Gum disease is the leading cause of tooth loss in adults, which means a large share of people considering implants have arrived there through periodontitis. The question that follows is fair: if my gums caused this, will implants last any better?
The answer is neither a simple yes nor a simple no. It depends on whether the underlying disease is brought under control, and on what bone remains.
Dr. Jin-Ho Cho at Shine Dental Newington — BDS (University of Sydney, 1987), more than 35 years in practice, over 9,000 implant fixtures placed — assesses gum health before any implant plan is finalised, for the reasons set out below.
What periodontitis does to the jaw
Gum disease begins as gingivitis — inflammation of the gum that is reversible. Left untreated in a susceptible person, it progresses to periodontitis, where the inflammation extends into the bone that supports the teeth. Bone is lost, the attachment between tooth and bone recedes, and eventually teeth loosen.
Two consequences matter for implant planning.
Bone has already been lost. The volume needed for an implant may be reduced, sometimes considerably. This is measurable only from a three-dimensional CBCT scan, not a standard x-ray.
The susceptibility remains. Periodontitis is driven by the interaction between bacteria and an individual's immune response. Removing the teeth removes the sites of disease, but not the tendency.
Why does that second point matter so much?
Because implants can develop a closely related problem. Peri-implantitis is inflammation of the gum and bone around an implant, and a history of periodontitis is the strongest single predictor of it.
The tissue around an implant is also less defended than around a natural tooth. There is no periodontal ligament, and the fibre attachment is arranged differently, so once inflammation is established it can progress more readily. Our article on peri-implantitis covers the signs and treatment.
This is not a reason to avoid implants. It is the reason the sequence matters.
What has to happen first?
Active gum disease is treated before implants are placed. This is not a formality. Placing implants into a mouth with active periodontitis introduces them to the same bacterial environment that caused the original loss.
Treatment typically involves thorough cleaning below the gum line, a review of home care technique, addressing contributing factors such as smoking, and re-assessment after healing. Where disease is advanced, more involved periodontal treatment may be needed, sometimes with referral.
Remaining hopeless teeth are addressed. Teeth with very poor prognosis act as reservoirs of bacteria. A plan usually deals with these as part of the sequence rather than leaving them alongside new implants.
Stability is confirmed before proceeding. A period of demonstrated gum health — with bleeding resolved and cleaning consistent — gives a far better basis than proceeding immediately.
This adds time. It is time that materially changes the outlook.
What about the bone that has already gone?
This is assessed from the CBCT scan. The options depend on what remains:
- Grafting to rebuild volume, as described in our bone grafting guide.
- Shorter or narrower implants positioned to use available bone.
- Angled implants, which underpin All-on-X full-arch treatment and often make it possible in jaws that would need extensive grafting for individual implants.
- A different approach entirely, such as a bridge or an implant-retained denture using fewer implants.
Our article on implants with bone loss covers this in more detail.
Does this change the long-term plan?
Yes, in one important way: maintenance is not optional.
For someone with a periodontal history, the ongoing programme after implants typically involves more frequent professional maintenance visits than the standard interval, deliberate cleaning technique around each implant, radiographs at intervals to compare bone levels against a baseline, and prompt attention to any bleeding.
Smoking and blood sugar control both compound the risk — see smoking and implants and diabetes and implants. Where they apply, addressing them is part of the plan rather than a suggestion.
So what is the honest answer?
Implants after periodontitis are frequently possible and frequently successful, provided the disease is controlled first and maintenance is genuinely sustained afterwards. Studies of patients with a periodontal history report higher rates of peri-implantitis than in patients without one — the difference is real, and it is substantially influenced by whether the underlying condition is managed.
What would be misleading is to suggest implants are immune to what happened to your teeth, or conversely that a periodontal history rules them out. Neither is accurate.
Individual outcomes vary with bone volume, gum condition, general health, habits and how consistently maintenance is kept up.
Arranging an assessment
Assessment includes a review of gum health, a CBCT scan taken on site where implants are being considered, and a written, itemised quote with item numbers before anything is booked. Where gum treatment is needed first, that will be set out as part of the sequence.
Consultations run in English or Korean. HICAPS on-the-spot claiming is available, and the practice is a CBHS and NIB preferred provider.
Call (02) 9748 4822, mobile 0430 442 018, or send an enquiry.