Periodontal disease is a serious bacterial infection that affects the soft tissues and bone supporting the teeth. This infection causes inflammation and leads to the gradual destruction of the jawbone, which anchors the natural teeth in place. Dental implants are surgical fixtures, typically made of titanium, placed into the jawbone to replace the root of a missing tooth, providing a stable foundation for a prosthetic crown. Whether these two conditions can coexist depends entirely on the patient’s current state of health.
Candidacy and Necessary Treatment Prerequisites
Implants cannot be placed in the presence of active periodontal disease because the infection will compromise the surgical site and lead to implant failure. The first step for any patient with a history of gum disease seeking implants is achieving complete periodontal health. This process often begins with non-surgical treatment, such as scaling and root planing, a deep cleaning procedure designed to remove bacterial deposits and tartar from below the gum line.
Once the active infection is managed, the gum tissues must be allowed a period of stabilization. The dental professional monitors pocket depths and inflammation levels to confirm the disease is arrested. The next step is evaluating the remaining bone structure, as periodontitis causes bone loss that may leave insufficient volume to support an implant. Significant bone loss may require a preparatory procedure like bone grafting or a sinus lift to rebuild a dense foundation. Only after the disease is stable and the jawbone has sufficient volume and density is a patient cleared to proceed with the implant surgery.
What is Peri-implantitis?
Individuals who have successfully overcome periodontitis carry a heightened risk for peri-implantitis after the implant is placed. Peri-implantitis is an inflammatory condition affecting the tissues surrounding a functional dental implant. This condition begins with peri-implant mucositis, which involves inflammation and bleeding of the gum tissue around the implant without associated bone loss.
If left untreated, peri-implant mucositis progresses to peri-implantitis, where the inflammation spreads to the bone and begins to cause bone loss around the implant fixture. The underlying cause is the colonization of the implant surface by bacteria, often the same types that caused the patient’s original gum disease. Common symptoms include gum swelling, redness, bleeding when probed, and the presence of pus, which ultimately leads to a loss of the supporting jawbone and potential implant failure.
Long-Term Care for Implant Survival
Because a history of periodontitis increases the susceptibility to peri-implantitis, long-term maintenance for these patients must be rigorous. Daily home care requires specialized tools to effectively clean the implant post and the prosthetic crown, such as floss threaders, tufted floss, and water flossers. Consistent and thorough cleaning prevents the bacterial plaque accumulation that initiates inflammation.
Professional monitoring and cleaning must also be more frequent to ensure the earliest signs of inflammation are addressed immediately. Patients with a history of gum disease typically require professional maintenance appointments, including cleanings and monitoring, every three to four months. During these visits, the clinician performs periodontal probing and takes routine X-rays to monitor the bone level around the implant, identifying early signs of bone loss before the condition becomes difficult to manage.
Alternatives to Dental Implants
For patients who are not suitable candidates for implants, either due to severe, irreversible bone loss or an inability to maintain the required level of oral hygiene, other restorative options are available. A fixed dental bridge is one common alternative, which replaces a missing tooth by anchoring an artificial tooth to crowns placed on the natural teeth on either side of the gap. While bridges are fixed and stable, they require the adjacent teeth to be permanently reduced to accommodate the crowns.
Another option is a resin-bonded bridge, such as a Maryland bridge, which uses metal or porcelain wings bonded to the back surface of the adjacent teeth, thus preserving more of the natural tooth structure. Removable partial dentures are a third option, which is a custom-made appliance that replaces multiple missing teeth and can be taken out for cleaning. Although partial dentures are often the most affordable solution, they offer less stability than fixed options and can sometimes accelerate bone loss over time.