Implants have no periodontal ligament, and that changes everything in maintenance

Implant maintenance is often handled like that of a tooth, and the anatomical differences between the two make that equivalence risky.

The principal difference is the absence of the periodontal ligament. A tooth is suspended in its socket by fibres connecting it to bone, whereas an implant is in direct contact with it.

The ligament brings blood supply, proprioception and remodelling capacity. The implant has none of these.

The most important consequence concerns defence. Peri-implant tissue has a lower blood supply and its collagen fibres run parallel to the surface instead of inserting into it.

The result is a less effective barrier against bacterial progression in depth, which is why peri-implantitis advances more rapidly than periodontitis under comparable conditions.

The absence of proprioception has a practical effect: the patient does not perceive overload on an implant as they would on a tooth, and reports no symptoms until the situation is advanced.

Probing is performed with even lighter pressure, because the tissue offers less resistance and the probe penetrates more readily at the same force.

Values are interpreted differently and compared with the baseline recorded when the prosthesis was fitted, which is that implant's individual reference.

Bleeding on probing remains the most useful indicator, and its appearance at a previously stable implant should be taken seriously even without an increase in depth.

On instruments the rule is firm: nothing metallic touches the implant surface. Curettes in titanium, carbon fibre or plastic, and coated ultrasonic tips.

The scratch produced by a metal instrument creates a rough surface favouring bacterial adhesion, and the damage is permanent.

Air polishing with glycine or erythritol is now the preferable choice on implant surfaces, because it removes biofilm without mechanical contact and without altering the titanium.

In summary: the absent ligament reduces blood supply and defence, peri-implantitis progresses faster, probing needs lighter pressure and an individual baseline, no metal instrument touches titanium, and fine powders are the better choice.