At New York Periodontics, peri-implantitis is one of the core focuses of our practice. As dental implants have become more common, the diagnosis and treatment of implant-related disease has become one of the most important areas in modern periodontics.
Dr. Hector Sarmiento is recognized as one of the clinicians at the forefront of peri-implantitis diagnosis, research, education, and treatment. He has written scientific articles on peri-implant disease, its causes, classification, and treatment, and he lectures extensively on this subject to periodontal programs and clinicians throughout the world.
In 2016, Dr. Sarmiento, along with Dr. Michael Norton and Dr. Joseph Fiorellini, published “A Classification System for Peri-implant Diseases and Conditions” in the International Journal of Periodontics & Restorative Dentistry. This classification system was designed to help clinicians diagnose peri-implant diseases based on etiology, rather than only describing the amount of tissue or bone loss present.
Peri-implantitis is an inflammatory disease that affects the gum tissue and bone surrounding a dental implant. It is similar to periodontal disease around natural teeth, but it occurs around implants. If left untreated, peri-implantitis can lead to progressive bone loss, infection, gum inflammation, bleeding, pus, discomfort, implant instability, and eventually implant failure.
Peri-implantitis usually begins with inflammation of the soft tissue around the implant, known as peri-implant mucositis. At this earlier stage, the inflammation may be limited to the gum tissue and may be reversible with proper treatment. Once the inflammation progresses into the supporting bone, it becomes peri-implantitis.
The BMP most relevant to oral surgery, periodontics, and dental implant site development is recombinant human BMP-2, also known as rhBMP-2. The FDA-approved dental/oral-maxillofacial product is INFUSE® Bone Graft, which consists of rhBMP-2 placed on an absorbable collagen sponge carrier. FDA labeling states that INFUSE® Bone Graft is indicated as an alternative to autogenous bone graft for sinus augmentations and localized alveolar ridge augmentations for defects associated with extraction sockets.
In simpler terms, rhBMP-2 is FDA approved in dentistry for specific bone-building procedures where bone is needed to support dental implants or dental restorations, particularly in selected sinus lift and ridge augmentation cases.
Peri-implantitis can develop for several reasons. While bacteria and plaque accumulation are major factors, they are not the only causes. Dr. Sarmiento’s published work emphasized that peri-implant disease should be diagnosed according to its cause, because different causes require different treatment strategies. His classification described etiologic categories including bacterial causes, exogenous irritants, iatrogenic factors, extrinsic pathology, and lack of keratinized tissue.
Common contributing factors may include:
Because peri-implantitis can have multiple causes, proper diagnosis is essential. Treating every implant problem the same way can lead to poor outcomes. At New York Periodontics, we evaluate why the disease occurred before determining how it should be treated.
Dental implants can be highly successful, but they must be maintained properly. Plaque, calculus, inflammation, and bacterial buildup around implants can lead to progressive tissue breakdown. Unlike natural teeth, implants do not have a periodontal ligament, and bone loss around implants can sometimes progress quickly.
Professional implant maintenance allows us to:
At New York Periodontics, our hygiene team is trained to monitor implants carefully and alert the doctors when early signs of inflammation, bone loss, or tissue instability are present.
Treatment depends on the cause, severity, implant position, bone loss pattern, soft tissue quality, and patient risk factors. In early cases, treatment may involve non-surgical debridement, detoxification of the implant surface, antimicrobial therapy, improved home care, and more frequent maintenance.
Dr. Sarmiento commonly uses biologic materials in combination with bone grafting materials to treat peri-implantitis. These may include PRF, PDGF, EMD, collagen membranes, bone grafting materials, and other regenerative adjuncts, depending on the clinical situation.
In more advanced cases, surgical treatment may be necessary. This can include:
The goal is to reduce inflammation, detoxify the implant surface, regenerate lost bone when possible, improve the surrounding soft tissue, and create a healthier environment for long-term implant stability.
Dr. Sarmiento has helped shape the way clinicians diagnose and understand peri-implantitis. His research has contributed to periodontal education by emphasizing that peri-implantitis is not one single disease with one single cause. Instead, it must be diagnosed based on etiology, anatomy, implant position, soft tissue quality, prosthetic design, and patient risk factors.
His work on peri-implant disease classification has been cited in the scientific literature and has helped clinicians better understand how to diagnose and manage these complex conditions.
At New York Periodontics, this expertise allows us to treat implant complications with a highly specific, biologically guided approach. We do not simply clean around the implant and hope the problem improves. We determine why the implant is breaking down and design a treatment plan around the cause.
Dental implants are a major investment in your health, function, and quality of life. Maintaining them properly is essential. Peri-implantitis can often be managed more predictably when it is detected early, before severe bone loss or implant mobility occurs.
At New York Periodontics, peri-implantitis treatment is one of our most advanced areas of expertise. Through careful diagnosis, scientific classification, biologic materials, laser-assisted detoxification, bone grafting, soft tissue enhancement, and long-term maintenance, we work to preserve implants whenever possible and protect patients from progressive implant failure.
Our goal is to help patients maintain healthy, functional, and stable implants for life.
