Implants with periodontitis: can implants be placed when teeth are loose, and how it is done

Key points

• Implants can be placed with periodontitis, and it is often the only way to restore chewing once the natural teeth can no longer be saved.
• But the order is different: inflammation is treated first and a decision is made about which teeth to keep; hopeless teeth are extracted and the bone is levelled; only then do implants go in.
• Patients with a history of periodontitis carry a higher risk of inflammation around an implant, so aftercare hygiene is stricter and more frequent.
• The clinic has a case: teeth damaged by periodontitis were extracted with bone levelling, followed by immediate implant placement on four abutments with dentures on both jaws.

What periodontitis is and why it complicates implants

Periodontitis is inflammation of the tissues that hold a tooth in place: the gum, the ligament and the bone. Bacteria in plaque and tartar work their way under the gum, the bone around the roots shrinks, and the teeth start to loosen. At a late stage they fall out or are extracted.

This creates three problems for implant placement:

Infection. Placing an implant next to an inflamed pocket is a known risk.

Bone. It has already shrunk and is often uneven — a jagged ridge with dips where the pockets used to be.

The bacteria remain. The same microbes that ate away the bone around the teeth will attack the implant. Hence a higher risk of peri-implantitis.

None of this rules out implant placement. Each point simply demands its own step in the plan.

How it is done: the sequence

1. Diagnostics. A CBCT scan (11,000 ₸) and a periodontist's exam: pocket depth, the mobility of each tooth, bone volume. This is where the main decision is made — which teeth can be saved and which cannot.

2. Treating the gums. If some teeth are kept, professional cleaning (25,000 ₸) and pocket treatment with the Vector device (70,000 ₸), sometimes as a course. The goal is to clear active inflammation before surgery.

3. Extracting hopeless teeth. Mobile teeth are extracted easily (8,000 ₸ per mobile tooth). What matters more is what happens next.

4. Levelling the bone. With periodontitis, the bone around the teeth has already changed shape — after extraction an uneven ridge is left. It is levelled (alveolar ridge reduction) to create a flat, dense base for the implants and denture. This is the key step specifically with periodontitis — it is exactly what was done in the clinic's case.

5. Implant placement. Most often done at the same time as extraction, if the inflammation allows: implants go into the prepared site, and the patient is never without teeth. With a full clearance, All-on-4/5; with a partial one, individual implants next to the teeth that were kept.

6. The denture. Temporary in the first days, permanent after integration.

How it went at the clinic

A patient with teeth damaged by periodontitis — saving them was not possible. The teeth were extracted, the ridge was levelled, four implants were placed in the same operation, and later removable-but-fixed dentures were fitted on both jaws. The logic of the case is simple: with periodontitis the bone has already changed, and a level base has to be built before supports are placed on it.

A second, similar case: loose bridges and chronic gum inflammation with an odour. The old restorations and problem teeth were removed, and implants were placed right away — one of them into the pterygoid bone, which avoided the need for a sinus lift; the patient received a temporary restoration after three days.

What comes after: the key difference

A patient with a history of periodontitis is a patient with a higher future risk of peri-implantitis. That is not a sentence — it is a routine:

professional cleaning every 4 months instead of every six;

a water flosser at home daily;

a check-up scan once a year;

at the first sign of bleeding near an implant, a visit — not waiting;

With this routine, implants in patients with a history of periodontitis last just as long as they do in anyone else.

What it costs

It depends on how many teeth are kept. Benchmarks: treating the gums — 25,000–70,000 ₸ per visit; extraction — from 8,000 ₸ per tooth; one Izen implant — 80,000 ₸; a full jaw with All-on-4 Izen — 1,200,000 ₸, All-on-5 — 1,500,000 ₸ (with a temporary denture). The consultation is free; the estimate follows the CBCT scan and the periodontist's exam. Instalments with Kaspi Red 0-0-24 or Halyk 0-0-12.

Related services and guides

• Dental implants in Astana
• Full-arch implant restoration in Astana
• Professional dental hygiene in Astana

Frequently asked questions

All my teeth are loose — do they all have to come out?

No. The periodontist assesses each one; a loose tooth is sometimes strengthened through treatment. Only teeth with almost no bone left are extracted.

Are implants with "parodontosis" the same thing?

In everyday speech "parodontosis" is used for any gum disease; the doctor will confirm the exact diagnosis at the exam. The approach to implants is similar.

How long do I wait after extraction?

With immediate implant placement, not at all — the implants go in during the same surgery. If the inflammation is severe, healing takes 2–3 months.

Will implants integrate if the bone has been "eaten away"?

The bone is levelled and augmented if needed; with a full clearance, All-on-4/5 works around the shortfall using tilted implants.