Gum Problem Around Dental Implant

A gum problem around and implant can be the beginning of the end for the implant.

Gum On Implants VS. Teeth

Because dental implants are not teeth they behave differently than natural teeth.  Dental implants need extra thick gums.  They also need as much gum as possible around them.  This may be more important than the bone foundation!

In this video I describe two types of gum tissue that we all have.  There is a proportion of “good gum” that is attached and strong, versus loose gum that is found closer to our lips.

Symptoms Of Gum Problems Around Implants

If you are experiencing redness, receding gum line, tenderness, pain, bleeding, pockets, inflammation around your implant there is likely a gum problem.  These are the common symptoms of a gum problem around dental implants. Of course brushing it very well will help but if the gum is not healthy it likely needs to be surgically corrected.  Dental implants fail because of gum problems.

Gum problem on dental implant
Gum problem on dental implant

Gum grafting can correct some of the problems.

This video is really important so take a few minutes to watch it!

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Burbank, California

Video transcription:

Hello, I’m Dr. Ramsey Amin. The topic today is gum problem. I have a gum problem around my dental implant. That’s something we see a lot of, and we’ll begin to see more of over time, not because dental implants are bad, but sometimes they’re not treatment planned appropriately, and sometimes, genetically, our gums are little thin. So, we might have enough bone, and that’s oftentimes the focus, bone, bone, bone. You don’t have enough bone, but the reality is it’s the gum that provides the life and longevity to dental implants, so let’s get into this topic a little deeper. If you’re having a gun problem with your implant, it’s probably red. It probably hurts. It probably bleeds. It probably is inflamed and just looks a little funny or just kind of tender when you brush. Those are things that aren’t normal.

There’s two types of gums to have around our mouth. I’ll kind of show you my own teeth here. We have the light pink gum that’s right near the surface of our teeth, and that’s really durable. It’s kind of like the surface of our… the skin of our hand or palm. It’s very dense. You can beat it up, and it can take a lot. The other type of skin is the one under our lip, really low, like down in here, this pink stuff with all the veins in it, and it moves around a lot. That gum is more like the skin around our eyelid. It’s very, very tender and very thin. So, we have two types of gum in our mouth, that thick, attached, keratinized gingiva we call it. That’s the thick stuff. Then, we have the thin, mobile gum tissue that allows our lip to move and to make these motions. I know I kind of look funny doing this, but I want to get the point across.

Really, if your implant doesn’t have enough of this good gum around it… Of course, it has to have bone, but if it has this good gum around it, it can often make up for not enough bone around an implant and really hold it stable over time. So, a gum problem can be remedied by a gum graft if it’s done soon enough. Sometimes I do them before the implant. I actually add gum through some way. I can borrow gum from the inside and transfer it to the outside, or I can rotate some of the fat from our cheek and bring that in.

Or, sometimes it’s done before the implant. Sometimes it’s done during the implant. Sometimes we have to do it after the implant, although we’d like to do it before as much as possible so that we don’t have a problem. The sooner it gets done, the better. Once you begin to lose bone around the implant, the success of a gum graft, bringing back that good skin, is less successful, and that skin or that gum comes from the roof of our mouth over here, usually on the side, on the upper right, our left side, or right behind our wisdom teeth on the upper. It’s called a tuberosity. It’s got a lot of dense gum, like this hand skin.

So, that could be transplanted, basically placed underneath there, stitched in place. It’s a very delicate and precise procedure, especially around an implant done with very, very fine suturing we call microsurgical. Some of these I call oral plastic surgery procedures, and they will help bring back maybe a tooth that looks too long, or it doesn’t have the gum on either side. Not all teeth are correctable this way. Sometimes I wish that we could correct all of them. In fact, I see 35% of what I do our revisions and redo procedures, so I’m kind of sometimes the last guy people see when there’s really a big problem. Obviously, if we can do it right the first time, but some people genetically just have very thin gum. They don’t have any of that good skin. They just has really nothing at all, and they’re maybe not a great dental implant candidate, or at least they need to go through more procedures to get a good, solid, long-lasting result.

