Periimplantitis

Peri-implantitis: Symptoms, Causes and Treatment

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Peri-implantitis is a bacterial infection affecting the tissue and bone surrounding a dental implant. It is the leading cause of implant failure and, unlike tooth decay, develops silently — often without pain until significant bone loss has already occurred. Early detection and prompt treatment are essential to save the implant.

At Asensio Advanced Dentistry in Valencia, peri-implantitis is one of the most common reasons patients seek a second opinion or emergency consultation. This guide explains what it is, how to recognise it, what causes it and what can be done. For guidance on preventing it through correct daily cleaning, see our dental implant care guide.

What is peri-implantitis?

Peri-implantitis is an inflammatory condition affecting the soft tissue and bone around a dental implant, caused by bacterial biofilm accumulation. It is the implant equivalent of periodontitis — the gum disease that destroys the bone supporting natural teeth. Without treatment, peri-implantitis leads to progressive bone loss around the implant and ultimately to implant failure.

The condition develops in two stages. The first — peri-implant mucositis — affects only the soft tissue around the implant and is fully reversible with professional treatment and improved oral hygiene. If left untreated, mucositis progresses to peri-implantitis, which involves irreversible bone loss. This distinction is critical: peri-implant mucositis caught early can be resolved completely; established peri-implantitis requires more complex intervention and may not be fully reversible.

Symptoms of peri-implantitis

Many patients are unaware they have peri-implantitis because the early stages are often painless. The following signs should prompt an immediate professional assessment:

Symptom What it indicates
Redness or swelling of the gum around the implant Peri-implant mucositis — early stage, reversible
Bleeding when brushing or probing around the implant Active inflammation — requires professional assessment
Purulent discharge (pus) around the implant Active bacterial infection — urgent treatment needed
Persistent bad breath not resolved by brushing Bacterial accumulation around the implant
Pain when biting or clenching Possible bone loss or implant instability
Implant mobility Advanced peri-implantitis — significant bone loss

Causes and risk factors

Peri-implantitis is caused by bacteria — the same bacterial species responsible for periodontal disease in natural teeth. However, several factors increase the likelihood of developing the condition:

Risk factor Why it matters
Poor oral hygiene Allows biofilm to accumulate and harden around the implant
Smoking Impairs healing, reduces immune response, masks early symptoms
History of periodontitis Patients with previous gum disease are at significantly higher risk
Diabetes (uncontrolled) Impairs immune function and wound healing around implants
Poor implant quality or placement Suboptimal positioning creates areas where bacteria accumulate
Absence of regular professional reviews Early-stage disease goes undetected until significant damage has occurred

How peri-implantitis is diagnosed

Diagnosis requires a professional examination that includes probing around the implant to measure pocket depth, assessment of bleeding on probing, and radiographic imaging to evaluate bone levels. A single X-ray is insufficient — comparison with baseline images taken at implant placement is essential to identify bone loss that has occurred over time.

At Asensio, patients who present with symptoms of peri-implantitis receive a full diagnostic including digital periapical radiography and, where indicated, 3D CBCT imaging to assess the extent of bone involvement before any treatment is planned.

Treatment options

Treatment depends on the severity of the condition at the time of diagnosis. This is why early detection is so important — mucositis treated promptly resolves completely, whereas established peri-implantitis with significant bone loss requires more complex intervention:

Stage Treatment Outcome
Peri-implant mucositis Professional cleaning, improved oral hygiene protocol Fully reversible
Mild peri-implantitis Mechanical debridement, antiseptic treatment, surface decontamination Arrestable — bone loss does not progress
Moderate peri-implantitis Surgical access for deep cleaning, possible bone regeneration Partial bone recovery possible
Advanced peri-implantitis Implant removal, site treatment, possible re-implantation after healing Implant may not be salvageable

Frequently asked questions

Can peri-implantitis be cured?

