet Fuat BozabaHead physician, works in periodontology and oral surgery · Last updated: October 2026 · About the head physician

Contact: Yayla Dental Akademi, Ferit Selimpaşa Cad. No:44A, Bahçelievler, Istanbul (Basın Sitesi, opposite Migros; about 600 m from İlkyuva metro station). Monday–Saturday 10:00–21:00, Sunday closed. WhatsApp and phone: +90 544 289 66 33 · Online booking: DoktorTakvimi.

Sources

This page is for information only; diagnosis and treatment plans are determined by a dentist after an examination. Prevalence figures are ranges from the cited sources and do not describe an individual outcome.