Sure, anybody can put an implant in, and anybody can make the teeth, or do an All on 4, or whatever, but longevity to these procedures. I have cases that are 20 years old at this point, and I’m proud of them, and it’s because they’ve undergone a really good treatment plan, really good execution as well. If you have a gum problem, the bottom line is treat it early. Probably have a gum graft using your own gum as opposed to a synthetic or cadaver type of gum. It’s called AlloDerm.

Those are other options, not quite as good. They’re better for teeth. Gum grafting around teeth is much easier, does not require as much technical expertise. Gum grafting around implants is definitely a very specialized methods, and techniques, and tunneling. We don’t always open the gum. We just make a tunnel and put it through in that direction. So, again, give some consideration to that. If you’re having a gum problem, treat it early. Feel free to ask them questions on this post over here, and I’ll try to get to them as soon as I can, but certainly get yourself taken care of.

47 thoughts on “Gum Problem Around Dental Implant”

  1. Hello, Dr. Ramsey! I’ve started my front upper tooth implant journey 2 years ago. After removing remnant of the broken tooth the surgeon put bone graft and implant all at once. It got infected and implant failed. The surgeon removed everything and did the bone graft. 4 month later he put second implant. 4 month later comes the implant check. ( This time successful) Unfortunately every time the surgeon sees me he keeps cutting my gum, creating scar tissue. Also with time my gum recessed and looks like the rats took to it. Now, I’m being presented with three choices. 1- to create a crown with a gum looking porcelain to close the gap( my last resort), 2- to go to periodontist and do the gum graft ( which I can’t afford), and 3- take another 6-8 months to let my gum naturally grow/mature ( which I’m leaning towards ). However the surgeon wants to remove the healing abutment and stitch my gum close. How necessary is it to close my gum? Cutting it again will create more scar tissue and more stress on the gum!. Please let me know if it is necessary to remove the healing abutment for the gum growing/ healing purposes? Thank you!

    Reply
    • Remove the healing abutment for the gum growing/ healing purposes is easy and cheap. You do not need to wait 6-8 months after that but rather only 4-6 weeks! I sense there is a bigger problem , but burying the implant again is an easy way to get back that gum and just move it to a better position. Let me know you received this response!

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  2. ai have 4 dental implants on my bottom On the left side and one in the middle have a receding gum line what should I do?

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  3. Aloha e Dr. Amin- I have full top permanent dental implants [6] with bone grafts being done. The procedure began in August 2019 [three years ago]. Long story, but I had moved out of state and was flying back and forth to continue the work, until CO19. I have since been going to a DDS in my new state. Everything was good until my permanent tops went on [6 months ago], and now I have one spot that keeps having issues. The Dr. has tried removing the permanent dentures and lasering the gum at that one spot [three months ago] and most recently [last week] he removed the tops again to cut back the gums in that one area. I am very good with my dental hygiene so am wondering why this one spot just does not heal up? And is there anything I can be doing on my end to remedy this issue? Mahalo for sharing hour expertise with all of us!

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  4. Dear Dr. Amin,
    I had three implants placed in the lower jaw on 11 July. I did it in another city. Everything went find, but then last week I started feeling some pain around on of the implants. I went to see the doctor and they told me I was not cleaning my temporary abutments properly. I thought I just need to use surgical very soft brush and gently go over, but it seemed I need to brush it more thoroughly. The doctor cleaned the area, said the stability is OK. She said I need to brush around the abutment, but I am a bit scared. Today everything is painful as I believe she irritated the gums while cleaning, but I am still freaking out. How thorough I need to be with this cleaning? After every meal or? Can I do some damage? Would salt water help now?
    Thank you very much!

    Reply
    • It sounds like you had been placed about a month ago. At this point he should be able to brush them just like any other tooth including using an electric toothbrush. If the gum is tender it is possible that may be something is wrong or possibly the gum tissue is just too thin. If the implant is doing well but the gums are thin I would suggest you do a gum graft onto the implant. Basically he would be donating gum from the roof of your mouth and transplanting it into the area of the implant. It is a very common procedure that I do a few times a week.

