Bleeding around an implant is not normal simply because the implant is present. Peri-implant mucositis is inflammation in the soft tissues without additional supporting bone loss. Peri-implantitis combines inflammation with progressive loss of supporting bone. The distinction depends on clinical findings compared with previous records and appropriate radiographs.

What should trigger assessment?

  • bleeding or suppuration on gentle probing
  • increasing probing depth compared with previous records
  • radiographic bone loss beyond expected early remodelling
  • redness, swelling, recession or difficulty cleaning the restoration
  • pain, a bad taste, discharge or patient-reported change
  • mobility, which may indicate loss of osseointegration or a mechanical complication and requires prompt investigation

Do not use BPE around implants. Record implant-specific probing depths, bleeding, suppuration, recession and the condition of the restoration. Gentle probing is important for monitoring and does not cause peri-implantitis.

Send any comparison you have

Previous records can help show change, so send placement or loading dates, implant details, baseline probing measurements and radiographs if they are readily available.

Do not delay referral if those records are missing or the implant was placed elsewhere. We will document the current clinical picture, arrange the imaging needed and work from the information that can be established.

Look beyond the pocket

Peri-implant disease is often multifactorial. Assess plaque control, access for interdental cleaning, prosthesis contour, residual cement, implant position, soft-tissue dimensions, occlusal or mechanical complications, smoking, diabetes control and the patient's history of periodontitis.

Where the prosthesis prevents examination or cleaning, early restorative input can be as important as instrumentation. A design that cannot be maintained may need modification or removal before inflammation can be controlled.

Refer at the point you are concerned

You can provide site-specific oral-hygiene support, remove accessible deposits and check for obvious excess cement or restorative causes if this is straightforward. Record anything you have done and send the response if known.

None of this is a prerequisite for assessment. If the diagnosis is uncertain, access is difficult or you simply want us to take over the problem, refer immediately and we will complete the investigation and initial treatment. Routine systemic or local antibiotics are not a substitute for mechanical management and their routine use for peri-implantitis in primary care is not recommended.

Refer early when delay reduces options

Early referral does not mean every implant needs surgery. It means obtaining a diagnosis and coordinated plan before further bone loss, soft-tissue change or prosthetic limitations make treatment less predictable.

When should referral be considered?

Consider early specialist assessment when there is:

  • confirmed or suspected progressive bone loss
  • suppuration, deepening pockets or persistent bleeding, whether or not initial care has been attempted
  • an implant in an aesthetically or anatomically demanding site
  • rapid progression, extensive defects or involvement of multiple implants
  • uncertainty about diagnosis, implant position or restorability
  • a need to remove or redesign the prosthesis to gain access
  • complex periodontal, medical or smoking risk
  • a previous failed attempt to treat the site
  • mobility, pain, swelling or an acute implant-related problem

What to send

Send whatever you have. Implant details, placement dates, radiographs, charting, photographs and previous treatment are useful but not required. “Implant problem” is enough to start.

You can ask for diagnosis only, one phase of treatment, complete management or simply ask us to assess and decide what is needed. If the implant was restored elsewhere, missing component or laboratory information should not delay assessment.

What happens after referral?

Assessment considers the implant, surrounding tissues and restoration together. Treatment normally begins with a non-surgical phase and re-evaluation. Depending on the response and defect, options may include supportive care, prosthesis modification, surgical access, resective or regenerative treatment, or implant removal.

The aim is not to retain an implant at any cost. It is to agree a proportionate plan that the patient understands and that can be maintained over time.

Further reading: the EFP clinical guideline on peri-implant diseases and the SDCEP periodontal-care summary.