Can You Have Dental Implants If You Have Gum Disease?

Gum disease in brief

Gum disease starts with plaque, the soft film of bacteria that builds up on teeth. Gingivitis is inflammation of the gums alone: they bleed easily and may look red or swollen. Periodontitis goes further and damages the bone and fibres that hold the teeth in place. Teeth can then loosen, drift or be lost.

The two behave differently. UK guidance for dentists says that gingivitis is reversible with better self-care². The damage periodontitis causes is not reversible, but the disease can be stabilised. The bone that has been lost largely does not come back³.

This matters for implants for two reasons. An implant needs enough healthy bone to hold it. And the bacteria and habits that caused gum disease around teeth can cause a similar disease around implants.

Why gum disease is treated first

The studies that followed people with implants and a history of gum disease were done in treated patients. Our sources contain no evidence on implants placed while periodontitis is still active. At our clinic, gum disease is treated and brought under control before an implant is planned.

The European guideline on periodontitis describes treatment in four steps⁴:

1. Cleaning and risk factors: instruction in daily cleaning, help with risk factors such as smoking and diabetes, and professional removal of plaque and tartar above the gum. Tartar cannot be removed at home; it needs professional cleaning⁵.
2. Deep cleaning below the gum: removing the deposits on the root surfaces inside the gum pockets.
3. Further treatment where deep pockets remain after the first two steps; this may include surgery.
4. Supportive care: regular reviews and cleaning for life, at intervals of 3 to 12 months set by your own risk.

Treatment can restore gum health, but a person whose periodontitis is under control remains at higher risk of it coming back⁶ and needs close monitoring. The same holds after implants are placed.

What a history of gum disease changes for an implant

The figures below come from observational studies. They show an association, not proven cause and effect, and they are averages across many clinics, not your personal risk.

• Implant loss. Across 14 prospective studies, people treated for periodontitis lost implants at about 1.75 times the rate¹ of people without that history. In studies with ten or more years of follow-up it was about twice as high. After a fast-progressing form of the disease (grade C), it was about six times as high, an estimate with a wide margin of uncertainty.
• Inflammation with bone loss around the implant. Peri-implantitis was about three times more common per patient. For inflammation of the gum alone around implants (mucositis), the review found no significant difference.
• What is not known. These were treated patients. The review does not measure how much regular supportive care lowers the risk.

Other factors add to this. Smoking raises the risk of periodontitis starting or getting worse by about 85 per cent⁷. In people smoking more than 20 cigarettes a day, implant loss was about 2.5 times as likely per implant⁸. Per patient it was about 4 times as likely. For diabetes the findings on implant loss are mixed. Two of three reviews found no significant difference (2021 review⁹; 2016 review¹⁰), and the third found higher odds of implant loss¹¹ in people with diabetes than in people without. All three found more bone loss around implants, so blood-sugar control, daily cleaning and regular reviews matter.

Gum disease around an implant: peri-implantitis

Plaque collects on an implant as it does on a tooth. Peri-implant mucositis is inflammation of the gum around the implant. Peri-implantitis is that inflammation together with loss of the bone that supports the implant; if it is not controlled, the implant can be lost. Peri-implantitis needs treatment by your dentist; what is done depends on what the examination finds, and it may need surgery. Daily cleaning helps to prevent it but does not treat it on its own.

It is not rare. A 57-study review found peri-implantitis in about 20 in 100 patients and about 12 in 100 implants¹²; the rate depends on the definition used, and these figures show how many people had it when they were examined, not a risk over a set number of years. In reviews of full-arch bridges on implants followed for 5 to 15 years, it was reported in 4 to 18 in 100 patients¹³, as far as the review summaries show; these figures come from different studies and definitions and cannot be compared directly. A history of periodontitis raises these odds, as the figures above show.

Where gum disease has cost most of the teeth in a jaw, a fixed bridge on four or six implants is one option. Before any teeth are removed, ask which could be kept, why each extraction is needed and what the alternatives are, such as a removable denture. The same risk factors and the same need for care apply; see the All-on-4 page. Where too little bone is left, bone grafting may be discussed; see bone grafting.

Keeping your gums and implants healthy

• Clean every day. Brush twice a day with fluoride toothpaste and clean between the teeth and implants every day. If you have a bridge on implants, ask your dental team to show you how to clean around each implant and under the bridge. For people treated for periodontitis, the European guideline recommends interdental brushes as the first choice⁴ where they fit. The wider evidence on cleaning between the teeth is of low certainty¹⁴.
• A baseline record. The 2017 consensus report recommends that an X-ray and gum measurements be taken as a baseline¹⁵ when the crown or bridge on the implant is completed. Later changes are judged against that record.
• Regular supportive care. The European guideline on peri-implant diseases calls for a structured supportive care programme¹⁶ once implants are in use. The interval between reviews is set for each patient¹⁷ by their risk; that guideline covers check-ups in general, not implants. A history of gum disease usually means closer follow-up.
• Smoking. Stopping helps both gums and implants. Tell your dentist if you smoke and how much.

How implant treatment runs, stage by stage, is explained on the dental implants page, and gum treatment on the gum diseases page.

When to see a dentist

See a dentist if your gums bleed when you brush or eat hard food¹⁸, if they are painful or swollen, or if you have bad breath that does not go away. Ask for an urgent appointment if your gums are very sore and swollen or your teeth feel loose. With implants, bleeding, swelling, pus, a bad taste or a gum line that is receding around an implant are also reasons to be seen, even if nothing hurts. An implant, or a crown or bridge on it, that feels loose should be checked soon.

Emergencies. Difficulty breathing or swallowing, rapidly spreading swelling of the face or neck, high fever or swelling around the eye are serious signs. Go to the nearest emergency department or call 112.

Frequently asked questions