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  5. I’ve developed an infection with my dental implant that has caused some bone loss, in which they are planning to do a bone graft. But they say this happened because I have a gap between my implant and both teeth beside it. This has been the case for 25 years and I’ve had no problems and they’ve made no suggestions to fix the gaps except if I wished to due to aesthetic reasons. I feel like they should have advised this earlier or at least caught it in 2X year cleanings and got me in to the specialist before the infection got to the point where it caused bone loss. Now, I have to pay thousands of dollars to fix!! My question is: is it true you need to have implant touching both teeth or you risk infection? are there other ways to prevent infection? should I change dentists?

    Reply
    • It sounds like a space developed between your crown of your implant and the tooth next to it. This can cause bone loss which leads to infection. Even though you have been seen on a regular basis, sometimes dental implants problems progressed very quickly and unbeknownst to you or your dentist. It can unfortunately go from 0-60 in 3 seconds as an analogy.

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  6. Hello there. I received a dental implant on my tooth ~4 years ago and, until recently, have had no issues. As of the past 3-4 months, I have been experiencing irritation and gum recession at my implant and neighboring teeth on either side. I went to my dentist, who gave me one of those insertable antibiotics. It seemed to get a little bit better, but the gum recession has now gotten worse and pulled away some from the implant. Would gum grafts be a feasible fix?

    Reply
    • Sometimes a gum graft will fix things. Rarely will a bone graft correct a problem around an implant but a thick gum graft can buy you some time in certain situations. Is the implant in the front of the mouth?

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  7. Hi I just had my front tooth removed and an immediate implant on #8 top tooth 4 days ago. I have noticed the seems the post isprotruding on the backside of my gum. Is that normal?
    Please advise.

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  8. Hi I had 2 implants fitted after stitches removed gums were sore swolllen,1 implant fine but other the gum is swollen around the implant looks like the implant is being covered by the gum trying to heal over it,rang dentist who said sounded fine not to worry it was normal,but I’m worried something is not right surely 2 weeks after surgery it shouldn’t be swollen over the implant?

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      • Hello Dr. Ramsey,
        I had an implant on the 4th tooth (upper right quadrant, 2nd premolar). It was a one step surgery, a tooth extraction and an implant (no tooth inflamation was present). 8 days after surgery and still i can’t stop taking pain medications (alternating every 4 hours between paracetamol and ibuprofen). I referred back to my dentist: all is fine: gums seems very good (neither swollen nor inflamed, just a clear pink color with no bleeding signs or irritation)- dental implant is completely stable). Worth to mention that on the 6th day, pain is more localized in the gum area (on the tip of the screw positioned on my implant). On the 7th day, not knowing what to do with my pain, i started zithromax 500g for a 3 days period (i have a feeling it helped but still). Today is my 8th day and i still feel pain with an intensity ranging from 4 to 8 over 10 and that 4-5 hours after taking my medications (paracetamol and ibuprofen). Is it normal to still feel pain with this intensity and for how much time it is normal to last? I’m worried about that although no signs of infection is present around my implant. Before my 7th day, even with medications, there was always pain in the background (3/10). How much will it last? What is the amount of time i will still experience this intensity of pain and for how long i will still have to take pain medications (whilst considering at all times that no signs of infections are present on site). Is it normal?

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  9. Hi Dr. Ramsay, Would really appreciate your thoughts/suggestions on the following. Further to having a dental implant fitted 3-yrs ago approximately I’ve been in constant discomfort and very often pain in the surrounding area. There’s a sensation of something needing to be shifted from underneath the crown and I’m constantly sucking air through the tulip shaped crown. The crown was rotating persistently on its axis however even recently I’ve been told that the implant itself is ‘sound’. The discomfort sometimes feels like a hot soldering iron being wedged into my gum/jaw and mostly feels like the implant is being torn away from my jaw. Sometimes there’s a sensation of barbed wire being dragged along my gum. Nothing I’ve tried gives long term relief from the discomfort and I suffer from a lot of headaches from this. Dentogen / clove oil sometimes gives slight relief however rarely. It’s been suggested that the crown is removed and a cap covering to the hole left behind is fitted to determine whether symptoms are alleviated however, particularly as this is making me feel so very, very low I’m exhausted and at a loss as to what is likely to help. Your comments would be appreciated. Thank you.