Peri-implant mucositis — the early stage — is fully reversible with professional treatment and improved oral hygiene. Established peri-implantitis involving bone loss can be arrested but the bone loss itself is generally not fully reversible. This is why early detection is critical — the sooner treatment begins, the better the outcome.

How common is peri-implantitis?

Studies suggest that peri-implant mucositis affects around 43% of implant patients and peri-implantitis affects around 22% — making it the most common complication of dental implant treatment. The majority of cases are preventable with correct daily cleaning and regular professional reviews.

Does peri-implantitis mean my implant will fail?

Not necessarily. Implants diagnosed with peri-implantitis at an early or moderate stage can often be saved with appropriate treatment. Advanced cases with significant bone loss may require implant removal, but even then, re-implantation after treatment of the infection site is possible in many cases.

How can I prevent peri-implantitis?

Consistent daily cleaning with a soft toothbrush, interdental brush and water flosser removes the biofilm that causes the infection. Regular professional reviews every six months allow early-stage disease to be identified before bone loss occurs. Smoking cessation significantly reduces risk. See our guide to cleaning All-on-4 implants and our dental implant care guide for detailed advice.

I have symptoms of peri-implantitis — what should I do?

Contact us as soon as possible. Early intervention makes a significant difference to the outcome. Call us on 0800 048 8058, email office@dentalasensio.co.uk, or visit our dental implants abroad page. UK patients can send existing X-rays for a preliminary remote assessment before travelling.

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Nitrous Oxide Sedation at the Dentist — What to Expect

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Nitrous oxide sedation — commonly known as laughing gas — induces a state of deep relaxation during dental treatment, reducing anxiety, pain perception and emotional stress without putting the patient to sleep. Dr. Lucía Asensio Romero and the team at Asensio Advanced Dentistry in Valencia have used nitrous oxide alongside IV conscious sedation for many years, allowing anxious patients to receive comprehensive dental treatment comfortably.

Nitrous oxide is the most widely used sedation method in dentistry across the USA, France, Australia and Scandinavia — countries with the most developed dental anaesthesiology practices. It has an excellent safety record and is suitable for the vast majority of patients, including those with dental phobia who have avoided treatment for years.

The first consultation is completely free. Call us on 0800 048 8058 or email office@dentalasensio.co.uk to book.

Nitrous oxide vs IV sedation — comparison

Factor Nitrous oxide IV conscious sedation
Administration Inhaled through a nasal mask Intravenous — administered by anaesthesiologist
Level of sedation Mild to moderate — patient remains conscious and responsive Deep — patient is in a twilight state, often with no memory of the procedure
Recovery time 5–10 minutes — patient can drive after Several hours — patient must be accompanied home
Best for Mild to moderate anxiety, routine or moderate treatments Severe phobia, complex or lengthy procedures
Available at Asensio Yes Yes — with anaesthesiologist present

Frequently asked questions

Does nitrous oxide work for severe dental phobia?

For severe phobia, IV conscious sedation is usually more appropriate — it provides a deeper level of relaxation and most patients have little or no memory of the procedure afterwards. See our full guide to conscious sedation abroad at Asensio.

Is nitrous oxide safe?

Yes — nitrous oxide has been used safely in dentistry for over 150 years. At Asensio we use the Master Flux Plus Italian system, which precisely controls the ratio of nitrous oxide to oxygen throughout the procedure. The effects wear off within minutes of removing the mask.

Can I drive after nitrous oxide sedation?

Yes — nitrous oxide clears from the system rapidly. After a short recovery period of 5–10 minutes breathing pure oxygen, most patients can drive. This is one of the key advantages over IV sedation, which requires a companion to accompany you home.

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type of dental implants

Types of Dental Implants: Which is Right for You?

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Dental implants are not a one-size-fits-all solution. The right type of implant depends on how many teeth you need to replace, the condition of your jawbone, your overall health and your budget. At Asensio Advanced Dentistry in Valencia, we offer the full range of implant solutions — from single tooth replacement to complete full-arch restoration for patients with severe bone loss.

