Skip to main content Skip to footer

Managing peri-implant disease risk

Print this page

Managing peri-implant disease risk

Key recommendation

Prior to placing implants in patients with a diagnosis of periodontitis, stabilise any periodontal disease around teeth which are to be retained, address modifiable risk factors (e.g. inadequate oral hygiene, smoking, systemic disease) and explain the need for ongoing periodontal and implant maintenance care after placement to reduce the risk of peri-implant disease.

(Strong recommendation; low certainty evidence)

There is a lack of direct evidence related to interventions to address factors related to a higher risk of developing peri-implant disease prior to implant placement. However, indirect evidence relating to post-placement maintenance care suggests that addressing risk factors is beneficial, both in terms of preventing peri-implant disease and promoting implant survival.117-119 In addition, principles of treatment planning dictate that advanced treatments should not be provided until any current disease is under control. The evidence is considered low certainty due to risk of bias, indirectness and the observational nature of some studies. However, this guidance includes a strong recommendation in favour of the intervention because of the potential increased risk of peri-implant disease and implant loss if any current disease or risk factors are not addressed prior to implant placement.

For all patients considering dental implant therapy, a periodontal examination is essential during the treatment planning phase to determine the periodontal status of the patient (see Assessment). This will allow any existing periodontal disease to be identified and treated prior to implant placement. It will also ensure that patients can be informed of their increased risk of peri-implant disease and the need for additional ongoing maintenance care post-placement. The EFP Prevention and treatment of peri-implant diseases guideline10 recommends thorough assessment of the patient's risk profile to identify and manage modifiable risk factors prior to implant placement. This is described as primordial prevention. It also recommends treatment of any existing gingivitis and/or periodontitis to a stable endpoint prior to implant placement and adherence to a supportive care programme afterwards.

Guidance from the Royal College of Surgeons of England120 states that patients with a history of periodontitis should have the disease treated and stabilised for at least six months prior to the start of the implant treatment. The EFP Treatment of stage IV periodontitis guideline9 does not specify a time limit between stabilisation of disease and proceeding to rehabilitation. 

Further details on the development of the recommendations in this guidance can be found in Methodology.

Treatment and control of periodontal disease prior to implant planning, placement and restoration:

  • reduces the risk of peri-implant disease in those at higher risk; 
  • helps the clinician to more predictably assess patient response and likely prognosis of remaining teeth; 
  • gives the patient time to acquire skills in oral hygiene;
  • supports the clinician in providing a restoration with a good long-term prognosis.

For those patients who have had extensive disease, planning should incorporate a view on prognosis (see Assessing tooth prognosis) and retention or extraction of other teeth in the mouth and consideration of any special challenges due to bone loss at potential implant sites which may complicate surgery. In some cases, referral to a practitioner or team with enhanced or specialist skills may be appropriate.
 
In patients with a diagnosis of periodontitis who are considering dental implant(s):

Discuss the risk of peri-implant disease with the patient and explain that they are at higher risk of complications due to their history of periodontal disease. 

Explain to the patient that after the implant(s) is placed, there will be an ongoing, lifelong need for both periodontal and implant maintenance care to reduce the risk of peri-implant disease.

Provide non-surgical (and if necessary surgical) treatment to control any active periodontal disease around teeth which are to be retained.

  • Address modifiable risk factors, such as inadequate oral hygiene, smoking, and systemic disease (e.g. diabetes), before implant placement, where possible. 

If the patient is referred externally for placement of the implant(s) (and restoration, if applicable), ensure that there is communication with the external team regarding the patient’s periodontal condition and the status of modifiable risk factors.

Prior to implant placement, ensure plans for ongoing maintenance care after placement are in place to prevent, and if necessary monitor, peri-implant inflammation.