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  10. Hello Dr. Ramsey. Last Monday, I noticed my front tooth, number 7, was loose. I saw my dentist the next morning. Apparently the post from a root canal I had done a long time ago detached. I had veneers placed on six of my front top teeth about 8 years ago, and they still look good, but now this is jeopardizing everything. I do not want a bridge, and I’m very concerned about the gum receding with an implant. Is there anything I can do to better the outcome of implant surgery? A probiotic? A gum stimulator? Anything? Please advise as soon as you can – I have to decide quickly. Thank you.

    Reply
    • Sorry. Just seeing this now In the spam folder. What did you end up doing? Best thing is to be treated by someone with A LOT of experience. Front teeth are considered the most difficult to get great long term results

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  11. Hi Dr.Ramsey, I have a minor hole at the end of my front teeth and I’ve had a major cavity on (my) left lower tooth for a while now and it feels like the gum around it is a bit bigger than normal. I haven’t had insurance till recently so I’ve never seen a dentist. I will be seeing one in a couple weeks but until then, is there any thing I can do to help the tooth and the pain that comes with it

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  12. Greeting Dr. Ramsey! I had a second front tooth dental implant with socket bone graft 13 days ago. I had no pain the day after surgery and the gums around the implant looked okay. The only problem that still persists is some swelling at the roof of my mouth. Two days ago, I noticed that gum tissue around the the implant is receding. I went to the clinic and they took away the sutures, saying it’s okay. Should I be worried that this is the beginning of the end, as you say? I don`t think gums can grow back at this point. What do you advise? Thank you very much.

    Reply
    • This may not be the beginning of the end. It depends if the implant was put in with a surgical flap or if it was placed without a flap.

      A flap is where the gums are open and then sutured closed. In this method which is really common, the gum may look worse at first and then bounce back.

      Keep me posted 👌

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      • Thank you for your answer dr. Ramsey!
        I do appreciate it very much! It might have been a gum flap.I could see a small gap with sutures after surgery, which grew larger after 10 days and the gum line went a little bit higher.
        Maybe I did wrong around that time trying to clean the area, even though very gently with a very sot toothbrush. I am only rinsing with chlorhexidine now. Let’s hope for the best!
        Thank you very much!!

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  13. Greetings dr. Ramsey!
    I had a single dental implant surgery 13 days ago of my second front tooth. Everything went fine, no pain the day after the surgery and gums around the teeth looked good. The only problem that persisted was a little bit of swelling at the roof of my mouth. Two days ago , I noticed that the gum around the temporary crown is receding. I went to the clinic yesterday and they took away the sutures, saying it’s okay. I do have problems with gums and I am afraid they won’t grow back and it might be the beginning of the end, as you say.
    What do you advise? Thank you very much.

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  14. I broke my front tooth off into my crown a few weeks ago. The other front tooth was cracked, so I had them both pulled so I can get implants.
    I ended up having bone and grafting done 2 weeks ago. I went back to get my stitches taken out last Monday. The oral surgeon said, some of the membranes were showing. He may take out in a few weeks. He said it was going to take longer to heal. I’m a diabetic so I’m not shocked.
    The area what would be behind my two front teeth is swollen (roof of mouth) and I’m in a lot of pain. I’m concerned something is wrong. The bone and graft came from the back area of my mouth. No pain there.
    Could this be a failed bone and graft?
    Should I still be hurting?

    Reply
    • If you are in a lot of pain in it already been 2 weeks then you may be having partial failure of the graft. I am assuming your diabetes is in good control with a reasonable A1c below 7 and not very high. You might need to take another round of antibiotics until this heals. It should not still be hurting

