Implant therapy has been widely proved to be a predictable treatment option yielding high survival and success rates. Patients with a history of periodontitis exhibit a 3.3 higher risk ratio of developing peri-implant diseases. Similar to periodontitis, susceptibility of the host’s immune response predisposes peri-implant tissues to experiencing plaque-associated inflammation and finally tissue breakdown. Further, both diseases share the same risk factors. Similar survival rates were however reached over a duration of 20 years when periodontally compromised patients adhered to a tailored maintenance program. The present review summarizes the evidence of peri-implant disease and implant loss in patients with a history of periodontal disease as well as of the importance of periodontal and peri-implant maintenance therapy.
Periodontitis is a bacterially induced chronic inflammatory disease of high lifetime prevalence (Eke et al. 2015) that may result in the destruction of the periodontium and ultimately in tooth loss. Replacing lost teeth with dental implants has become standard today with high survival rates ranging between 95-98% over 5-10 years (Jung et al. 2012). Besides survival, implant success and esthetic outcomes are of utmost importance, both of which are determined by healthy peri-implant conditions.
Similar to periodontitis, susceptibility of the host’s immune response predisposes peri-implant tissues to experiencing plaque-associated inflammation with ensuing tissue breakdown, defined as peri-implantitis (Berglundh et al. 2019). Moreover, well-established risk factors for periodontitis are comparable to those for peri-implantitis (Heitz-Mayfield & Lang 2010). Recently, 20-year outcomes were published reporting on similar survival rates of SLA implants in periodontally healthy and periodontally severely compromised patients when complying with supportive periodontal therapy. However, non-compliant periodontally compromised patients experienced implant loss at a higher rate (Roccuzzo et al. 2022).
A 2022 systematic review with meta-analyses corroborated these findings, demonstrating a higher risk for implant loss and a 3.3 risk ratio of developing peri-implantitis for patients with a history of periodontitis over a 5-10-year period (Carra et al. 2022).
Consequently, active periodontal therapy aiming at eliminating pockets of > 5 mm and a tailored supportive periodontal therapy are an effective strategy to establish long-term healthy peri-implant conditions and thus implant success – provided that implants are installed according to today’s standards of care.
The present article summarizes – with no claim to completeness – some basic aspects of peri-implant tissues, provides evidence of peri-implantitis and implant loss in patients with a history of periodontal disease and puts an emphasis on the impact of supportive periodontal therapy illustrated by a clinical case with a 10-year follow-up.