Am I a Candidate for Dental Implants?

Most adults missing one or more teeth are candidates for dental implants — the more than 3 million Americans already living with implants are the proof, and the ADA reports a 90 to 95% success rate over 10 years when placement protocols are followed. In my chair, five things actually decide it: how much bone you have at the site, whether conditions like diabetes and osteoporosis are controlled, that the area is free of active infection, your willingness to stop smoking around surgery, and a jaw that has finished growing. Almost everything else is workable.

The patients who genuinely cannot proceed are a small group: uncontrolled diabetes, active IV bisphosphonate therapy, recent head-and-neck radiation, certain immunosuppressed states. Even most of those become candidates once I coordinate with their physician — I have placed implants in patients with severe bone loss, prior radiation, and high-A1c diabetes that other offices turned away.

If a practice told you no, it is almost always because they don’t do the bone grafting or sinus-lift work that would make you a candidate — not because implants are truly off the table. Get a second opinion before you accept that answer. Below, I walk through each of the five factors the way I do at a real consult.

This is the most common reason patients get told no — and the most fixable one. Once a tooth comes out, the jawbone around it begins to resorb; the body absorbs roughly 25% of ridge width in the first year after extraction. After five years with nothing in the gap, the site is often too thin or too short for a standard implant. That is a bone problem, not a candidacy verdict.

I confirm exactly what you have with a 3D CBCT scan at your consult. CBCT is the single most important tool I use — without it you are placing implants blindfolded, and you never want a blindfolded surgeon measuring millimeters next to a nerve. If the bone is inadequate, I can almost always rebuild it: particulate grafts, block grafts, sinus lifts, and ridge expansion add one to six months to the timeline but have restored candidacy for the large majority of the “not enough bone” patients who come to me. For the deeper mechanics, I wrote a full page on getting implants with significant bone loss.

I trained at UCLA and place every implant myself — no associates, no hand-offs. The goal of grafting isn’t just to seat a fixture; it’s to give me dense, healthy bone so the implant builds a strong band of keratinized gum that seals out bacteria for the long haul. Bring any previous CBCT or panoramic X-ray and I will read it with you at the consult.

Usually not. Controlled diabetes and osteoporosis medication change how I plan and pace a case, not whether I can do it. What I screen for is anything that starves the implant of blood supply during the first three months of healing — that is the window that decides integration — and most of it I can manage or work around.

Diabetes. A well-controlled diabetic with an A1c below 7.5 behaves, in my experience, almost like a healthy non-smoker; well-controlled diabetics in the literature show implant survival comparable to non-diabetics. Because my UV-activated implants increase blood flow to the site, I can treat diabetics up to roughly an A1c of 9 — with a signed consent that the implant might still fail, in which case I redo it. I learned to take that seriously the hard way: I’ve had a patient who swore he wasn’t diabetic slip past screening and then fail, and his A1c turned out to be over 10. Now I follow up harder. The full thresholds live on my page about dental implants with diabetes.

Osteoporosis. Oral bisphosphonates (Fosamax, Actonel) are generally compatible — large numbers of patients on these prescriptions integrate fine. IV bisphosphonates (Zometa, Aredia) are a stronger concern because they slow circulation in bone, exactly the thing healing needs; I review timing with your oncologist and lean on UV activation and PRP to help the site heal. If you take a bone-density drug, start with implants with osteoporosis and bisphosphonates.

Heart conditions. Most are not a barrier. I pre-medicate with antibiotics for prosthetic heart valves, recent endocarditis, or specific congenital conditions, following the American Heart Association protocol, and coordinate with your cardiologist when blood thinners are involved.

Yes — smoking is a risk to manage, not an automatic no. It roughly doubles failure odds, and the mechanism is no mystery: nicotine constricts the blood vessels feeding the surgical site, so a constant heavy smoker can spin an implant out at the three-month check with almost no torque, because there was never enough blood supply to fuse. A smoker’s 10-year survival sits closer to 85% versus the high 90s in non-smokers.

So I ask smokers to stop one week before surgery and eight weeks after — the first four to six weeks are the critical window for the gum to seal and establish its blood supply. After that the tissue has keratinized and the seal is protective. Nicotine patches and gum carry the same vasoconstriction, so I want true abstinence through that window, not a substitute. I also make every smoker a custom smoker’s guard: a mouthguard that physically shields the implants while you smoke.

If you genuinely cannot stop, the implant can still take — I just want you choosing with eyes open on the higher risk, and I document it. Vaping looks similarly disruptive on current evidence, and I treat it the same way. The honest numbers and exactly what I ask are on my page for dental implants for smokers.

Age alone almost never decides it. There’s a real lower limit — a jaw still growing isn’t ready — but there is no upper one. What I weigh is medical health, blood supply, and bone quality, not the number on your license.

Too young. I don’t place implants while the jaw is still growing — typically before about 17 in females and 19 in males. The jaw keeps growing after the rest of the body finishes, and an implant set too early ends up in the wrong vertical position while the natural teeth around it keep erupting.

Too old. No upper limit. I routinely place implants in patients in their 70s and 80s; an active 85-year-old with controlled blood pressure is a stronger candidate than a sedentary 55-year-old with uncontrolled diabetes. Older bone carries less blood supply and more calcium, which is exactly where UV activation and PRP earn their keep — they bring circulation, stem cells, and healing factors to a site that would otherwise struggle. I cover the specifics on dental implants for seniors.

Get a second opinion from an implant-focused dentist who actually does the full range of bone grafting and sinus-lift work. A “no” usually means that office doesn’t perform the procedure that would make you a candidate — not that it can’t be done. The cases I’m proudest of are the ones others turned away: prior radiation therapy, severe periodontitis, a diabetic at A1c 9, a smoker-and-diabetic. I tell those patients up front that a failure is possible, stretch the timeline, and consent it carefully — and the large majority still succeed.

Bring any imaging you have — panoramic X-ray, CBCT, periapical films — plus a list of your medications and any past surgical reports. The more I know walking in, the more useful the consult is, and the more likely I can tell you yes that day.

The consult is 45 minutes with me, not an associate, at my Downey office — the CBCT scanner is down the hall, so I read your bone on the screen with you the same visit rather than referring you out. You leave with an itemized treatment plan, your exact pricing in writing, and a straight answer on whether implants are possible. It requires no deposit. When a case does come together, my work carries a 10-year biological warranty on the bone integration and the seal — never a “lifetime implant warranty,” which no honest practice can promise.