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  15. Hi-
    I had #15 removed May 2020 after having a root canal that had problems. January 2021 I had a sinus lift, bone graft (bovine) and titanium implant done. The oral surgeon said normally can do without having #15 but it bugged me a lot not having a tooth there. I also grind my teeth which doesn’t help. The oral surgeon said I was healing well when I went back for follow up. I went back a month ago as I was concerned as something didn’t feel right. He looked at it and said it looked good but to make sure #14 (root canal years ago and crown) is ok as if not it will mess up the bone graft. My dentist took an xray and said #14 loooks fine (temp crown fell off and took xray with it off) I previously had the endodontist look at it to make sure #14 was ok (w/temp off) My gum has been numb since the surgery which I was told is normal and now not really numb, but it hurts in the back on the top of my gum way in the back. If I touch it, even from outside of my cheek, it feels like pain radiates from the very back to where #14 is. I have what feels like a slimey mouth all the time and taste is not great. Feels like the top gum above #14 & #15 and back from #15 is heavy is the only way to describe it. #14 (crown) that after #15 was removed, the gum above #14 receded a bit. The crown was removed and it’s been a process to get the permanent crown put on. I was going to do it before the implant procedure, but they had a cancellation and so I took the appt for the sinus lift, bone graft, and implant. (The temp fell off of #14 but the surgeon said it was fine to do the surgery) He did the sinus lift above #14 as well as #15 just in case #14 became a problem in the future. I have another temp crown on #14 as waiting for the permanent. Could my gum be infected? There is no pus and it looks more white than the other gums in the back above/behind #15. Could I be allergic to the implant material (bovine) or the titanium implant? He didn’t want to do the ceramic type implant. I feel like my body is fighting something and feel it has to do with the implant as it just started about a month or so after the implant surgery. My mouth doesnt feel normal at all. I don’t have a fever and even when I get sick I rarely get a fever. I really wish I never had this surgery at this point. My sinuses have been fine, no discharge, etc. Will my mouth feel better once the crown is put on the implant on #15? Would a CBCT scan be good to have? I am really worried. Sorry…I just don’t know where to turn. Thank you for any help or suggestions you can offer, I appreciate it.

    Reply
    • Hi Debbie,

      Sorry for the late reply. How is it now? Yes, a CBCT would help see things more clearly. Something is not right. It should feel like nothing is there at all.

      Let me know. Maybe have another DDS have a look at it?

      Dr. Amin 😊

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      • Good Morning Dr. Ramsey,
        I recently received a dental implant in October. The healing process had been fine. No signs of infections and the area had cleared properly. I went to my dentist for my final check up for my crown and they removed the implant for the first time in 5 months for an impression. 4 days later the implant area has become swollen. I’m not in any pain but this is the first time I have been swollen around the area. I called my dentist and they prescribed amoxicillen. Do you think my implant was infected when they removed the implant? Im feeling scared and a little upset because I practiced my oral hygiene and kept the area clean. Will the antibiotics heal the swelling and bring my gums back to normal?

        Reply
        • It should go back to normal in just a few days. Sometimes there’s a little bit of bacteria trapped underneath the healing abutment. It may have been a tiny bit loose and you did not recognize it. All should be good. Keep me posted if it is not. How is it now?

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          • Good evening Dr., I had a cap on my tooth in right side upper 4 and 5 before 5 years, it 6 paining now for the past 5 days due to corona I am afraid to go to Dr., but I feel my face is bulging due to pain, so I am taking antibiotics with pain killer, in this time shall I go for covid vaccination?. Please let me know what shall I do Dr.

          • Dr. Ramsey,
            I’m having a similar issue. Dental implant healing was fine no issues until I get my crown 6 months later. I had some pain with biting and the crown had a big space between the neighboring tooth. Finally the dentist replaced it with a different crown and now it feels tender at the gumline consistently. Oral surgeon and Prosthodontist have both said the implant is stable, x-Ray is normal and the bite is fine as well as no sign of infection. What could be wrong?

  16. do implant go in straight or angled? had an implant next to my canine that coursed problem, when eating i would have pain in the real tooth, dentist root canaled my good tooth and crown it. few years later i was eating when said tooth snapped in upper jaw, saw on x-ray that implant had cross the root of the tooth so close that i believe pressure from it snapped the tooth. had root extracted implant put in it is on an angle to it look to me to be just about on top of the implant next to it, it was just put in, could this cause me problems? i have quit a few implant at the cost of these thing if there ‘s a problem can implants ,be replaced .dentist put crowns on my back teeth that are short causing problems with my bite and jaw .he won’t replace them ! told him of problem he won’t pay to fix this.and i think he should!! do i have recourse in this??

    Reply
    • Hi Anna,

      Great question! Usually this means there is a bigger problem under the gum. The bone is likely melting away causing this. I would suggest you see someone asap.

      Keep me posted

      Dr. Amin

      Reply

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