Who can have a dental implant? Age, smoking, diabetes, osteoporosis and lifespan

How long does an implant last?

A well-integrated implant has no expiry date. A large review of the scientific literature, combining 18 studies, found 96% of implants still in place after 10 years. Many last far longer, often a lifetime.

What wears out is mainly the crown on the implant: it can chip or need to be redone after many years, without touching the implant itself.

The two main causes of losing an implant are:

• failure to integrate in the first few weeks: the bone does not "fuse" with the implant. This is rare, and the implant can usually be placed again after healing;
• peri-implantitis, years later: an infection of the gum and bone around the implant, the equivalent of gum disease around a tooth. It is prevented by good brushing and regular check-ups.

People often talk about implant "rejection". The term is misleading: titanium is not rejected like a transplanted organ, and true titanium allergy is exceptional. When an implant is lost, it is almost always a problem of bone integration or infection.

From what age?

An implant does not grow with the jaw. You therefore need to wait for the end of growth, usually around 18, sometimes a little later for a front tooth. Until then, a temporary solution (a plate, a bonded bridge) bridges the gap.

Up to what age?

There is no upper age limit. What matters is general health and the quality of the bone, not the date of birth. Patients over 80 receive implants with excellent results, particularly to stabilise a lower denture.

After 70, Belgian health insurance (INAMI) reimburses two lower-jaw implants to secure a full denture: see Lower denture that won't stay in after 70: two implants reimbursed by INAMI.

Smoking: the main risk factor

Smoking is the factor that weighs most on the success of an implant. Tobacco reduces blood flow to the gum and bone: healing is slower, and the risk of failed integration and of peri-implantitis is clearly higher.

It is not an absolute contraindication, but:

• stopping smoking, or at least cutting down sharply, for a few weeks before and after placement clearly improves the chances;
• in a heavy smoker, a bone graft or a sinus lift is riskier and needs an honest discussion;
• e-cigarettes are not harmless either: mention them.

Diabetes: yes, if it is well controlled

Well-controlled diabetes does not prevent an implant: results are close to those of patients without diabetes. Poorly controlled diabetes slows healing and encourages infection. In that case, the diabetes is brought under control with your doctor first, then the implant is planned.

Bring your latest glycated haemoglobin (HbA1c) result to the consultation: it is the most useful indicator.

Osteoporosis and bone treatments

Osteoporosis in itself does not prevent an implant. What matters is the treatment:

• tablets for osteoporosis (oral bisphosphonates) usually allow an implant to be placed, with precautions;
• injections (intravenous bisphosphonates, denosumab), especially at high doses for cancer, carry the risk of a rare but serious complication: osteonecrosis of the jaw, an area of bone that no longer heals. In that context, an implant is often advised against.

Never change these treatments on your own: the decision is made with the doctor who prescribes them. Bring the exact name of the medicine, the dose and how long you have been taking it.

Blood thinners and other medicines

Anticoagulants and antiplatelet drugs (for example for the heart) are not a contraindication. In most cases they are not stopped: bleeding is controlled locally. The approach is decided with your doctor or cardiologist, never on your own.

Also mention treatments that suppress immunity (long-term steroids, post-transplant treatment, some chemotherapies): they require careful timing of the procedure.

Head and neck radiotherapy

Radiotherapy to the mouth or neck permanently weakens the jawbone. Implants are sometimes still possible, but these are cases for specialist surgery, planned together with the oncology team. This is an area where experience in maxillofacial surgery and reconstruction makes the difference.

Other situations to mention

• Gum disease (periodontitis): it must be treated and stable before the implant, otherwise the risk of peri-implantitis increases.
• Bruxism (clenching or grinding the teeth): it does not prevent an implant, but a night guard protects the crown.
• Pregnancy: treatment is usually postponed until after the birth, particularly because of X-rays and medicines.
• Lack of bone: this is not a contraindication, but an extra step. See Not enough bone for a dental implant: what are the options?.

What to bring to the consultation

So that the assessment is complete from the first appointment:

• the full list of your medicines, with the doses;
• your latest blood test results if you have diabetes;
• your recent X-rays, if you have any;
• the letter from your referring dentist, if you are referred.

At the Waterloo practice, the assessment includes a 3D scan (CBCT) done on site, which shows the height and width of the bone and the position of the nerves and sinuses. This makes it possible to say precisely whether the implant can be placed straight away, after a graft, or with another solution.

In summary

• The vast majority of adults can have an implant; 96% are still in place after 10 years.
• Age: after the end of growth, with no upper limit.
• Smoking: the main risk factor, but not a ban; stopping around the time of placement helps a lot.
• Diabetes: no problem if it is well controlled.
• Osteoporosis: it all depends on the treatment; high-dose injections call for the greatest caution.
• Blood thinners: usually not stopped, decided with your doctor.

For the next steps, read Having a dental implant placed: steps, pain and timeline and Cost of a dental implant in Belgium: what matters and what is reimbursed. All the information on implant treatment at the practice is on the Dental implants page.