This guide explains the main types of dental implants available, who each is suitable for, and how to know which option applies to your situation. All assessments at Asensio begin with a free consultation including a panoramic OPG X-ray — so you will have a clear recommendation before committing to any treatment.

Single tooth implant

A single dental implant replaces one missing tooth with a titanium post, an abutment and a porcelain crown. It is the most common implant procedure and the most reliable long-term solution for a single missing tooth — outperforming dental bridges in both longevity and bone preservation.

The procedure involves placing the implant post into the jawbone under local anaesthesia, allowing it to integrate with the bone over three to six months, and then fitting the final crown. In suitable cases, an immediate implant can be placed on the same day as the extraction.

At Asensio, a single implant costs from £750, using Nobel Biocare or Klockner implant systems. See our prices page for a full breakdown.

Implant-supported bridge (multiple consecutive teeth)

When two or more consecutive teeth are missing, an implant-supported bridge uses two implants to support the replacement of three or more teeth. This avoids the need for an implant for every missing tooth while providing a fixed, stable result superior to a traditional bridge — which requires grinding down the adjacent healthy teeth for support.

Implant-supported bridges are suitable for patients with good bone volume in the area of the missing teeth and healthy adjacent teeth that do not require treatment.

All-on-4 — full arch replacement

All-on-4 uses just four implants to support a complete fixed arch of teeth — upper jaw, lower jaw, or both — in a single surgical session. It is the most transformative implant procedure available and the most popular treatment at Asensio for UK patients travelling for dental tourism.

The angled posterior implants maximise the use of available bone, which means most patients can receive All-on-4 without bone grafting. Fixed provisional teeth are fitted on the same day as surgery. The cost at Asensio is £6,480 per arch — compared to £10,000–£20,000 in the UK.

For full information see our All-on-4 dental implants abroad page and our guide to All-on-4 cost in Spain.

Immediate implants

In suitable cases, a dental implant can be placed on the same day as the tooth extraction — eliminating one surgical appointment and reducing overall treatment time. Immediate implants require adequate bone volume and absence of active infection at the extraction site.

Not every case is suitable for immediate placement. The decision is made after a 3D CT scan assessment. For more information see our immediate dental implants guide.

Zygomatic implants — for severe bone loss

Patients with severe maxillary bone atrophy who are not suitable for conventional implants or All-on-4 may be candidates for zygomatic implants. Instead of anchoring in the jawbone, zygomatic implants are fixed in the cheekbone (zygoma) — which retains its density even when the jaw has resorbed significantly.

Zygomatic implants are a specialist procedure performed by surgeons with advanced training in this specific technique. At Asensio, Dr. Lucía Asensio Romero has over 30 years of experience in complex implant cases including zygomatic implant placement. For more information see our zygomatic implants page.

Implants for patients with bone loss

Bone loss — through long-term tooth loss, gum disease or previous failed implants — is one of the most common reasons patients are told they cannot have implants. In most cases this is not true. Between All-on-4 angled implants, biomaterial augmentation and zygomatic implants, there is a solution for the vast majority of patients with reduced bone volume.

If you have been told you cannot have implants because of bone loss, we recommend a second opinion. See our guide to dental implants with bone loss for more information.

Which type of implant is right for me?

The answer depends on your specific clinical situation — the number of teeth missing, available bone volume, general health and treatment goals. The table below gives a general guide:

Situation Likely solution
One missing tooth, good bone Single implant
2–3 consecutive missing teeth Implant-supported bridge
Most or all teeth missing, adequate bone All-on-4
Full arch missing, severe bone atrophy All-on-4 with biomaterials or zygomatic implants
Tooth needs extracting, good bone, no infection Immediate implant

The definitive recommendation is made after a clinical assessment with OPG X-ray and 3D CT scan if required. At Asensio the initial consultation — including the OPG X-ray and treatment plan — is completely free.

Frequently asked questions

What is the best type of dental implant?

The best implant is the one that matches your clinical situation. For single missing teeth, a single implant is the gold standard. For full arch replacement, All-on-4 is the most effective and cost-efficient solution for most patients. For severe bone loss, zygomatic implants may be the only fixed option available.

