Normal-Appearing Dental Implant with Pain, Peri-Implantitis, and Bone Loss

Pain, bleeding, and gum tissue swelling around dental implants are common signs of inflammation, otherwise known as peri-implantitis. But in some circumstances, patients report pain around the implant with no apparent signs or evidence of such inflammation. The implant may appear healthy and normal despite such symptoms.

This patient complained of pain around an implant for a couple of years. But at every dental visit, she was told everything looked fine and there were no problems. Clinically, the implant restoration and surrounding gum tissue appeared normal. The X-ray showed slight thinning of the bone in one area, indicative of bone loss, but otherwise with normal appearance as well. A cone beam CT scan was also obtained with no remarkable findings.

The implant crown was removed for inspection. The area around the implant appeared normal, with only slight redness indicating mild inflammation commonly caused by plaque retention from poor oral hygiene. The gum tissue was then probed, discovering deep pockets and advanced bone loss around the implant. The degree of inflammatory tissue and progressive bone loss became clearer after surgical exposure to the implant. Such degree of inflammation and bone loss is consistent with progressive peri-implantitis and reported symptoms. 

Implant surface treatment and bone grafting to regenerate bone around an ailing dental implant may be an option in some circumstances; however, the patient opted for implant removal due to a poor prognosis. The implant was removed atraumatically, and the site was grafted to restore the ridge for future replacement.

Visual inspection and standard 2-dimensional dental x-rays may be inadequate in diagnosing peri-implantitis in an otherwise normal-appearing dental implant. Probing and surgical exploration are necessary for a definitive diagnosis and treatment planning.