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September 1, 2026Periodontitis does not automatically rule out the possibility of dental implant treatment, but the condition must be assessed and managed before the implants are placed.
The health of the gums and the bone supporting the teeth is essential both for the stability of natural teeth and for the long-term success of dental implants.
In this article, Dr. Anamaria Ghiurcă, a specialist in periodontology, outlines the appropriate approach for patients with periodontal conditions who require dental implant treatment.
What is periodontitis and how does it affect oral health?
Periodontosis, medically known as periodontitis, is a chronic inflammatory condition that affects the tissues supporting the teeth: the gums, the periodontal ligaments and the alveolar bone. The main cause is the build-up of bacterial plaque, but the progression of the disease can be influenced by contributing factors such as:
- individual predisposition;
- smoking;
- poor oral hygiene;
- unhealthy habits;
- ill-fitting dental prostheses;
- certain systemic conditions.
The disease begins with inflammation and bleeding of the gums. As it progresses, the following may occur:
- gum recession;
- persistent bad breath;
- tooth sensitivity;
- the formation of periodontal pockets;
- tooth mobility or shifting.
In advanced stages, the inflammation progressively affects the structures that anchor the tooth in the bone. Loss of bone support leads to increased tooth mobility and may ultimately result in tooth loss.
Bone resorption – the most significant consequence of periodontitis
Bone resorption occurs when periodontal inflammation leads to the progressive loss of the alveolar bone that supports the teeth. As bone volume decreases, the teeth have less and less support and may become loose.
The quantity and quality of bone are also important when considering the replacement of lost teeth with dental implants. The implant must be inserted into an adequate volume of bone in order to achieve stability and to allow the process of osseointegration to take place.
For this reason, patients who have suffered significant bone loss due to periodontitis may, in certain situations, require bone regeneration or augmentation procedures prior to or at the same time as implant placement.
Can you have a dental implant if you have periodontitis?
Yes, dental implants can be an option for patients with periodontitis, provided that the periodontal disease has been treated, controlled and its progression halted prior to the procedure.
“The presence of active periodontal inflammation can compromise the health of the tissues surrounding the future implant and increase the risk of complications. Therefore, the decision to place an implant is only made following a periodontal assessment and once the disease has been stabilised. Once the inflammation is under control, the implantologist can analyse the available bone volume and determine whether the implant can be placed under favourable conditions.” – Dr Anamaria Ghiurcă, specialist in periodontology at the DENT ESTET clinic, 98 Aviatorilor.
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When is a dental implant recommended?
Dental implant treatment may be recommended to replace a single missing tooth, several teeth, or as part of an extensive oral rehabilitation.
The suitability is determined on a case-by-case basis, following clinical and imaging assessments and depending on the prognosis for the remaining teeth.
In the case of periodontal disease, a dental implant may be recommended when:
- periodontitis is stabilised;
- oral hygiene is adequate;
- the necessary bone conditions for implant support are present.
When should treatment be postponed?
Dental implant treatment should be postponed if there is active periodontal disease or other conditions that may affect healing and osseointegration.
Gingival inflammation, active periodontal pockets, inadequate oral hygiene or certain uncontrolled systemic conditions require assessment and treatment prior to the procedure.
How is the treatment plan determined?
The treatment plan is drawn up following a comprehensive assessment of periodontal health, the remaining teeth and bone structure. In complex cases, collaboration between the periodontist, implantologist and prosthodontist allows the various stages to be integrated into a plan tailored to each patient’s situation.
The importance of a dental consultation
A specialist consultation enables the stage of periodontal disease to be determined and an assessment to be made of whether existing teeth can be preserved or replaced with implants.
The clinical examination is supplemented by radiological investigations, such as cone-beam computed tomography (CBCT), which can provide three-dimensional information on bone volume and the anatomical structures important for implant planning.
Periodontal treatment prior to dental implant placement
Periodontal treatment aims to control inflammation and infection prior to the insertion of a dental implant. Depending on the severity of the disease, this may include:
- professional cleaning and control of bacterial plaque;
- subgingival cleaning (subgingival curettage) and treatment of periodontal pockets;
- regenerative or resective procedures, where indicated;
- periodontal reassessment to check the response to treatment.
Only once the condition has stabilised can the dentist decide on the right time to proceed with dental implant treatment.
How to choose the implant solution in cases of periodontitis
The type and number of implants are determined based on the number of missing teeth, the available bone volume and the extent of the required restoration.
In complex cases, the treatment plan must also take into account the prognosis for the remaining teeth. The aim is to achieve a stable, functional solution that can be properly maintained and monitored in the long term.
When are the All-on-4® and All-on-6® solutions recommended?
Solutions such as fixed dentures supported by 4 or 6 implants may be suitable for patients with extensive or total edentulism and, in certain situations, for those whose remaining teeth have a poor prognosis.
These concepts allow a fixed restoration to be supported by 4 or 6 implants, the number and position of which are determined according to the patient’s anatomical and bone characteristics.
Where the necessary clinical criteria are met, immediate loading with a fixed temporary restoration may also be possible, so that function and aesthetics are restored within a short timeframe.
What factors influence the success of dental implants in patients with periodontitis?
The success of dental implants in patients with a history of periodontal disease depends both on managing the condition and on maintaining the long-term health of the tissues surrounding the implant.
Treatment does not end with the insertion of the implant or the fitting of the prosthetic restoration, but continues through monitoring and prevention.
Oral hygiene and regular check-ups
Thorough oral hygiene and regular check-ups are essential for maintaining the health of implants.
“Bacterial plaque must be removed daily, including from the areas around the prosthetic restorations, and professional cleanings and regular check-ups allow for the early identification of any signs of inflammation.” – Dr Anamaria Ghiurcă
Systemic conditions
Certain systemic conditions can affect periodontal health and the outcome of dental implant treatment.
Studies show that conditions such as diabetes, particularly when not properly controlled, can affect healing and the body’s response to infection. For this reason, medical history and general health must be assessed before treatment.
How can peri-implantitis be prevented?
Peri-implantitis can be prevented through rigorous control of bacterial plaque and regular monitoring of the implants and the surrounding tissues. The condition is characterised by inflammation of the peri-implant tissues associated with bone loss and can compromise the implant if left untreated.
Patients with a history of periodontitis require extra care, as maintaining long-term results depends not only on adhering to the schedule of check-ups and cleanings set by the periodontist, but also on rigorous oral hygiene practised at home by the patient.
Frequently asked questions about dental implants and periodontitis
Is periodontitis a contraindication for dental implants?
Not automatically. A dental implant may be considered once periodontal disease has been treated and stabilised, and the condition of the bone has been assessed.
An implant can be lost due to periodontitis
Implants do not develop periodontitis, but the tissues surrounding them can be affected by peri-implantitis, which can lead to bone loss and, in advanced cases, compromise the implant.
Is it necessary to add bone?
Not in all cases. The need for bone grafting is determined by the volume and shape of the available bone in the area where the implant is to be placed.
How long does the treatment take?
The duration varies from patient to patient and depends on the stage of periodontal disease, the need for bone regeneration procedures, the number of implants and the time required for osseointegration.
Is it possible to have a dental implant if all the teeth have been extracted?
Yes, under certain conditions. Patients with complete edentulism may benefit from implant-supported fixed solutions, including All-on-4® or All-on-6®, provided that clinical and imaging assessments indicate that such treatment is appropriate.