Clinical strategies for implant therapy in patients with periodontitis

Patients with periodontitis face significantly increased risks of implant failure and peri-implantitis. These adverse outcomes are mainly associated with the enrichment of periodontal pathogens and microbial dysbiosis, host immune imbalance, smoking, and poor adherence to supportive periodontal therapy. In addition, complex hard- and soft-tissue defects and occlusal trauma caused by periodontitis further increase the complexity and long-term uncertainty of implant therapy. Therefore, implant treatment in patients with periodontitis should adopt a systematic management strategy centered on “inflammation control, functional reconstruction, and long-term maintenance.” On the premise of periodontal inflammation control and stable maintenance, clinicians should comprehensively evaluate the remaining dentition, hard-tissue and soft-tissue defects, dental implant surgical plan, prosthetic modality, and occlusal load. When necessary, hard-tissue and soft-tissue augmentation procedures should be performed to reconstruct a stable tissue founda tion. Digital technologies should also be integrated to coordinate the three-dimensional implant position, tissue support, and biomechanical load distribution, thereby achieving stable functional and esthetic rehabilitation. Further, risk stratification, plaque control, host inflammatory modulation, supportive periodontal therapy, and behavioral interventions should be reinforced to improve the long-term stability and predictability of implant rehabilitation. In the future, the integration of multi-omics technologies, artificial intelligence-based risk prediction, digital-intelligent implant workflows, and novel regenerative materials may further promote individualized precision therapy.