Dental Implants and Perio Complications

Restoration and Implantology
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Nobel Biocare’s Jonathan Fleet looks at minimising inflammatory response to dental implants

In this article I will highlight the importance of minimising soft tissue inflammatory response after the placement of dental implants because this may threaten post placement longevity.

Before considering the possible inflammatory response to implants it is necessary to evaluate whether the soft tissues are already compromised. Conditions such as gingivitis and periodontitis cause swollen, inflamed gums and can have a significant effect on the long-term success of implant procedures.

Patients with a history of periodontitis have been found to be at a much higher risk of implant failure. One study found that implant survival rates in patients who had experienced periodontitis in the past were as low as 79.22% – a significant difference when compared to periodontally healthy patients who had a survival rate of 91.67% [1].

Once an implant procedure has been performed, proper oral health maintenance is paramount in order to prevent inflammatory responses caused by plaque build-up. A study considering 17 years of data on the subject found that patients who failed to uphold a good maintenance plan – or did not receive one at all – had a cumulatively lower survival rate for their implants compared to those who did [2].

This clearly demonstrates the importance of maintaining good oral hygiene standards before and after surgery.

Material choices

In rare cases, titanium oxide, a common implant surface material, has been shown to react with the microbiology of oral soft tissues, causing an inflammatory response [3]. Though there is still some debate as to why this occurs, it is generally believed that the principal cause is due to a concentration of titanium ions in the tissues surrounding the implants [4].

These allergies are thought to be more common in people who are allergic to other metals, but a patch test may be a good idea for all patients in order to assess whether they are sensitive to titanium [5].

Although such a reaction to titanium is uncommon, it does mean that for a significant portion of the population a different implant material would be more suitable. In light of this, implants formed from zirconia are fast becoming a popular alternative. These solutions offer greater aesthetics thanks to their white color and demonstrate many other benefits that mean they may be a better option for patients who have a history of periodontitis.

NobelPearl™ implants, one the latest innovations from Nobel Biocare, are particularly suited to such cases. Made of metal free ceramic, they have been designed for excellent soft tissue attachment and low inflammatory response [6], and also demonstrate a low plaque affinity [7] that helps prevent plaque related conditions developing.

There is no “one size fits all” solution to predicting the soft tissue inflammatory response to implants. However, by evaluating the possibility of periodontal disease and exploring alternatives – including metal free implants – it becomes more likely that you can reduce the risks of post implant complications.


Jonathan Fleet is the Nobel Biocare Product Manager for UK & Ireland. For more information, call 0208 756 3300, or visit 


1] Veitz-Keenan, A., Keenan, J. Implant Outcomes Poorer in Patients with History of Periodontal Disease. Evidence-Based Dentistry. 2017; 18: 5.

2] Gay, I., Tran, D., Weltman, R., Parthasarathy, K., Diaz-Rodriguez, J., Walji, M., Fu, Y., Friedman, L. Role of Supportive Maintenance Therapy on Implant Survival: a University‐Based 17 Years Retrospective Analysis. International Journal of Dental Hygiene. 2016; 14: 267-271.

3] Eger, M., Sterer, N., Kohavi, D., Gabet, Y. Scaling of Titanium Implants Entrains Inflammation-Induced Osteolysis. Sci Rep. 2017; 7: 39612.

4] Goutam, M., Giriyapura, C., Mishra, S., Gupta, S. Titanium Allergy: a Literature Review. Indian J Dermatol. 2014; 59(6): 630.

5] Goutam, M., Giriyapura, C., Mishra, S., Gupta, S. Titanium Allergy: a Literature Review. Indian J Dermatol. 2014; 59(6): 630.

6] Cionca, N., Hashim, D., Mombelli, A. Zirconia Dental Implants: Where Are We Now, and Where Are We Heading? Periodontol 2000. 2017 Feb; 73(1):241–258.

7] Scarano, A. Bacterial Adhesion on Commercially Pure Titanium and Zirconium Oxide Disks: An in Vivo Human Study. J Periodontol. 2004 Feb; 75(2):292–296.