The short answer
Dentists look at your bone, your gums, your general health, your medications, whether you smoke, and whether you can keep up with daily cleaning and check-ups. Many issues, such as gum disease, low bone volume or poorly controlled diabetes, can be treated or improved first. Sometimes another option simply suits you better.
The eight factors at a glance
This guide is about the assessment itself: what the dentist looks at, and why. If you're still deciding whether implants are worth considering at all, ImplantOptions.ca covers who tends to be a good candidate and when implants may not suit you.
Enough height and width to hold an implant, or a plan to rebuild it.
Healthy, stable tissue around the site. Active gum disease is treated first.
Jaw growth needs to be finished. There's no upper age limit.
Conditions that affect healing need to be well managed.
Some affect bone, bleeding or immunity and change the plan.
A well-studied risk factor for implant problems.
Cleaning, grinding and keeping up with check-ups.
What else could work, now or instead.
1. Bone
An implant sits in the jawbone, so there has to be enough of it. After a tooth is lost, the bone that held it gradually shrinks. Gum disease and injury can take more.
- A CBCT scan measures the height and width of bone at the planned site
- Where there isn't enough, a bone graft can often rebuild it, though that adds a healing stage
- The upper jaw tends to have softer bone than the lower jaw, which can influence planning
Bone quality is harder to measure than bone size. Your dentist forms a view from the scan, your history and, during surgery, how the bone actually feels.
Do I have enough bone, or would I need a graft first?
2. Gums and soft tissue
The gum forms a seal around an implant, a bit like the collar of a shirt. If that tissue is inflamed or infected, the risk of problems later goes up.
- Active gum (periodontal) disease needs to be treated and stable before implant surgery
- A band of firm, attached gum around the site helps with healing and cleaning
- Sometimes a soft-tissue graft is suggested if the gum is thin
People who have had gum disease can still have implants. They do need to keep up with cleanings, because a history of gum disease is linked with a higher risk of inflammation around implants later.
3. Age and jaw growth
Implants don't move with a growing jaw the way natural teeth do, so they're normally placed once growth has finished, usually somewhere in the late teens to early twenties.
At the other end, there's no upper age limit, and many older adults have implants. Overall health matters much more than the number of birthdays.
4. Health conditions
Some conditions change how you heal or how surgery needs to be planned. Having one of them rarely rules implants out on its own. What matters is how well it's managed.
- Diabetes: well-controlled diabetes is generally compatible with implants. Poorly controlled blood sugar slows healing and raises infection risk.
- Osteoporosis: many people with osteoporosis have implants. Some of the medications used to treat it also need to be discussed (see below).
- Heart conditions and blood pressure: may mean medical clearance or changes to how surgery and sedation are planned.
- Immune conditions: conditions or treatments that weaken immunity can slow healing and need careful planning.
- Bleeding disorders: need coordination so bleeding is managed safely.
Does any of my health history change how you'd plan this?
5. Medications
This is where a written list really helps. A few groups of medications matter for implants:
- Bone medications (antiresorptives, including bisphosphonates): used for osteoporosis and some cancers. They change how bone renews itself and can raise the risk of a rare jaw complication after surgery, so the dentist needs to know the drug, the dose and how long you've taken it.
- Blood thinners: tell your dentist exactly which ones you take. Whether any adjustment is needed is a decision for your dentist and your prescribing doctor together.
- Immunosuppressants and long-term steroids: can slow healing and affect bone.
Don't stop anything on your own
Never pause or change a prescribed medication because of dental treatment without talking to the doctor who prescribed it.
6. Smoking and vaping
Smoking is one of the most thoroughly studied risk factors in implant dentistry. A 2015 systematic review found higher implant failure rates and more post-operative infections in people who smoke. It's also a recognized risk indicator for inflammation and bone loss around implants over the long term.
Vaping has been studied far less. Nicotine narrows blood vessels, so many dentists treat it with similar caution.
Smoking doesn't automatically mean no. It does mean a frank conversation about risk, and usually advice to stop well before surgery and through healing.
How much does smoking (or vaping) change my risk, and when should I stop?
7. Daily habits and follow-up
An implant can't decay, but the gum and bone around it can still become inflamed. Long-term success depends a lot on what happens at home and at check-ups.
- Cleaning: daily brushing and cleaning between teeth, plus regular professional cleanings
- Grinding or clenching: heavy forces can damage the crown or the implant, so a night guard may be suggested
- Showing up: treatment involves several visits over months, and then ongoing check-ups
8. If implants aren't right, or aren't right yet
Sometimes the answer is "not yet". Gum treatment, a bone graft or better control of a health condition may make implants possible later. Sometimes another option simply fits your situation better:
Tooth-supported bridge
- Fixed in place, no surgery
- Uses the neighbouring teeth for support, which means shaping them
Removable denture
- Partial or complete, no surgery
- Comes out for cleaning; fit can change as bone shrinks
For a fuller comparison, ImplantOptions.ca lays out implants, bridges and dentures side by side.
Common questions
What disqualifies someone from getting dental implants?
There is rarely a single factor that rules implants out for good. Uncontrolled diabetes, active gum disease, not enough bone without a grafting option, some immune-suppressing conditions and heavy smoking can all raise the risk or mean treatment has to wait until they're addressed.
Can people with diabetes get dental implants?
Often, yes. Well-controlled diabetes doesn't usually prevent implant treatment. Poorly controlled blood sugar slows healing and raises infection risk, so your dentist will want to know how well it's managed.
Do I need a bone graft before getting implants?
Not always. It depends on how much bone is available at the planned implant site and where it sits. A CBCT scan measures bone height and width and maps nearby anatomy; your dentist judges bone quality using that and other clinical information. If there isn't enough bone, grafting can often rebuild the site, though it adds time.
Am I too old for implants?
There's no upper age limit. General health, medications and the ability to look after the implant matter far more than age.
References
- Chrcanovic BR, Albrektsson T, Wennerberg A. Smoking and dental implants: a systematic review and meta-analysis. J Dent. 2015;43(5):487-498.
- Heitz-Mayfield LJA. Peri-implant diseases: diagnosis and risk indicators. J Clin Periodontol. 2008;35(8 Suppl):292-304.
- Derks J, Tomasi C. Peri-implant health and disease: a systematic review of current epidemiology. J Clin Periodontol. 2015;42(Suppl 16):S158-S171.
- Tyndall DA, Price JB, Tetradis S, Ganz SD, Hildebolt C, Scarfe WC. Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(6):817-826.
