Is a Dental Implant Right for You? 7 Things Your Dentist Checks First

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Is a Dental Implant Right for You? 7 Things Your Dentist Checks First

With insights from Eileen Chen-Mizuuchi, DDS, and Roddy Castells, DDS

If you have lost a tooth, or been told one needs to come out, a dental implant is probably one of the options on the table. Implants are a well-established treatment. Published research puts the overall failure rate at around 5%, so most implants do well.

That average hides a lot of variation, though. Whether an implant suits you depends less on the implant and more on your mouth, your health and your habits.

An implant is a small post placed in the jawbone, where it bonds with the bone over several months. A connector called an abutment holds a crown, bridge or denture on top. Because the whole system relies on healthy bone and gums, a careful dentist checks several things before recommending one. Here are the seven that matter most, and what you can do about each.

Eileen Chen-Mizuuchi, DDS Illume Dental of McKinney

DENTIST INSIGHT According to Dr. Eileen Chen-Mizuuchi, DDS, a dentist in McKinney, TX at Illume Dental of McKinney, most adults with healthy gums and enough jawbone density are good candidates for implants.She notes that chronic conditions such as diabetes, and tobacco use, can affect eligibility, and that any gum disease has to be treated first. An in-person consultation is what confirms whether an implant is the right choice.

1. The health of your gums

Gum disease needs to be under control before an implant goes in. Implants can develop their own form of it, called peri-implantitis, which is inflammation that destroys the bone holding the implant.

It is more common than most people expect. A 2025 systematic review from the Academy of Osseointegration and the American Academy of Periodontology found peri-implantitis in about 21% of patients with implants. It found the earlier, reversible stage, peri-implant mucositis, in about 46%. A history of periodontitis is one of the better-documented risk factors. Expect your dentist to treat any active gum disease and confirm it is stable first.

2. How much bone you have

An implant needs enough bone height and width to anchor in. Once a tooth is gone, the bone that held it starts to shrink. One systematic review found the ridge lost about 3.9 mm of width and 1.7 mm of height on average while the socket healed.

Your dentist will measure your bone with X-rays and often a 3D scan. If there isn’t enough, grafting or a sinus lift can often rebuild it.

DENTIST INSIGHT According to Dr. Roddy Castells, DDS, a dentist in Tomball, TX at Castells Dental Group, bone grafting builds the support an implant needs and can help prevent further bone loss.He adds that full integration of the graft can take several months, so it lengthens the overall treatment timeline.

Roddy Castells, DDS Castells Dental Group

If you are about to have a tooth removed and might want an implant later, ask whether preserving the socket at the time of extraction makes sense.

3. Whether you smoke

Smoking is the most consistent lifestyle risk factor for implant failure. A 2021 meta-analysis covered 292 publications and more than 150,000 implants. It found implants in smokers had about 2.4 times the odds of failing compared with those in non-smokers.

A 2024 review also found the risk rises with the number of cigarettes smoked per day. The effect of e-cigarettes is less clear, and researchers are still studying it. If you smoke, quitting before treatment is one of the most useful things you can do for your implant. Your dentist and physician can help you plan it.

4. Diabetes and other health conditions

Diabetes does not automatically rule out an implant, but blood sugar control matters. The 2025 review above identified diabetes as a potential risk indicator for peri-implantitis. An earlier review linked it to about 2.5 times the odds.

Bring your most recent A1C result and a full list of your conditions to the consultation. Your dentist will also ask about anything that affects healing or immunity, and about past radiation to the head or neck.

5. Your medications

Some bone-strengthening drugs need special attention. Antiresorptive medications, such as bisphosphonates and denosumab, are linked to a rare but serious complication called medication-related osteonecrosis of the jaw (MRONJ). In MRONJ, an area of jawbone fails to heal.

The risk depends heavily on the dose and the reason for the drug. The American College of Prosthodontists notes that oral bisphosphonates taken for osteoporosis are far less likely to cause it than high-dose intravenous treatment for cancer. For patients receiving these drugs for cancer, American Dental Association guidance lists implants as contraindicated. It also advises finishing needed dental surgery before therapy begins when possible.

Never stop a prescribed medication on your own. Tell your dentist everything you take, including blood thinners and supplements, so they can coordinate with your physician.

6. Your bite and the teeth around the gap

Your dentist will look at how your teeth meet, whether you grind or clench, and the health of the teeth beside the gap. Heavy grinding can overload an implant, so a night guard may be part of the plan.

One advantage of an implant over a traditional bridge is that the neighboring teeth don’t need to be reshaped to support it. Age matters too. Implants don’t shift as the jaw grows, so dentists usually wait until jaw growth is complete.

7. Your commitment to aftercare

An implant can’t get a cavity, but the gum and bone around it can still get infected. Maintenance makes a measurable difference. A 2018 review found peri-implantitis in a median of 9% of patients who kept up regular preventive cleanings, compared with 18.8% of those who didn’t.

Plan on brushing twice a day, cleaning around the implant with floss or a small interdental brush, and keeping regular professional cleanings and exams.

If an implant isn’t the right fit, or isn’t right yet

Often the honest answer is “not yet.” Gum disease can be treated, smoking can be stopped, blood sugar can be brought under control, and bone can be rebuilt. Each of those can turn a poor candidate into a good one.

If an implant isn’t advisable, there are proven alternatives:

• A fixed bridge supported by the neighboring teeth
• A removable partial denture
• A full denture
• A denture that snaps onto a few implants, which needs less bone than replacing every tooth individually

Cost is part of the decision too. Many dental plans limit or exclude implant coverage, so ask for a written estimate of each option before you commit.

Questions to ask at your consultation

• Are my gums healthy and stable enough for an implant?
• How much bone do I have, and how will you measure it?
• Will I need a bone graft or a sinus lift?
• How do my health conditions and medications affect the plan?
• Who will place the implant, and who will make and attach the crown?
• What are my alternatives, and what do they cost and how long do they take?
• What will maintenance look like over the years?

The best implant outcomes start well before surgery, with an honest look at your gums, bone, health and habits. A thorough consultation should answer every question above. If it doesn’t, keep asking.

This article is for general education and is not a substitute for an examination by a dentist.

Disclosure: This article includes input from two dental practices, Illume Dental of McKinney and Castells Dental Group, both of which provide dental implant treatment. It does not recommend a specific provider.

References

1. Stiller HL, Ionfrida J, Kämmerer PW, Walter C. The Effects of Smoking on Dental Implant Failure: A Current Literature Update. Dentistry Journal. 2024;12(10):311.
2. Mustapha AD, Salame Z, Chrcanovic BR. Smoking and Dental Implants: A Systematic Review and Meta-Analysis. Medicina. 2022;58(1):39.
3. Prevalence, incidence, systemic, behavioral, and patient-related risk factors and indicators for peri-implant diseases: An AO/AAP systematic review and meta-analysis. Journal of Periodontology. 2025;96(6):587–633.
4. Dreyer H, Grischke J, Tiede C, et al. Epidemiology and risk factors of peri-implantitis: A systematic review. Journal of Periodontal Research. 2018;53(5):657–681.
5. Van der Weijden F, Dell’Acqua F, Slot DE. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. Journal of Clinical Periodontology. 2009;36(12):1048–1058.
6. American College of Prosthodontists. Position Statement: Medication-Related Osteonecrosis of the Jaw.
7. American Dental Association. Oncology Agents and Medication-Related Osteonecrosis of the Jaw. Oral Health Topics.