Do all types of dental implants use the same materials?

The implant post is always titanium — the same material regardless of implant type or brand. The difference between implant systems is in the design, surface treatment and the precision of the components. At Asensio we use Nobel Biocare and Klockner systems exclusively — two of the most clinically validated brands in implantology.

How long do different types of implants last?

The titanium implant post is designed to last a lifetime and carries a lifetime guarantee on materials at Asensio. The prosthetic restoration — crowns, bridges or All-on-4 prosthesis — may require maintenance over time depending on wear and materials used.

Can I get implants if I have been told I have insufficient bone?

In most cases yes. All-on-4 angled implants, biomaterial augmentation and zygomatic implants are all solutions developed specifically for patients with reduced bone volume. If you have been told implants are not possible, request a second opinion — contact us at office@dentalasensio.co.uk with your existing scans.

How do I find out which type of implant I need?

The first step is a free consultation at Asensio, which includes a panoramic OPG X-ray and personalised treatment plan. Call us on 0800 048 8058 or visit our dental implants abroad page for more information.

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Invisalign Treatment

Invisalign Treatment Abroad in Valencia — Clear Aligners at Asensio

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Invisalign treatment abroad at Asensio Advanced Dentistry in Valencia is performed by Dr. José Luis Lanuza Guillem, orthodontic specialist and certified Invisalign provider with over 15 years of experience in clear aligner treatment.

Invisalign in Valencia costs 50–70% less than equivalent UK private treatment. A full Invisalign case at Asensio starts from £1,800 — compared to £3,500–£5,500 at UK private orthodontic clinics — using the same official Invisalign aligners manufactured by Align Technology.

The first consultation is completely free. Call us on 0800 048 8058 or email office@dentalasensio.co.uk to book.

How Invisalign works

Invisalign uses a series of custom-made removable clear aligners, each slightly different from the last, to move the teeth gradually to their correct position. Each aligner is worn for approximately two weeks before being replaced by the next in the series. The aligners are removed for eating, drinking and oral hygiene — there are no dietary restrictions and brushing and flossing are unaffected.

Stage What happens
Free consultation Clinical assessment, digital scan of teeth, ClinCheck 3D simulation showing projected tooth movement and final result
Aligner fabrication Custom aligner series manufactured by Align Technology — typically ready in 3–4 weeks
Treatment Aligners worn 20–22 hours per day, changed every two weeks — review appointments every 6–8 weeks
Retention Fixed or removable retainer fitted on completion to maintain the result

Invisalign abroad — how it works for UK patients

Invisalign treatment for UK patients at Asensio is structured to minimise trips to Valencia. The initial consultation, scan and aligner fitting can be completed in two visits. Subsequent review appointments — typically every 6–8 weeks — can be scheduled around your availability, with remote monitoring available between visits. Most UK patients make 3–4 trips to Valencia over the course of their treatment.

Frequently asked questions

Is Invisalign painful?

Most patients experience mild pressure for 2–3 days when switching to a new aligner — this is normal and indicates the teeth are moving. It is significantly more comfortable than traditional fixed braces.

How long does Invisalign treatment take?

Treatment duration depends on the complexity of the case. Mild corrections can be completed in 6–9 months. Moderate cases typically take 12–18 months. Dr. Lanuza will give you a precise timeline at the free consultation after reviewing your ClinCheck simulation.

Can I get Invisalign if I have had braces before?

Yes — Invisalign is frequently used to correct relapse after previous orthodontic treatment. A clinical assessment will determine the extent of movement required and whether Invisalign or another approach is more appropriate.

