What type of dental patient makes a good candidate for having tooth implants placed?

Evaluating a dental patient's suitability for tooth implants.

Once a decision has been made that dental implants will be considered as a treatment option, the treating dentist must make a determination about the patient's suitability for them

Factors that need to be evaluated include: 1) Patient health (medical conditions, medicines). 2) Patient habits (smoking, tooth grinding, oral home care). 3) Jaw bone quantity and quality.

I) Medical conditions.

An initial aspect of a dentist's evaluation will involve reviewing the patient's health history.

A) Medical conditions that contraindicate the placement of dental implants.

There are a number of medical conditions that typically bar elective oral surgery and therefore preclude the placement of dental implants. Some of these conditions include a recent myocardial infarction (heart attack) or cerebrovascular accident (stroke), valvular prosthesis (artificial heart valve) surgery, immunosuppression (a reduction in the efficacy of the immune system), bleeding issues, active treatment of malignancy (cancer), drug abuse, psychiatric (mental) illness, and intravenous bisphosphonate use (a type of drug used to treat osteoporosis).

Clearly any medical condition that places a dental patient at risk for further health deterioration (or even demise), prolonged bleeding or increased risk of infection has to be resolved before an elective dental procedure such as placing dental implants is considered.

B) Medical conditions that may influence a tooth implant's success rate.

Any medical condition that impairs the normal healing process can compromise the outlook for the successful placement of a dental implant. As an example, people who suffer from the effects of uncontrolled diabetes mellitus are not good candidates for tooth implants. However, the mere presence of a disease does not necessarily preclude the placement of tooth implants or significantly alter their long-term prognosis if the medical condition is controlled by treatment or medication.

II) Medicines.

The dentist will need a complete listing of the medicines that the potential dental implant candidate takes. These medicines must be evaluated both in light of the effect they may have upon the implant placement procedure as well as the healing process that occurs afterwards. Additionally, the dentist must evaluate these drugs in light of how they may interact with those drugs that the dentist typically utilizes when performing treatment. High on the dentist's list of drugs of concern are those utilized in the treatment of cancer, drugs used in anticoagulant therapy, and bisphosphonates (a class of drugs used in the treatment of osteoporosis).

III) Patient habits.

A) Smokers may have lower long-term dental implant success rates than nonsmokers.

Many research studies (but not all) have reported that the long-term success rate of tooth implants for smokers is lower than that found for nonsmokers. Clearly among smokers there will be a wide variation in the way each practices their habit and this may be the reason why the findings of some studies conflict with others. It is, however, generally thought that the effects of smoking include a reduction in bone density and bone quality as well as impaired wound healing. It is easy to see how these factors could affect the long-term outlook for a dental implant.

This does not mean that a smoking habit should be considered to be an absolute contraindication for the placement of implants. Instead, smokers need to realize that if they do continue to smoke that they are probably at higher risk for implant failure. Some treatment protocols have been suggested that call for smoking cessation one week prior to and then eight weeks following the placement of a dental implant, so to minimize the effects of smoking during the early stages of implant healing (osseointegration).

B) Bruxism (tooth clenching and grinding) may compromise dental implant success.

Bruxism is a term that refers to a parafunctional habit that includes clenching and grinding of the teeth.

The act of bruxing can result in excessive forces being directed to the bone-implant interface. This type of biomechanical overload has been correlated with tooth implant failure.

A habit of bruxing should not necessarily be considered a contraindication for the placement of dental implants but its destructive influence should be recognized and addressed (often by way of the dentist making a mouthguard for the patient).

IV) Tooth implants and age considerations.

As a general rule, placing tooth implants should be delayed until the age of 18 to 19 years. This age typically represents a time frame during which an adolescent's jaw growth and development can be considered to be complete.

Advanced age doesn't necessarily contraindicate the placement of dental implants but it can present challenges. It has been suggested that a failure to practice adequate oral hygiene, a phenomenon that often accompanies advanced age, places the long-term survival of a tooth implant at risk. However, to the converse and especially in the case where an elderly patient cannot tolerate a removable appliance (partial or full denture), dental implants may be a reasonable choice and one that makes it possible for the dental patient to maintain adequate nutrition where otherwise they could not.