Many people lose teeth to gum disease and then worry that the same problem will stop them having implants. Usually it does not, but the order of treatment matters. The gums need to be treated and stable before an implant goes in, and afterwards the implant needs closer care than it would in someone who never had periodontitis.
A history of periodontitis does raise the risk
A 2024 systematic review and meta-analysis by Serroni and colleagues in Clinical Implant Dentistry and Related Research looked only at prospective cohort studies, 12 in all, comparing implants in people with and without a history of periodontitis. Those with a history of gum disease had a higher risk of losing implants, both within five years and beyond. Their risk of peri-implantitis was about four times higher, and they lost on average about 0.75 mm more bone around their implants. The authors rated the certainty of the evidence as low, mainly because there are no randomised trials on this question, but concluded that a history of periodontitis is a significant risk factor.
A higher risk is not a ban. Most implants in people with treated gum disease still do well. The research simply explains why the gums are brought under control first and why maintenance afterwards is not optional.
Why an implant should not go into inflamed gums
An implant relies on the same gum and bone that periodontitis attacks. If the bacteria that caused the disease are still active, they can colonise the new implant surface just as they did the natural teeth. Placing an implant into a mouth with active gum disease starts it off at a disadvantage. Our guide to gum disease treatment explains what is involved in getting the infection under control.
Getting the gums ready
For most people, treatment starts with deep cleaning below the gum line, often called scaling and root planing, to remove the hardened deposits and bacteria that home brushing cannot reach. Our article on what a deep clean involves walks through it. Alongside that, daily cleaning between the teeth becomes a habit rather than an occasional extra.
The gums are then reassessed. A dentist or OHT measures the pockets around the teeth and checks for bleeding. Stable gums mean shallower pockets, little or no bleeding and no active infection, and that usually takes a period of months to confirm. Teeth that cannot be saved may be removed during this phase, and the X-ray shows how much bone remains for implants later.
Smoking is part of the conversation too. It slows healing and is linked with both gum disease and implant problems, so cutting down or quitting before surgery gives the implant a better start.
Two conditions to know about after the implant is in
An implant can develop its own version of gum disease. The early form, peri-implant mucositis, affects only the gum around the implant and is usually reversible with professional cleaning and better home care. If it continues, it can progress to peri-implantitis, where the infection reaches the supporting bone. That is harder to treat and, if left, can lead to the implant loosening.
| Condition | Tissue involved | Usual outlook |
|---|---|---|
| Peri-implant mucositis | Gum only | Usually reversible with cleaning and home care |
| Peri-implantitis | Gum and bone | Harder to reverse; needs prompt treatment |
People with a past history of periodontitis are more prone to both, which is why early signs deserve attention rather than a wait-and-see approach.
Looking after the implant for the long term
Daily cleaning matters as much around an implant as around natural teeth, particularly at the gum line where the crown and its connecting part (the abutment) meet the gum. Our article on the parts of a dental implant shows where these sit. Interdental brushes or floss suited to implants help reach the sides.
Maintenance visits are often more frequent than the usual six-monthly check for people who have had periodontitis, with the dentist or OHT measuring around the implant and taking X-rays when needed. Between visits, bleeding, swelling, a bad taste or tenderness around an implant is worth reporting early. Our guide to signs an implant may be in trouble lists what to look for.
Questions patients ask about implants after gum disease
Can I have an implant while my gum disease is still active?
Generally not. The gums are treated and allowed to settle first, so the implant is not placed into an active infection.
How long do the gums need to be stable first?
It varies from person to person. Most dentists want to see healthy, stable gums over a period of months, confirmed by repeat measurements.
Will the surgery hurt more because of my gum history?
It is not expected to. Implant surgery is usually done under local anaesthetic, and a history of gum disease is not expected to make the procedure itself more painful. Our guide to whether getting an implant hurts describes what to expect.
Gum health first, then the implant
Gum disease changes the order of treatment and the care afterwards, not necessarily the answer. At Lumi Dental, our oral health therapists focus on gum health and prevention, and implants are planned and placed at the practice once the gums are stable. Free consults are available for implant treatment; see our current offers or read more on our dental implants page.
This article is general information and not a substitute for an individual dental assessment.
