In short: Implants do not get decay — but the tissue around them can become inflamed. If that goes unnoticed, bone is lost, and this peri-implantitis is considerably harder to treat than periodontitis on a natural tooth. What matters is daily cleaning of the margins, regular professional aftercare and not smoking.
An implant is not a maintenance-free solution. It is the most robust form of tooth replacement we have, and it lasts as long as the tissue around it stays healthy.
Why inflammation at an implant is more dangerous
A natural tooth is anchored elastically in bone through fibres and is well supplied with blood. An implant is bonded directly to bone — more stable, but with less defensive reserve at the transition to the gum. If bacteria settle there, a superficial inflammation of the mucosa develops first. That is reversible. Once it spreads to the bone it is called peri-implantitis: the bone recedes and the implant loses support. That loss is not recoverable, and treatment is demanding.
The second difference is perception. Because there is no nerve in an implant, the early pain signal is missing. Many cases of peri-implantitis are found at a check-up — which is exactly what the check-up is for.
Daily care
- Brush twice daily as usual, with particular attention to the transition between crown and gum
- Clean between the teeth daily — interdental brushes in the right size, special floss to pass under bridges
- With fixed bridges on implants: clean the underside consistently, this is where most accumulates
- A water flosser can supplement but not replace mechanical cleaning
- Watch for blood when brushing — at an implant this is an earlier and more important signal than at a natural tooth
The risk factors that really count
Smoking is the strongest. It worsens blood supply to the tissue, markedly increases the rate of peri-implantitis and takes effect during healing already. Then come pre-existing or untreated periodontitis — anyone who lost their own teeth to periodontitis carries the same risk on to the implant — poorly controlled diabetes, and missed aftercare appointments. Technical factors matter too: a crown margin that is hard to clean makes good hygiene practically impossible, which is why cleanability is part of the planning.
Aftercare at fixed intervals
For implant patients, shorter intervals than for general prophylaxis are appropriate — considerably shorter with a history of periodontitis. Checks cover bleeding tendency, pocket depths at the implant, the fit of the connection, and at intervals the bone level on X-ray. Cleaning uses instruments that do not damage the implant surface — a difference from cleaning natural teeth.
Put plainly: over ten years, aftercare costs a fraction of what a lost implant and its replacement cost. It is the cheapest part of the whole treatment.
Frequently asked questions
How often should I come for checks with implants?
More often than the standard twice a year, particularly in the first year and with a history of periodontitis. We set the interval according to findings and risk profile.
Can implants get decay?
No, titanium and ceramic do not decay. The risk lies entirely in the surrounding tissue — and in your own neighbouring teeth, which can still get decay.
How do I recognise peri-implantitis?
Early signs are blood when brushing, reddened or swollen gum at the implant and a feeling of pressure. Pain comes late. That is why the checks matter more than your own sensation.
Can peri-implantitis be treated?
Yes, and the earlier the more successfully. Treatment cleans the implant surface, surgically in advanced cases. Bone already lost does not come back by itself.
This article provides general information and does not replace a dental examination. Medically reviewed by Dr. F. J. Rodríguez Ruíz, MSc., dentist at A+ Dental, Düsseldorf-Oberkassel.