Penam Periodontics - Evidence based Personalized Periodontics

Periodontitis and Implants.

The second major risk for late implant loss is periodontal disease and the resultant low grade infection around the implant. The rate of bone loss around an implant is much greater than we see around natural teeth. The risk posed by periodontal disease seems to occur in the same three basic ways as seen for plaque control:

  1. Poor oral hygiene by the patient allowing development of periodontal disease;
  2. Having implant or implant components that prevent patient from cleaning of the implant resulting in the same outcome as poor oral hygiene and periodontitis issues; and
  3. Having implants attachment mechanisms which facilitate plaque accumulation between the implant and the tooth related implant components leading to periodontal issues.

Calculate your risk

Periodontitis should be treated and stable prior to considering implant placement. Patients with periodontal disease are at increased risk of losing implants. Even in mild to moderate periodontitis at ten years they are ~2-3 fold more likely to lose an implant. Patients with more severe periodontal disease are ~2-3 time more likely to lose an implant by 5 years and ~10 times more likely by 10 years. It is important that periodontal disease patients know these facts before starting implant therapy as alternative treatments may offer lower risk of failure and therefore higher risk of success and better outcomes. The alternatives may include bridgework or dentures.

Periodontitis and Implant Component fit. Placement of ill fitted crowns will result in inflammation and bone loss around implants in patients with periodontitis. Patients with periodontitis and implants were ~3 fold more likely to show bone loss at 5 years and ~11 fold more likely to show bone loss by 10 years. The rate of bone loss is much greater in those with poorly fitting or uncleanable crown units. This shows that the long term implant survival is much lower in subjects with even mild to moderate periodontitis compared with those with no periodontal issues.

Implant types which may allow greater plaque accumulation. The older implant designs with plaque retentive issues are associated with greater bone loss and earlier implant loss in subjects with periodontal disease compared with those without. These older designs facilitate bacterial accumulation in small crevices which than leads to growth of the periodontal causing bacteria. There is nothing the patient can do about this – it is a maintenance issue for the dentists who placed them. Our practice does not place these types of implants.

© Penam Investments Pty Ltd 2020.

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