OMFS-0236Implant-related casesInfectionintermediateMandibular left first molar implant (36)

Bleeding and bone loss around a lower molar implant

61-year-old female

Draft — educational study aid, pending faculty review.

§Chief complaint

Gum bleeding and bad taste around an implant placed 6 years ago

§Medical & dental history

01Type 2 diabetes, HbA1c 7.8%
02Ex-smoker
03History of gum disease
04Missed implant maintenance for 3 years

§Clinical examination

01Swollen gum around implant 36 with bleeding and pus on probing
02Probing depth 7 mm (was 3 mm at fitting)
03Implant not mobile; cement residue felt below the crown margin

§ figuresFigures (3)

Dental Implantology — radiology image: The x-ray controlling from 1976/77 shows an subperiosteal implant (according Cherchéve) in the maxilla. Two implant tripods (according Pruin) in the lower canine region and two stabilized blade Implants (according Heinri — Fig. 1The x-ray controlling from 1976/77 shows an subperiosteal implant (according Cherchéve) in the maxilla. Two implant tripods (according Pruin) in the lower canine region and two stabilized blade Implants (according Heinri
“Panoramic radiograph of historic dental implants” · Dentistxxx · CC BY-SA 3.0 · Wikimedia Commons

Dental Implantology — radiology image: Dental radiograph depicting both platform switching and platform matching dental implants — Fig. 2Dental radiograph depicting both platform switching and platform matching dental implants
“Platform switch” · DRosenbach · CC BY-SA 3.0 · Wikimedia Commons

Dental Implantology — radiology image: Dental radiographs demonstrating different emergence profiles on a lower left implant crown. — Fig. 3Dental radiographs demonstrating different emergence profiles on a lower left implant crown.
“Emergence profile” · w:user:DRosenbach · Public domain · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Dental Implantology figures pending faculty review.

§Differential diagnosis

Peri-implantitisBleeding, pus, deeper pockets and bone loss

Peri-implant mucositisBleeding but no bone loss

Failed (mobile) implantMobility means removal

§Final diagnosis

Peri-implantitis of implant 36 with excess cement

Bleeding and pus with deeper pockets and 4 mm of bone loss compared with the baseline radiograph define peri-implantitis.

§Investigations

01IOPA compared with baseline
02Blood sugar control review

§Radiology

01IOPA — crater-shaped bone loss of 4 mm around the implant; radiopaque cement below the crown

§Treatment plan

01Hygiene instruction and diabetes control
02Remove the crown and cement; non-surgical cleaning
03Surgical access, surface cleaning and bone grafting of the crater
043-monthly maintenance

§Surgical procedure

01Flap raised, granulation tissue removed, implant surface cleaned with titanium brushes and saline, defect grafted and covered with a membrane

§Follow-up & outcome

01Month 3 — no bleeding, pockets 4 mm
02Year 1 — bone partly refilled, stable

Outcome: Infection controlled and implant kept with regular maintenance.

§Discussion

01Excess cement, previous gum disease, poor maintenance, smoking and diabetes are main risk factors.

§Clinical pearls / learning points

01Always take a baseline radiograph when the crown is fitted.

§Viva questions

How is peri-implantitis different from mucositis?

Peri-implantitis includes bone loss; mucositis is reversible soft tissue inflammation only.

§MCQs

Q1A key risk factor for peri-implantitis is:

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Tumours Online — Head and Neck

IARC / WHO · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

L1 · Classification — 1
L6 · Textbook — 4

1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

Search latest PubMed evidence

Last literature search: 7 September 2026

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Current Classification