Implant and Peri-implant surgery procedures

Dental implants can replace missing teeth effectively, but their long-term success depends on healthy gums and bone. If you have current or previous gum disease (gingivitis or periodontitis), careful planning and, where needed, adjunctive periodontal procedures are essential before and after implant treatment.

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Why Gum Health Matters for Implants

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Gum disease is an inflammatory condition caused by dental plaque. In its advanced form (periodontitis), it leads to loss of the bone that supports teeth. Implants rely on bone and a healthy cuff of gum tissue for stability. Uncontrolled inflammation—around teeth or implants—raises the risk of complications such as peri-implant mucositis (gum inflammation around an implant) and peri-implantitis (inflammation with bone loss). Stabilising gum health first is therefore a prerequisite for predictable implant outcomes.

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Before Implants: Stabilising Gum Disease

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Comprehensive assessment

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A periodontal assessment includes gum-pocket charting, bleeding scores, mobility checks, and radiographs to evaluate bone levels. Your medical history (e.g., diabetes control) and lifestyle factors (e.g., smoking) are considered because they influence healing and disease control.

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Initial periodontal therapy

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Non-surgical care—professional biofilm and tartar removal, root surface debridement, and personalised home-care instruction—aims to control bleeding and reduce pocket depths. Implants are not planned until inflammation is resolved or well-controlled.

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Readiness criteria

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Typical indicators for proceeding include low plaque and bleeding scores, improved pocket measurements, and commitment to supportive periodontal maintenance. Where bone volume is insufficient after tooth loss or previous periodontitis, augmentation may be advised.

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Procedures Often Used When Gum Disease Is a Factor

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Guided bone regeneration (bone grafting)

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If the bone is thin or uneven due to past disease or tooth loss, guided bone regeneration may rebuild volume for implant stability. Biocompatible grafts and barrier membranes are placed to encourage the body to form new bone. This is frequently a staged step before implant placement; healing time is usually several months.

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Sinus floor elevation (upper back teeth)

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When bone height beneath the sinus is limited, a sinus lift creates space for graft material, improving support for implants. The choice between a lateral or crestal approach depends on available bone and planned implant position.

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Soft-tissue augmentation

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Thin or receded gums make plaque control harder and may reduce the tissue seal around implants. Connective-tissue grafts or alternative graft materials can increase gum thickness or correct recession, improving resilience and aesthetics around planned or existing implants.

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Implant Placement with Periodontal Considerations

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Implants are placed once tissues are healthy and any required augmentation has matured. Surgical planning uses radiographic guides or digital planning to position implants in bone with adequate surrounding tissue. A stable, cleansable emergence profile is prioritised to support daily plaque control—critical for patients with a history of gum disease.

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Problems Around Implants Linked to Gum Disease

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Peri-implant mucositis (reversible gum inflammation)

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Signs include redness, swelling, and bleeding on gentle probing without bone loss. Management is non-surgical: mechanical biofilm disruption around the implant, adjustment of home-care techniques (e.g., interdental brushes, super-floss, water-flossers), and targeted antimicrobial measures where appropriate. Early treatment is effective when home care is consistent.

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Peri-implantitis (inflammation with bone loss)

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This condition involves progressive loss of supporting bone. Treatment is staged:

• Non-surgical decontamination: Mechanical cleaning of the implant surface with instruments and air-abrasive devices, plus chemical disinfection where indicated.
• Surgical access: Flap surgery to access contaminated surfaces, reshape defects (resective approach) or attempt defect fill (regenerative approach), depending on bone defect shape.
• Regenerative techniques: In contained defects, bone grafts and membranes may be used to support bone regrowth; outcomes depend on defect anatomy, implant surface condition, and plaque control.

Not every site is suitable for regeneration; some require resective contouring for cleansability, and in advanced cases, implant removal may be the safest option.

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Aftercare and Maintenance (Critical for Gum-Disease Patients)

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Supportive periodontal care

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A personalised maintenance programme (often every 3–4 months initially) monitors bleeding, pocket depths, and bone levels, and includes professional cleaning adapted for implants. Review intervals may lengthen only when stability is demonstrated.

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Home-care essentials

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Daily plaque control is non-negotiable. Most patients benefit from:

• A soft brush or powered brush with correct technique around the implant crown margins.
• Interdental brushes sized to each space; super-floss or water-flossers where appropriate.
• Short, targeted antiseptic courses only when professionally advised.

What to Expect: Procedure Steps and Healing

• Anaesthesia: Local anaesthetic is used for comfort; sedation options may be available.
• Staging: If augmentation is required, it is commonly completed before implant placement and allowed to heal. Implants typically require a further integration period before restoration.
• Recovery: Expect mild swelling/tenderness for a few days. Soft-diet guidance and specific cleaning instructions are provided. Most patients resume normal routines quickly; grafts and implants need time (weeks to months) to integrate before final teeth are fitted.

Risks, Limits, and Candidacy

• Disease control: Implants should not be placed in the presence of uncontrolled periodontitis or persistent bleeding.
• Risk factors: Smoking, poor plaque control, and uncontrolled diabetes increase peri-implantitis risk.
• Surgical risks: Infection, graft failure, sinus complications (upper jaw), or nerve proximity issues (lower jaw) are discussed during planning; precautions are taken to minimise these.
• Outcome limits: Regeneration around implants is anatomy-dependent; not all defects can be rebuilt. Honest case selection and maintenance are key to long-term success.

Who May Need Extra Planning

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Patients with significant past bone loss, multiple missing teeth in periodontal cases, thin gum biotype, or medications affecting bone metabolism may require additional assessments and staged care.

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Book Your Consultation At Alpha Dental Group

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If you have gum disease or a history of it and are considering implants, or if you have discomfort or bleeding around an existing implant, book an assessment with Alpha Dental Group. We will stabilise gum health first, then outline any bone or soft tissue procedures needed, and plan implant care that prioritises long-term stability and straightforward daily cleaning.