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People who suffer from gum disease end up needing permanent tooth replacement quite often. What are the options available to them? Which among those is the best? We have the answer.

Gum disease (periodontitis) is extremely common all over the world [1]. It may be commonly referred to as gum disease but it actually affects all the supporting structures of the teeth including the bone, the ligament, the root surface as well as the gums [2].

This is also the reason why permanent tooth replacement in patients with gum disease is something that must be done with due consideration and caution.

Gum Disease And Permanent Tooth Replacement

Gum disease progresses slowly and does not cause pain. The changes that occur in the mouth may not be apparent to the patient and the destruction that silently spreads may only be discovered when teeth cannot be saved anymore.

This is why it is extremely common for patients suffering from gum disease to have missing teeth and to need permanent tooth replacement [3].

Gum Disease And Dental Implants

Dental implants require the presence of an adequate amount of bone support to be able to be placed successfully and they also require the maintenance of good oral hygiene, in the long run, to be able to last for a long amount of time [4].

Neither of these factors are a given in people who are suffering from severe gum disease [5].

If the primary cause of tooth loss is periodontitis then it likely that some amount of bone augmentation would have to be performed in order to provide as much support to the implant as possible. While this will help to increase the chances of success, it will also increase the cost to the patient as well as the complexity of the procedure considerably [6].

It has also been found conclusively that patients who suffer from periodontitis are much more likely to suffer from dental implant failure than other non-affected patients. The reason behind this is believed to be a continuation of poor oral hygiene habits that contribute to the growth of disease-causing bacteria in the mouth [7].

Even though dental implants are made from titanium and are not affected by decay, they are affected by the bacteria that cause gum disease indirectly. The bone which forms around the implants and keeps them in place is still the same as formed around natural teeth, and in fact, lacks certain ligaments which slow down the spread of disease around natural teeth somewhat.

This disease process, called periimplantitis, causes a destruction of the bone around the implants, makes them loose and eventually causes them to fall out, just like natural teeth [8].

Does this mean that patients with gum disease should not receive dental implant treatment? Not at all. It, however, does mean that patients must understand the importance of maintaining good oral hygiene and regular visits to the dentist for a professional cleaning to help make their implant treatment a success [9].

For patients who are able to maintain a good level of oral hygiene after receiving dental implants, the chances of success are similar to that of any other unaffected patient. In some cases, patients may be required to undergo gum treatment before dental implants can be placed at all.

Dental Crowns And Bridges In Patients With Gum Disease

It is extremely common to see patients with dental crowns and bridges on top of teeth that have been compromised by gum disease, and it is an extremely poor choice in our opinion [10]. Gum disease can be limited to a few teeth or spread in a generalized manner across the mouth.

As the support around the teeth diminishes, these teeth tend to drift into poor positions, develop gaps or fall out completely. The remaining teeth are also quite often compromised and to load them with the burden of additional missing teeth is just making things worse.

Patients often go for dental crowns and bridges because they are unable to afford comprehensive implant treatment. It may actually be better to get gum treatment for those teeth that can be saved and actually go in for a Removable partial denture so that the forces on the surviving teeth are as gentle as possible.

If the dentist determines that the supporting teeth are strong enough to provide support then dental crowns and bridges can be placed with no further complications. Care must be taken, however, to ensure that the patient improves their oral hygiene in order to prevent these supporting teeth from suffering more loss of support in the future.


Gum disease affects the teeth and implants in an extremely destructive manner. This is why the first course of action must be to bring the gum disease under control and then determine what kind of permanent tooth replacement can be undertaken.

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