Periodontal disease and the risk to Implants

Every year patients are referred to me for implant consultations. The patients have already lost or are about to lose teeth through active periodontal disease. The risk of placement in mouths with active disease is at best poor cosmetic outcome. At worst, full implant loss. Neither being the outcome anybody wants.

There are 3 categories

1 – For referred patients found to have no dental disease at all the implant process is simple, straightforward and the end result is the best it can be cosmetically. Simple yearly reviews are all that’s required post operatively.

2 – For referred patients found to have minor gingival inflammation a course of hygiene therapy is required. This is backed up with meticulous home care. Once stable and maintained gingival health is achieved, implant treatment can begin. Post operatively, providing the oral hygiene standard doesn’t slip, reviews are all that’s required.

3 – For referred patients found to have substantial active periodontal disease. Implant treatment doesn’t begin until periodontal treatment has proved to work, there should be no infection at all prior to placement. Placement with periodontal disease is total failure at the outset.

Just as periodontal disease causes bone and tooth loss, the equivalent disease process around implants perio-implantitis causes bone loss and implant loss. For this reason I work closely with two periodontologists. Optimum gingival health is essential for predictability in implant work.

Advanced periodontal treatments are used to achieve optimum gingival health. A product called ‘Emdogain’ is delivering extremely good results in drastically reducing pocket depths. It is an organic enamel derived matrix sourced from pig enamel. For the patient it requires a minor oral surgery procedure. This procedure results in the re growth of mandible and maxilla bone. Stabilising bone loss. Of course at every step of the implant process the patient is fully consented on any referral / procedure required.

Obviously, there is and will continue to be patients referred to me after having implants placed elsewhere who are developing the signs and symptoms of periodontal problems around implants.

There are 2 types :-

Peri-implant mucositis-minimal bleeding on probing, slight inflammation, no periodontal pockets.

Peri-implantitis– pockets around implants, lots of inflammation and bleeding, loose implant(s) and suppuration.

Both of these conditions can and are treated here with good results. Despite what some patients believe, implants require good oral hygiene, regular examination and looking after just as you would a natural tooth. So education here is key with annual detailed implant check ups.