Gum Disease With Full Mouth Implants All on 4/5/6

If you have active gum disease (periodontitis) and need full mouth implants All on 4/5/6 there are several issues to consider.  The most important of all is that the gum disease problem that you have around your teeth can also affect the implants. What!!!!

As I have said in the past, dental implants are not permanent!  Dental implants can lose bone and gum just like teeth can!  The real term for this is called “peri-implantitis.”  

It’s important to know that patients with active gum/periodontal disease who want dental implants need to be managed differently than someone losing teeth due to cavities or root canals. 

Let’s go through a case example of gum disease and implants

This patient in her 50s presented to my office for a second opinion.  All of her teeth have severe gingivitis/periodontitis and must be removed.  Many of the teeth were loose and she said that the gaps have been increasing, which is an ominous sign of a BIG problem.

After a very careful examination, face scan, digital dental models, 3D x-ray scan and a couple of visits we agreed that removal of all of the teeth was indicated. 

My goal was to make sure that she had teeth right away and that she had her dignity with a better-looking smile than when she started.

Part of the decision-making process for replacing all teeth (with full mouth dental implants) after gum disease is whether to do one arch at a time or to do both at once. 

I have found over the last 23 years of doing this type of treatment that if you leave behind any teeth that have gum disease, the patient is more likely to have bone loss around the implants.  An analogy is like having 1 person with COVID 19 in a closed, poorly ventilated room… eventually that person will infect everybody else. 

Removing all of the bad teeth removes the source of the disease and puts you at much lower risk of developing peri-implantitis of the implants!

The implant all on 4/5/6 process for her was very similar to how I treat all patients.  Luckily she had good bone underneath the bad teeth. 

But if you do not have great bone underneath the teeth, especially on the upper jaw, I would have to use zygomatic, pterygoid or other nonconventional implants in order to gain solid anchorage to have immediate teeth.  These specialized implants work very well and I use them all the time.

Prior to the visit she was started off on a double antibiotic of amoxicillin clavulanic acid along with metronidazole; she was also instructed to rinse with chlorhexidine several days prior.  It is always important to continue to brush your teeth really well, even on the morning of extraction, of all of the teeth.  This will make the gum healthier, easier to suture and increase the chance of success with the immediate implant (all on 4/6).  If the gums are healthy at the time of extraction there would be reduced pain and reduced bleeding as well.  Any and all smoking must be eliminated. 

In her case I placed 10 implants (5 were placed on the upper and 5 were placed on the lower). This will give a strong base.  Her teeth were made from solid zirconia.  They are nonremovable and gorgeous!

What happens after getting dental implants for severe gum disease?

On a yearly basis a panoramic x-ray should be taken to check the bone levels.  Your teeth should be cleaned by a hygienist who knows what they are looking at.  In my office we use a device specifically to remove biofilm around implants called the Airflow; nothing else really can get underneath the implants.  Traditional scraping methods do not clean implants. 

Remember the goal is to prevent the gum problem from coming back, infecting the full upper and lower dental implants.

I also personally show every single patient how to use a WaterPik and floss threaders.

So the bottom line is — you can have full mouth dental implants after periodontal (gum) disease.

If you have gum disease (or periodontal disease) and you’re interested in dental implants to replace your teeth, call my office to schedule your appointment.