What Peri-Implantitis Looks Like, Stage by Stage

Most people searching this want to compare what they are seeing in the mirror against what the condition actually looks like. That is a reasonable instinct, and this page describes the appearance stage by stage in as much detail as words allow.

One honest caveat first: appearance alone does not establish a diagnosis. Healthy tissue, reversible soft-tissue inflammation, and established bone loss can look similar from the outside, and the feature that separates them, whether bone has been lost, is only visible on an X-ray. What you can see is enough to tell you whether to get it examined. It is not enough to tell you which condition you have.

What Healthy Tissue Around an Implant Looks Like

Worth establishing the baseline, because most people have never been told what they are aiming for.

Healthy peri-implant tissue is pale pink, similar in tone to the gum around your natural teeth. It is firm rather than puffy, and it hugs the crown closely with a defined edge. There is no swelling at the margin, no color difference from the surrounding gum, and no bleeding when you brush or floss. The crown emerges from the tissue cleanly, and the gum sits at a similar height to that on adjacent teeth.

The most useful comparison is the tissue around your own natural teeth in the same area of the mouth. If the implant site looks noticeably different from its neighbors, that difference is the finding.

Early Inflammation: Peri-Implant Mucositis

This is the stage most people are actually looking at when they search, and it is the stage worth catching.

The tissue looks redder than the surrounding gum, ranging from a slightly deeper pink to a distinctly angry red immediately around the crown. It looks swollen and rounded rather than firm and tapered, so the margin loses its crisp edge and appears slightly puffed up against the crown. The surface may look smooth and shiny where healthy tissue has a matte, faintly stippled texture resembling orange peel.

The defining sign is bleeding on contact. Inflamed tissue bleeds with light brushing or flossing. If you see pink on the brush from one specific spot, that is the finding that matters most, and it is more reliable than color.

At this stage the bone is still intact and the condition is generally reversible.

Established Peri-Implantitis

When inflammation has extended into the bone, additional features appear, and these are the ones that indicate the reversible window has passed.

The crown looks longer. As bone and tissue recede, more of the restoration is exposed. Patients often describe this as the tooth "growing" or looking out of proportion with its neighbors.

Metal becomes visible. A grey or dark band appears at the gumline, or the threaded surface of the implant itself becomes visible. Threads showing above the tissue is an unambiguous sign that supporting bone has been lost.

The gum sits lower than on adjacent teeth. An asymmetry in gum height, particularly noticeable on front teeth, where it makes the implant look mismatched.

A dark shadow through the tissue. Where the gum has thinned over the implant, the metal underneath can show through as a greyish cast without being directly exposed.

Deep pockets. Not something you can see, but a clinician probing gently around a healthy implant finds a shallow sulcus. Around an affected implant the probe descends considerably further.

Signs of Active Infection

Some appearances indicate an active infectious process rather than chronic inflammation, and these need prompt attention rather than a routine appointment.

A white or yellow bump on the gum near the implant, usually tender, is typically an abscess. A small opening that weeps when pressed, sometimes releasing a bad taste, is a sinus tract draining infection from below. Visible pus at the gum margin when the tissue is pressed is unambiguous. Dark red or purplish, boggy tissue suggests a more advanced and long-standing process.

What Is Easy to Misread

Several things look alarming and are not peri-implantitis, and the reverse is also true.

Normal post-surgical appearance. In the first two weeks after placement, redness, swelling, and bruising are expected. Judging the appearance of a freshly placed implant against the descriptions above will mislead you.

Thin tissue showing metal. Some people simply have thin gum tissue, and a correctly positioned, entirely healthy implant can show a greyish tint through it, particularly on upper front teeth. This is an aesthetic issue rather than a disease process, though it is worth having confirmed.

Recession without inflammation. Gum can recede around an implant from causes other than peri-implantitis, including implant position, thin tissue, and aggressive brushing. Recession with no redness and no bleeding is a different problem from recession with both.

Looking fine while not being fine. This is the important one. Bone loss can be significant while the tissue above it looks unremarkable, particularly in smokers, whose reduced blood flow can mask redness and bleeding. Normal appearance is not proof of health.

How to Look Properly

If you want to assess your own implant sensibly: use bright light, ideally daylight rather than a bathroom bulb. Pull the lip well away so you can see the full margin where crown meets gum. Compare the site directly against your natural teeth on the other side of the mouth. Note the color, whether the tissue is firm or puffy, whether the crown looks longer than it used to, and whether any metal is visible. Then brush the area and see whether it bleeds.

Photographs on your phone, taken in the same light every few months, are more useful than memory for tracking change.

What to Do With What You See

Book an examination if the tissue is red or swollen, if it bleeds when cleaned, if the crown appears longer, or if metal has become visible. Be seen promptly if there is a bump, pus, a persistent bad taste, pain, or any movement.

An examination settles what looking cannot. A clinician measures pocket depths, records bleeding on probing, and compares an X-ray against the baseline taken when the implant was restored. That comparison is the only way to establish whether bone has been lost, and therefore which of the conditions described above you are actually looking at.

Dr. Pan assesses peri-implant disease in Wilmington, including implants placed by other clinicians. Related: mucositis versus peri-implantitis, bleeding around an implant, and the early signs of peri-implantitis.