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Complex All-on-4 Case: Full Arch Restoration with Bone Atrophy

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All on 4 complex case dentists

A complex All-on-4 case treated at Asensio Advanced Dentistry in Valencia — a complete upper jaw restoration in a patient with severe edentulism and maxillary bone atrophy, previously rejected by other clinics as unsuitable for standard implant treatment. Dr. Lucía Asensio Romero, specialist in implantology and oral surgery, resolved the case using biomaterials without the need for aggressive bone grafting procedures. The patient left the clinic the same day with fixed teeth and the ability to eat immediately.

complex case All on 4

Cases of this complexity — severe bone atrophy, previous failed treatment attempts, multiple rejected consultations — are precisely the type of situation that Asensio specialises in. Over 30 years of experience and more than 5,000 implants placed means our team has encountered and resolved the full spectrum of implant complexity, including cases that other clinics decline.

If you have been told you are not a candidate for dental implants due to bone loss or jaw atrophy, contact us for a free second opinion — call 0800 048 8058 or email office@dentalasensio.co.uk.

About this case

Definitivas-21

Complex All-on-4 case — preparing material

The patient presented with complete edentulism of the upper arch combined with significant maxillary bone atrophy — a condition that reduces or eliminates the bone volume available for conventional implant placement. Standard implant protocols were not viable without extensive bone grafting, which other clinics had either declined to perform or quoted at prohibitive cost and recovery time.

At Asensio, the case was resolved using the All-on-4 technique with biomaterials — four specially angled implants that maximise contact with the available bone, eliminating the need for bone grafting. The fixed provisional prosthesis was placed the same day as surgery, allowing the patient to leave the clinic with functioning teeth.

Why All-on-4 works for complex bone loss cases

All-on-4 implant surgery

The All-on-4 technique was specifically developed to address the challenge of reduced bone volume in edentulous patients. By angling the posterior implants at up to 45 degrees, the procedure maximises contact with existing bone — avoiding the anatomical areas most affected by atrophy. This approach means that many patients who have been told they need extensive bone grafting before implants can instead be treated directly with All-on-4.

For patients with extreme bone loss where even All-on-4 is not viable, zygomatic implants — which anchor in the cheekbone rather than the jaw — offer a further alternative. See our guide to dental implants with bone loss for a full overview of options.

What the All-on-4 procedure involves

All-on-4 final result

Stage What happens
3D CT planning Planmeca Promax 3D scan maps available bone volume and nerve positions — implant positions planned digitally before surgery
Extractions Any remaining failing teeth removed in the same surgical session
Implant placement Four implants placed — two straight, two angled posteriorly to maximise bone contact with available jaw structure
Same-day prosthesis Fixed provisional teeth attached to the implants the same day — patient leaves with functioning teeth
Final prosthesis Permanent fixed teeth fitted after osseointegration — typically 3 to 6 months later

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Zygomatic implants

Zygomatic Implants: Fixed Teeth When Conventional Implants Are Not Possible

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Zygomatic implants are a specialist surgical solution for patients with severe bone loss in the upper jaw who cannot receive conventional dental implants or All-on-4. Instead of anchoring in the jawbone — which has resorbed to the point where it cannot support standard implants — zygomatic implants are fixed in the cheekbone (zygoma), which retains its density and volume even after years of tooth loss.

For patients who have been told that implants are impossible because of insufficient bone, zygomatic implants often represent the only pathway to fixed teeth without extensive bone grafting. The technique was developed in Sweden by Professor Per-Ingvar Brånemark and has been refined over three decades into a predictable, well-documented procedure with high long-term success rates.

At Asensio Advanced Dentistry in Valencia, zygomatic implants are performed by Dr. Lucía Asensio Romero, a specialist in implantology and oral surgery with over 30 years of experience in complex implant cases. If you have been told you cannot have implants, contact us with your existing scans for a preliminary assessment before travelling. Call us on 0800 048 8058 or email office@dentalasensio.co.uk.

Who are zygomatic implants for?

