In: Dental Implants
Most healthy adults with reasonable bone are candidates for implants. Here are the factors that affect candidacy and the conditions that change the conversation.
Bone requirements
Implants need adequate bone in three dimensions:
- Height - typically 10+ mm vertical bone for a standard implant.
- Width - 6+ mm horizontal bone for a standard-diameter implant.
- Density - well-mineralized bone fuses faster than soft bone.
When bone is insufficient, options include:
- Bone grafting - restores volume. Adds 4-6 months to the timeline.
- Sinus lift - for upper back teeth where the sinus floor has dropped low.
- Shorter or narrower implants - for select cases.
- Different anchor sites (zygomatic implants for very advanced bone loss).
A CBCT scan shows your exact bone status.
Health conditions that complicate implants
- Uncontrolled diabetes - high glucose impairs healing and raises infection risk. Well-controlled diabetics have similar success rates to non-diabetics.
- Bisphosphonate therapy (Fosamax, Actonel, Reclast for osteoporosis) - small risk of medication-related osteonecrosis of the jaw. Discussed with prescribing physician.
- Recent head/neck radiation - significantly raises failure risk; usually requires hyperbaric oxygen therapy or alternative treatment.
- Active chemotherapy - usually defer until completion.
- Heavy smoking - 2-3× higher failure rate. Strong recommendation to quit at least during healing.
- Heart valve replacement or recent stent - antibiotic premedication may be needed.
- Severe immune compromise (uncontrolled HIV, organ transplant) - case-by-case.
Lifestyle factors
- Smoking is the biggest modifiable risk. We strongly encourage quitting at least 2 weeks before and during healing - many patients quit permanently after a successful implant.
- Alcohol - heavy use slows healing.
- Grinding/clenching - significant heavy grinders need a night guard to protect the implant.
- Pregnancy - defer to after delivery.
- Oral hygiene - implants need excellent home care; patients with chronic periodontal disease need stabilization first.
Age considerations
Implants are appropriate from late adolescence (around age 18-21, after full skeletal maturity) through advanced age. There is no upper age limit - 80- and 90-year-olds receive implants successfully when otherwise healthy. The key is medical health and bone status, not chronological age.
What we evaluate at the consultation
- Comprehensive medical history - flagging any of the conditions above.
- Comprehensive dental exam - periodontal status, remaining teeth, bite.
- CBCT imaging - bone volume, density, and proximity to nerves and sinus.
- Photographs - for aesthetic planning of visible-tooth implants.
- Discussion of options, timeline, and cost.
- Pre-authorization with insurance.
- Coordination with your physician, oral surgeon, or other specialists as needed.
Most patients leave the consultation with a clear treatment plan, timeline, and written estimate.
Frequently asked questions
- I was told I don't have enough bone - am I out of options?
- Not usually. Bone grafting restores most cases. Even severe bone loss can sometimes be addressed with sinus lifts, ridge expansion, or zygomatic implants. Get a second opinion before giving up on implants.
- Can I get implants if I smoke?
- Yes, but with significantly higher failure rates. Most surgeons require quitting at least during healing (2-3 months). Many patients use the implant case as motivation to quit permanently.
- I had radiation for cancer 10 years ago - can I get implants?
- It depends on the dose and which structures were treated. We coordinate with your oncologist and the surgeon. Some patients need hyperbaric oxygen pre-treatment; others are candidates without modification.
- What's the success rate?
- Modern implants have a 95-98% success rate at 10 years for healthy patients with good hygiene. Smokers, uncontrolled diabetics, and patients with poor hygiene have lower rates - but still typically above 85%.