When implants are placed in suitable patients, the large majority are still in place ten years later. A 2019 review of long-term studies in the Journal of Dentistry (Howe and colleagues) estimated 10-year implant survival at about 96%, and closer to 93% once patients lost to follow-up were accounted for. Those figures come from people who were assessed and prepared before surgery, which is why your dentist asks so many questions about smoking, diabetes and your jaw before suggesting an implant.
Three things carry the most weight in that assessment: how much bone there is, your smoking habits, and how well any diabetes is controlled. Gum health sits alongside all three.
Bone is checked first, on a 3D scan
An implant is a titanium post that bone grows tightly against, a process called osseointegration. For that to happen, the post has to be surrounded by enough healthy bone in every direction. A flat X-ray cannot show the width of the jaw, so a 3D (cone-beam) scan is used to measure height, width and the position of nearby structures such as the sinus and the nerve in the lower jaw.
Bone shrinks after a tooth is lost, so the longer a gap has been there, the more likely it is that the site needs building up. A bone graft or sinus lift can often add what is missing, either at the same visit as the implant or as a separate step months beforehand. Thin bone therefore changes the plan and the timeline more often than it rules implants out.
Smoking more than doubles the odds of an implant failing
Of the lifestyle factors, smoking has the clearest effect. Tobacco narrows the small blood vessels in the gums and bone, so healing is slower and infection more likely. A 2021 meta-analysis in Medicina (Mustapha and colleagues), which drew on 292 publications and about 150,000 implants, found the odds of implant failure were around 2.4 times higher in smokers, with more bone loss around the implants that survived.
That is a higher risk, not a refusal. Plenty of smokers keep their implants for many years, and the risk can be reduced by stopping before surgery and staying off cigarettes through healing. If you have been thinking about quitting, an implant is a good reason to plan the date, and our article on smoking and oral health covers the wider effects on the mouth.
With diabetes, control matters more than the diagnosis
People with diabetes ask this question often, and the evidence is fairly reassuring. A systematic review in the Journal of Dental Research (Chrcanovic and colleagues, 2014) found that implant failure rates were not significantly different between people with and without diabetes, although slightly more bone was lost around implants in the diabetic group. The authors cautioned that good comparative studies were scarce.
Poorly controlled blood glucose is a different matter. It slows wound healing, makes infection more likely and is closely tied to gum disease. Before implant surgery your dentist may ask for a recent HbA1c result and, if needed, work with your GP to get control steady first. The two-way link between blood sugar and the gums is explained in our article on diabetes and gum disease.
Healthy gums protect the implant later
Implants cannot decay, but the gum and bone around them can become inflamed and infected in a condition called peri-implantitis. The bacteria involved are much the same as those behind gum disease around natural teeth. That is why any active gum disease is treated and brought under control before an implant is placed, and why regular cleaning visits with a dentist or OHT matter for the life of the implant.
Other things your dentist will ask about
| Factor | What it can affect | How it is usually handled |
|---|---|---|
| Age | Implants in a growing jaw can end up out of line with other teeth | Wait until jaw growth has finished; no upper age limit |
| Grinding or clenching | Extra load on the implant, screw and crown | Often a night splint and regular checks |
| Bone-strengthening medicines | A small risk of poor bone healing after surgery | Full medication history, sometimes a talk with your doctor |
| Past radiotherapy to the head or neck | Reduced blood supply to the jaw | Careful individual assessment |
| Overall health | Ability to heal after surgery | Reviewed at the consultation |
If an implant is not the right fit
For some people the risks stay too high, or the time and cost of preparing the site do not suit them. Bridges and dentures are well established alternatives, each with its own strengths, and our comparison of implants, bridges and dentures sets them side by side. If cost is part of the decision, the dental implant cost guide explains the typical market ranges and what adds to them.
Questions we are often asked
How long before surgery should I stop smoking?
There is no single agreed cut-off. Stopping as far ahead as you can, and staying smoke-free while the implant heals, gives the best conditions. Your dentist can talk through a plan with you.
Is type 1 diabetes different from type 2 for implants?
Either type can be compatible with implants. What matters most is how stable your blood glucose is, so the conversation is about your recent control rather than the type of diabetes.
I was told years ago I did not have enough bone. Is that still true?
It may not be. Grafting techniques and 3D planning have made implants possible for many people who were once turned away, so a fresh scan is worth having.
Am I too old for an implant?
There is no upper age limit. Healing can be slower in later life and the 2019 review found slightly lower survival in people aged 65 and over, so general health is weighed carefully, but age alone is not a reason to say no.
Find out where you stand
Bone, smoking, diabetes and gum health are each assessed in person, usually with a 3D scan and a look at your medical history. At Lumi Dental we offer a free implant consult so you can hear what applies to you and what, if anything, needs to happen first. Learn more on our dental implants page or get in touch to arrange a time.
This article is general information and not a substitute for personal dental advice. Implant suitability and risks should be assessed by your dentist. Dr James Tran is a registered dentist.