Zygomatic implants are indicated for a specific group of patients: those with severe maxillary bone atrophy — significant resorption of the upper jawbone — who are not suitable for conventional implants or All-on-4 with standard biomaterial augmentation. This situation typically arises after:

Cause of bone atrophy Why it creates problems for standard implants
Long-term complete edentulism Bone resorbs progressively without tooth roots to stimulate it
Long-term denture use Denture pressure accelerates resorption of the underlying bone
Failed previous implants Bone loss at the failed implant site reduces available volume
Severe periodontal disease Chronic infection destroys supporting bone around teeth
Trauma or oncological surgery Direct bone loss from injury or surgical removal

Not all patients with bone loss require zygomatic implants. Many cases of moderate atrophy can be resolved with All-on-4 angled implants and biomaterial augmentation — as described in our complex All-on-4 case study. Zygomatic implants are reserved for cases where the bone volume is genuinely insufficient for any standard implant approach.

How zygomatic implants work

A zygomatic implant is significantly longer than a conventional implant — typically 30–52mm compared to 8–16mm for a standard implant. It passes through the remaining maxillary bone and the maxillary sinus, anchoring its apex in the dense cortical bone of the zygoma. This provides stable, immediate fixation that does not depend on the quality or volume of the jawbone.

In most cases, two zygomatic implants are used in combination with two or four standard implants placed in the anterior maxilla where bone is more preserved. This hybrid approach — known as the “quad zygoma” or standard zygoma protocol depending on the case — supports a complete fixed upper arch prosthesis fitted on the same day as surgery.

Stage What happens
Pre-surgical assessment 3D CBCT scan, surgical planning, prosthetic design
Surgery Placement of zygomatic implants under local anaesthesia with sedation if required
Same-day prosthesis Fixed provisional teeth fitted on the day of surgery
Osseointegration 3–6 months at home in the UK with functional provisional teeth
Definitive prosthesis Final restoration fitted at second visit to Valencia

Advantages vs bone grafting

The traditional solution for severe maxillary atrophy has been bone grafting — harvesting bone from another part of the body (typically the hip or skull) and transplanting it to the jaw, followed by a healing period of 6–12 months before implants can be placed. Zygomatic implants offer a fundamentally different approach:

Factor Bone graft approach Zygomatic implants
Treatment timeline 12–18 months total Fixed teeth same day
Number of surgeries 2–3 (graft + implants + prosthesis) 1 surgical session
Donor site surgery Yes — hip, skull or chin No
Graft failure risk 10–30% depending on case Not applicable
Cost Significantly higher Lower total cost — fewer procedures

For a real example of a complex bone atrophy case resolved at Asensio, see our complex All-on-4 clinical case — full arch restoration in a patient previously rejected by other clinics.

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Frequently asked questions

Am I a candidate for zygomatic implants?

Zygomatic implants are indicated for patients with severe maxillary bone atrophy who are not suitable for conventional implants. The definitive assessment requires a 3D CBCT scan to evaluate bone volume, sinus anatomy and surgical access. If you have been told you cannot have implants due to bone loss, send us your existing scans for a preliminary remote assessment — contact us at office@dentalasensio.co.uk.

Is the surgery painful?

Zygomatic implant surgery is performed under local anaesthesia. Conscious sedation is available for patients who prefer it. Post-operative discomfort is typically managed with standard pain relief and most patients describe the experience as less uncomfortable than anticipated. Mild swelling for 3–5 days is normal.

How long do zygomatic implants last?

Long-term clinical studies show zygomatic implants have success rates above 95% at 12 years. The zygoma — unlike the maxillary bone — does not resorb, providing a stable foundation for the implant throughout the patient’s lifetime.

Can I have zygomatic implants if I have already had failed conventional implants?

In most cases yes. Failed implants are removed, the sites are treated, and zygomatic implants bypass the compromised area entirely by anchoring in the cheekbone. Each case is assessed individually with a 3D CBCT scan before any treatment is planned.

How many trips to Valencia are required?

Most patients require two trips: the first for the surgical assessment and implant placement (typically 4–5 days including pre-surgical consultation), and the second for the definitive prosthesis fitting 3–6 months later. Fixed provisional teeth are worn between visits. For more information visit our how it works page or our dental implants abroad page.