Who can get a dental implant? Age, health, smoking and diabetes
Dr Pushkar SobtiAll-on-X implantologist, Delhi
A lot of the people who come to see me have already been told somewhere else that implants are not for them. They are too old, or diabetic, or there isn't enough bone.
In the first post of this series I wrote about the patient who made me an implant dentist. He was 79, a cancer survivor, and had been told his bone was too weak and he was too old. Today he eats everything. Far more people can have implants than think they can, and in most cases the reasons for a no can be worked around.
Am I too old?
There is no upper age limit for implants. Bone in a healthy 75-year-old fuses with titanium the way it does in someone much younger, just a little more slowly. What I look at is general health, not the date of birth. Many people in their seventies and eighties have put up with a loose denture for years, and for them fixed teeth change everyday life more than for anyone.
At the other end, implants are usually placed only once the jaw has finished growing, in the late teens or early twenties. Before that, a temporary solution is used.
What if I have diabetes?
Diabetes on its own is not a reason to refuse an implant. What matters is how well it is controlled. Before planning surgery I ask for a recent HbA1c, which shows your average sugar level over the past three months. When it is well controlled, implants heal and last much like they do in people without diabetes.
When sugar levels are high, healing slows and the risk of infection rises. In that case we work with your physician to bring it under control first, and then go ahead. A few weeks of better control can make the difference.
What about smoking?
I don't turn smokers away, but I tell them plainly what they are risking. Smoking reduces blood flow to the gums and bone, slows healing, and roughly doubles the chance of an implant failing. It also raises the risk of gum disease around the implant in the years that follow.
I ask patients to stop for at least two weeks before surgery and two months after, while the implant fuses with the bone. For some people this turns into the push to stop completely, which is even better.
Gum disease
Active gum disease is one of the main reasons implants fail later. The same bacteria that destroyed the bone around natural teeth can attack the bone around an implant. So if your gums bleed or teeth are loose, we treat the gums first and make sure they are stable before placing implants.
Having lost teeth to gum disease does not rule you out. It just means cleaning and regular check-ups matter even more afterwards.
Not enough bone
"Not enough bone" is the reason I hear most often for a previous refusal. A CBCT scan shows exactly how much bone there is and where. Often there is more than a flat X-ray suggests. Where there isn't, there are proven options: bone grafting, a sinus lift in the upper jaw, tilted implants as in All-on-4, or zygomatic and pterygoid implants that anchor in the dense bone of the cheek and the back of the upper jaw, so no graft is needed at all.
Medicines and health conditions to tell me about
- Blood thinners such as aspirin or warfarin: usually manageable without stopping them, but I need to know, and sometimes we coordinate with your doctor.
- Bone medicines for osteoporosis or cancer, especially injections such as zoledronic acid or denosumab: these need careful assessment, because they can affect how the jawbone heals.
- Radiotherapy to the head or neck: implants are often still possible, with extra planning and timing.
- Heart conditions, blood pressure and thyroid problems: when they are controlled, they rarely stand in the way.
Bring a list of everything you take, including over-the-counter medicines and supplements. It is the most useful thing you can bring to your first visit.
When I ask patients to wait
There are a few situations where I advise waiting: during pregnancy, during active chemotherapy, with uncontrolled diabetes, or straight after a heart attack or stroke. Most of the time that is a delay, not a refusal. Once things are stable, we plan again.
If you have been told you are not a candidate, it is worth a second look. Send me your X-ray or CBCT scan and your medical history on WhatsApp, and I'll tell you what I think can be done.
Questions
Is there an upper age limit for dental implants?
No. What matters is general health and the bone available, not the number of years. Many patients in their seventies and eighties have implants successfully.
Can I get dental implants if I have diabetes?
Yes, if your diabetes is well controlled. Your HbA1c tells me more than the diagnosis itself. With good control, implants heal and last much like they do in people without diabetes.
Can smokers get dental implants?
Yes, but smoking roughly doubles the risk of an implant failing and slows healing. Stopping for at least a couple of weeks before and a couple of months after surgery makes a real difference, and stopping completely is best.
Next · Fri 30 Oct
Six implant myths I hear every week. Pain, rejection, metal detectors, age, cost and how long they last.