• The global dental implant market in 2011 was $3-4 billion and the projected level in 2018 is $6.6 billion.
• Perceived benefits of implants over teeth include a belief of better aesthetics, better function, most cost effective, lack of complications and better long term survival compared to teeth.
• One needs to consider the dilemma of early intervention for periodontally compromised patients due to the consequences of late extraction i.e. delayed extraction(s) will result in more loss of soft and hard tissue.
• It’s important to make sure we distinguish between survival and success.
• No decision should be made without a detailed assessment. This needs to include consideration to the extent of the disease, the predictability of stabilising the periodontal disease and consideration of restorative issues.
• Radiographs are an important part of case assessment. Ideally periapically radiographs, especially in heavily restored teeth. A panoral radiograph will give a good overview but not as accurate.
• Periodontal treatment works and is effective at reducing tooth loss! It is economical and maintenance can be simple. Anterior teeth are easier to treat and maintain predictably. Molars are more difficult are there are more anatomical constraints.
• If periodontal disease is diagnosed early, treatment is usually very simple and predictable.
• The evidence base of the outcome of implant therapy in Perio compromised patients is limited and there is conflicting evidence (Ellegard et al, Hardt et al, Wennstrom et al, Karoussis et al). Systematic review of literature by Van der Weijden et al: “Based on limited data, it seems justified to conclude that the outcome of implant therapy in periodontitis patients may be different…by loss of supporting bone and implant loss.”
• 28-56% of patients with peri-implantitis at one or more implants.
• Remember implants and periodontal disease carry the same risk factors including: poor oral hygiene, smoking, uncontrolled diabetes, untreated dental disease.
• Can consider the Carl Misch rule to decide whether on not to extract or maintain the natural tooth.
• The judgement on whether to extract and replace with implants is complex and debatable. Decision-making should be joint. Consider patient and site specific factors.
• Periodontal disease treatment is predictable and evidence suggests it can arrest disease as well as help minimise and prevent tooth loss.
• There are more complications with implant prosthesis and maintaining teeth with history of periodontal disease. Treating periodontal disease is more predicable than treating peri-implantitis.
• General recommendations: through treatment planning, periodontal therapy essential before implant treatment, need to stabilise periodontal condition before planning option of implants, extraction of hopeless teeth and continued thorough periodontal and implant maintenance after implant placement.
• Implants are a treatment option for tooth loss but NOT a tooth substitute.

Periodontology