Effect of Periodontal Treatment Prior to Implant Placement on Marginal Bone Loss and Prosthetic Outcomes: A Systematic Review and Meta-Analysis

Abstract

Background: Periodontal disease and implant therapy are closely interrelated. Patients with a history of periodontitis are at significantly increased risk of peri-implant complications, including peri-implantitis, marginal bone loss, and implant failure. However, the influence of periodontal treatment rendered prior to implant placement on long-term marginal bone loss (MBL) and prosthetic outcomes remains insufficiently characterized in the current literature. This systematic review and meta-analysis was conducted to evaluate the effect of pre-implant periodontal treatment on MBL and prosthetic success rates in periodontally compromised patients.

Methods: A comprehensive search of PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databases was performed from January 2000 to December 2024. Randomized controlled trials (RCTs), prospective cohort studies, and retrospective studies comparing implant outcomes in patients who received periodontal treatment before implant placement versus those who did not were included. Primary outcomes were MBL (mm) and implant survival rates. Secondary outcomes included peri-implant probing depth, peri-implant tissue health, and prosthetic complications.

Results: A total of 2,341 records were identified; 24 studies met the inclusion criteria after screening, comprising 3,176 patients and 8,412 implants with a mean follow-up of 4.7 years. Meta-analysis revealed that patients who received adequate periodontal treatment prior to implant placement demonstrated significantly less MBL (weighted mean difference [WMD]: -0.41 mm; 95% CI: -0.67 to -0.15; p=0.002; I²=62%) compared to untreated patients. Implant survival rates were significantly higher in the treated group (OR: 2.14; 95% CI: 1.58–2.89; p<0.001). Subgroup analyses revealed that surgical periodontal treatment conferred additional benefit for MBL reduction (WMD: -0.58 mm) compared to non-surgical treatment alone (WMD: -0.29 mm).

Conclusion: Periodontal treatment prior to implant placement significantly reduces MBL and improves prosthetic outcomes. Clinicians are strongly advised to achieve documented periodontal stability before commencing implant therapy. Future well-designed RCTs are required to standardize treatment protocols and determine the optimal timing of implant placement following periodontal treatment.