Gum disease and dental implants: can you have implants after periodontitis?

How much does a history of gum disease raise the risk at implants?

If you have had periodontitis, a gum inflammation that has spread to the bone holding the teeth, your implants carry roughly twice the risk of inflammation and loss compared with people with healthy gums. Several meta-analyses reach similar results:

These figures have limits. Ferreira and colleagues point out that the association was not seen when only cohort studies were analysed, and that the results should be read with caution because of the differences between studies. In the umbrella review by Giok and colleagues, periodontitis is one of the factors with “highly suggestive” evidence for peri-implantitis; no factor reached the highest level of evidence.

The patient information of the European Federation of Periodontology (EFP) also names a history of periodontitis as a major cause of implant complications. The stages and signs of inflammation around an implant are described in our guide on peri-implantitis.

Does the severity of the gum disease matter?

Yes: the more severe and rapid the disease was, the higher the risk appears. In the meta-analysis by Sgolastra and colleagues, the risk of implant loss was about four times higher in the form described in studies as “aggressive”, which progresses quickly at a young age, and about 1.6 times higher in the slower chronic form. Within the chronic form, only severe disease was significantly linked to implant loss.

Residual pockets after treatment count too. According to data summarised in the 2023 EFP guideline, peri-implantitis was significantly more frequent in people who still had pockets deeper than 6 mm during maintenance. What matters is therefore not only whether you had periodontitis in the past, but how well it is controlled today.

Why must the gum disease be treated before implants are placed?

Because the guidelines recommend implants only after periodontitis has been treated successfully and is stable. The 2023 EFP guideline makes a strong recommendation to treat gingivitis and periodontitis according to guidelines to a stable endpoint before implant placement and to enrol patients in a supportive care programme. The EFP patient information likewise states that a patient must be free of periodontitis before an implant can be placed.

Oral hygiene is another precondition. The 2020 EFP guideline states that surgery should not be performed in patients who do not achieve adequate levels of self-performed oral hygiene. The endpoint it sets for active treatment is no pockets of 5 mm or more that bleed on probing and no pockets of 6 mm or more. An implant plan therefore becomes concrete only once the results of gum treatment are known.

How is gum disease treated?

The four steps of the 2020 EFP guideline are also reflected in the NHS description of treatment:

1. Risk control: instruction in cleaning with a toothbrush, interdental brushes and floss, removal of tartar, help with stopping smoking and good control of diabetes.
2. Cleaning below the gum line: deposits beneath the gum are removed, usually under local anaesthetic; the NHS calls this deep cleaning under the gums.
3. Re-examination: after a healing period the pockets are measured again. Remaining deep pockets are cleaned again or, if very deep, treated surgically.
4. Supportive periodontal care: hygiene check, bleeding check, cleaning, pocket measurement and X-rays when needed. The EFP guideline sets intervals of three to a maximum of twelve months, tailored to your risk.

The steps are described in detail in our guide How is gum disease (periodontitis) treated?

Gum treatment at home first, implants in Türkiye later: how does that fit together?

For many international patients, that is the most sensible order. Months of healing lie between the cleaning below the gum line and the re-examination, and that time cannot be bridged with a trip. If your dentist at home has diagnosed periodontitis, start the treatment there and plan the implants once the re-examination shows a stable condition.

For the preliminary assessment on WhatsApp, the following documents are helpful: your pocket measurements before and after treatment, recent X-rays, the date of the re-examination and your maintenance schedule. They allow us to judge whether the timing for implants is right and whether further steps would be needed on site. Which other documents to bring is listed in our guide on documents for dental treatment in Türkiye.

If the examination on site nevertheless shows active pockets, the implants may have to wait. A past periodontitis also affects planning: the bone that held the teeth may have been lost, so that a bone graft becomes necessary and changes the number of trips. How many stays are usually needed is explained in our guide How many days do I need to stay in Türkiye for dental implants?

Why is follow-up after implants so important?

Regular supportive care clearly lowers the likelihood of peri-implant disease. According to data in the 2023 EFP guideline, patients attending supportive peri-implant care regularly were at significantly lower risk of peri-implant diseases (odds ratio 0.42), while irregular attendance was associated with a 3.76-fold higher risk of implant failure. The guideline therefore recommends supportive care even when the tissues around the implants are healthy. Perussolo and Donos (2024) suggest a minimum interval of five to six months as a starting point, with the interval then tailored to your risk.

For international patients, this means: the maintenance visits with your dentist or hygienist at home should continue after implant placement and include the implants. They also help prevent the disease flaring up again at your own teeth. Between visits, you can send us questions and photos on WhatsApp; how care after your return is organised is described on our page on aftercare and follow-up.

How do you clean implants and teeth at home?

The toothbrush and interdental brushes are at the centre. The 2020 EFP guideline recommends supplementing tooth brushing with interdental brushes in people treated for periodontitis; where they do not fit, other interdental aids are used. The NHS advises cleaning between your teeth every day with floss or interdental brushes and not smoking.

At implants, cleaning depends on the type of restoration. The 2023 EFP guideline recommends designing implant-supported prostheses so that they remain accessible to the patient’s cleaning aids and professional probing, and adapting home care to the design. Practical tips are in our guide on caring for teeth on implants.

What should you watch out for with a history of gum disease?

• Do not start implants before gum treatment is complete and the re-examination is stable.
• If you smoke, get support to stop; both EFP guidelines recommend it.
• If you have diabetes, keep your blood sugar well controlled.
• Make interdental brushes a daily habit.
• Keep your maintenance appointments at home, even without symptoms.
• Report bleeding, swelling or a bad taste at the gums or an implant without waiting for the next appointment.

How do we plan implants after gum disease at Rönesans?

At the examination in our clinic in Serdivan, we assess your gums, your remaining teeth and your history of gum disease together. Because the disease attacks bone, we check the available bone with a cone-beam CT (CBCT) scan. Our dentists prepare the treatment plan together, and your treating dentist remains the same person.

Which teeth are kept, what is done at each tooth and what it costs is set out in a written treatment and cost plan before treatment starts; the fee is confirmed after the examination. After implant placement you receive an implant card and copies of your X-rays and treatment summary for your dentist at home. Send records and photos for a preliminary assessment to +90 532 363 49 54, or call us on +90 264 606 09 43. More about the treatment on our dental implants page.