Poorer implant outcomes in periodontitis patients?


The aim of this review was to update a 2008 review of implant survival and success rates, bone loss/bone-level changes and incidence of peri-implantitis for dental implants placed in partially dentate patients with history of treated periodontitis compared to periodontally healthy patients.


Searches were conducted in the Medline and Embase databases. Studies were selected using a three stage screening process performed independently and in duplicate. Randomised controlled trials (RCTs), controlled clinical trials, cohort studies, case–control studies and case series) reporting on titanium dental implant survival and/or success were included. Quality assessment was carried out independently by two reviewers using an adapted version of the Newcastle–Ottawa Scale (NOS). All definitions of implant survival (i.e. cumulative survival rate, post-loading survival rate, incidence of implant loss) were considered.Because of marked heterogeneity of study characteristics (e.g. definition of the outcome and study groups, follow-up, study size, reported statistical analysis and the outcome measurements, comparability of groups, control for confounders) meta-analysis could not be performed so a detailed narrative summary was presented.


  • 24 studies reported in 27 publications met the inclusion criteria.
  • There were 12 prospective cohort studies, 5 case series with a control group, 4 retrospective cohort studies or case–control studies and 3 other studies where a sub-group comparison between treated and non- periodontitis was carried out.
  • Most of the studies showed better implant survival rates for the non-periodontitis group, (range 91.67% to 100%), compared with the treated periodontitis group (range 79.22% to 100%), over a 1.2- to 16-year follow-up. The difference was only statistically significant in 5 studies.
  • Implant success and survival were higher in periodontally healthy patients, whilst bone loss and incidence of peri-implantitis was increased in patients with history of treated periodontitis.
  • There was a higher tendency for implant loss and biological complications in patients previously presenting with severe forms of periodontitis.
  • The strength of the evidence was limited by the heterogeneity of the included studies


The authors concluded:

Implants placed in patients treated for periodontal disease are associated with higher incidence of biological complications and lower success and survival rates than those placed in periodontally healthy patients. Severe forms of periodontal disease are associated with higher rates of implant loss. However, it is critical to develop well-designed, long-term prospective studies to provide further substantive evidence on the association of these outcomes.


The authors of this review decided not to conduct a meta-analysis owing to the marked heterogeneity of the included studies. However they do provide a very detailed summary of their findings that runs to 58 pages. A number of other systematic review of this topic have been conducted since the Ong et al review carried out by this group and the authors include these in their discussions. While their findings are similar to other systematic reviews on this topic they have chosen to be more cautious their interpretation of the evidence because of the marked heterogeneity and the limited availability of high quality study designs in included studies.


Sousa V, Mardas N, Farias B, Petrie A, Needleman I, Spratt D, Donos N. A systematic review of implant outcomes in treated periodontitis patients. Clin Oral Implants Res. 2015 Sep 18. doi: 10.1111/clr.12684. [Epub ahead of print] Review. PubMed PMID: 26381260

Ong CT, Ivanovski S, Needleman IG, Retzepi M, Moles DR, Tonetti MS, Donos N. Systematic review of implant outcomes in treated periodontitis subjects. J Clin Periodontol. 2008 May;35(5):438-62. doi: 10.1111/j.1600-051X.2008.01207.x. Review. PubMed PMID: 18433385.

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