A common complaint we hear from new patients is “I’ve been told I can’t have dental implants”.
Sometimes that advice is found to be correct, whether that may be temporary (you can’t have them now but you can have them in the near future), sometimes the situation is more complex than a quick “yes” or “no”. And yes, occasionally we do also tell patients that implants may not (currently or otherwise) be the right solution for them.
We understand that this can be upsetting, especially for those who have suffered a long time with missing teeth, loose dentures, or are embarrassed or struggle to eat some foods due to lack of teeth.
However, good dentistry is not just about whether practically an implant can be placed in the bone. The real record of successful treatment is when it can be carried out safely, predictably, and with good long-term outcomes. And when it is time to be repeated (as it is almost the case for any medical treatment, from heart surgery to artificial joints), it can be done in a way that is simple and safe.
The goal of dental implant treatment, an elective treatment, is to improve quality of life safely, ethically and providing years of stability. We wrote a blog back in 2019 with FAQs in dental implants, which included a section on why you may not be able to have implants. We thought that it may be time to update and elaborate on this further.
Here Are the Main Reasons Why Implant Treatment May Not Be Right for You:
Medical Conditions
Diabetes
- Uncontrolled diabetes is a contraindication for elective surgery, as it can compromise healing and increase the risk of loss of implants and subsequent bone loss. This could potentially lead to a worsened situation than if treatment was avoided.
- Controlled diabetes is a different story. Many patients with well-managed diabetes successfully have implant treatment. However, the risks of compromised healing, infection, implant failure and bone loss are likely to remain at higher levels, compared to patients who do not have diabetes. Many other factors come into play, and your specific circumstance will need carefully assessing before deciding on any treatment, such as general overall health, previous experience with healing, gum condition, and any co-morbidities.
Cancer
- As dental implant surgery is elective, it is sensible to delay this until cancer treatments have finished, as they clearly take precedence
- Not all cancers are the same, and although modern medicine has improved the treatments, cancer and thepies for it affect the immune system, which could increase risk of infection or implant loss
- In some cases, longer term effects may increase the risks significantly to the end that it may be sensible to replace teeth with a different approach.
Autoimmune Conditions
- Certain conditions including rheumatoid arthritis and lupus, among others, may affect response to surgery and healing, and may need specific planning or coordination with other specialities, or may be best avoided totally.
Conditions Affecting Surgery or Healing
- Some medical conditions can affect the safe provision of surgery, for example uncontrolled high blood pressure, unstable angina and severe bleeding disorders.
- Sometimes, medications taken for other conditions can actually be the issue – Steroids, bisphosphonates and some antidepressants are known to affect bone metabolism and therefore healing and long term implant success.
Age
- Contrary to belief, it is younger patients, below the age of 20-25, who should avoid implants as the jawbones are still developing. Placing implants too early can lead to problems as the bone reshapes with time.
Lifestyle Factors
Smoking
- is the most obvious lifestyle factor affecting implant success. It is not a coincidence insurance companies apply an extra premium for smokers.
- Smoking Is documented to affect the blood supply, healing, and success of implant treatment. Heavy smokers, especially those with other health issues, may have severe complications if they have elective surgery.
- Picking up smoking again after implant treatment (even a long time after) can increase the risk profile and lead to delayed implant failure.
Alcohol
- Excessive alcohol consumption (as defined by the NHS) is a contraindication to dental implant treatment as it affects the liver, which controls crucial mediators for healing, the immune system and bone metabolism.
Poor Diet
- Often overlooked, nutrition can significantly affect the healing process and integration of implants.
Poor Oral Hygiene
- Implants rely on healthy gums and surrounding tissues. Unsatisfactory hygiene will lead to inflammation of the gums, and affect their healing after surgery. Moreover, unhealthy gums around implants will recede much faster than normal ageing, leading (often very quickly) to bone loss, exposed implant threads and eventually implant loss, even if the implants were well placed and stable to begin with.
Other Oral Conditions
Bruxism
- That is excessive tooth grinding.
- To paraphrase Dr House from House MD, ‘’everybody grinds’’, some people more than others.
- Bruxism is a central nervous system function, that in reality, although manifesting in the mouth and jaw region, has very little to do with it. It may not necessarily be a reason not to have implants, but careful planning and execution will be required from skilled clinicians with a good understanding of complex occlusal (bite) factors.
Severe Bone Loss
- This is a common reason patients are told they are not suitable for implants. In reality, modern techniques and procedures in implant dentistry have advanced and nowadays it is rarely a valid reason.
- It is important to note that implant dentistry exists in a wide spectrum of complexity. Some cases are straightforward, but some require advanced planning, and surgical techniques that not every clinician is proficient with.
- This may be why some patients implants are “not possible” with one clinician – it may be beyond their own experience, training or scope of practice. In such cases, referral to a more experienced implant team may offer a patient additional options.
- This does not deem the original clinician wrong – good dentists are able to recognise their own limitations in the safety of their patients.
- At Bridgeways Dental, we have yet to find a patient, even with severely atrophic jaws, that we had to refuse on this basis. And no, this is not because we use some secret invented technique guarded more securely than the Coca-Cola recipe.
- The methods we use are simple, based on published scientific evidence, researched extensively, and refined over many years by experienced and meticulous clinicians
Uncontrolled Gum Disease
- This is the most common reason that we will not offer dental implant treatment, especially when it comes to uncontrolled severe periodontitis (gum disease). In these cases, healing will be compromised, gums may recede rapidly, and implants may not integrate into the bone (early or immediate failure) or be lost some time after.
- The positive news is that periodontitis can be stabilised and controlled in nearly all cases with the right treatment, something we are proud to place at the centre of our focus at Bridgeways Dental.
- It is important that patients with a history of gum disease, that is now well controlled, receive ongoing professional maintenance and excellent home care to protect their teeth and implants, but it is worth noting that long term results are generally lower in these patients compared to those without gum disease.
Final Thoughts
Being told implants are not appropriate at a particular moment in time is not a judgement about you, and it is not necessarily the end of the road.
Nowadays, in most cases, implant treatment can be performed with reasonable or good outcomes, be it with additional preparation, stabilisation or elimination of diseases and lifestyle risk factors, and careful multi-disciplinary planning.
The goal is not simply to place implants. It is to restore dentitions to provide health, stability, function, aesthetic improvement and confidence for many years to come, with safety.
If you have been told that implants are “not possible” for you, do reach out as we may be able to help. It may mean that some extra steps are needed, but in many cases it is still achievable, and very worthwhile.
