When Is a Dental Implant Advisable and When Not?

A dental implant serves as an artificial tooth root and enables permanent replacement of a missing tooth. It provides patients with a natural feeling when speaking and chewing and helps restore their smile and quality of life.

Missing teeth should be replaced as soon as possible, not only for aesthetic reasons but also to prevent consequential damage. Every tooth gap can lead to the remaining teeth shifting and the bite changing over time. This causes other teeth to be incorrectly loaded, which can result in further tooth damage. Additionally, untreated tooth loss can cause the jawbone to deteriorate, as the bone is resorbed without the stress from a tooth root. An implant can halt this process while providing aesthetically pleasing and functional tooth replacement. Therefore, an implant can generally be advisable whenever one or more teeth are missing and durable, fixed tooth replacement is desired.

When only a single tooth has been lost, the decision often comes down to choosing between a conventional bridge and an implant. An implant is very advisable in such cases, especially when the adjacent teeth are healthy.

Why? With a bridge, the two neighboring teeth would need to be ground down and crowned to serve as pillars for the bridge. This means that even completely intact teeth are modified. A single-tooth implant avoids this: the implant post is inserted directly into the gap in the jaw and later supports the crown. The neighboring teeth remain intact. This preserves more natural tooth structure. Additionally, the implant crown has no difference in appearance or cleaning compared to the surrounding teeth. It can be brushed like a normal tooth and no special bridge gaps need to be cleaned.

When several teeth in a row are missing, implants can also be an excellent solution. Instead of placing many individual implants, in some cases strategically placed implants can support a bridge construction. For example, three missing teeth can be replaced by two implants and a three-unit bridge anchored on them. Even when teeth are missing in different areas of the jaw, multiple implants can be distributed to close these gaps. Compared to a removable partial denture, an implant offers a firmer fit and a more natural feeling. Patients can laugh, speak, and eat freely again without fear of the tooth replacement loosening.

Dental implants also enable stable treatment in an edentulous jaw. A common variant is to insert two to four implants in the lower and upper jaw respectively. Either a full denture can be attached to these, which then clicks into place and remains removable but holds much more securely than a conventional denture, or even a fixed bridge construction that encompasses all new teeth. Through implants in the edentulous jaw, many people regain significant quality of life: the “third teeth” sit firmly, chewing works better, and pressure points from slipping dentures are avoided. Especially in the lower jaw, where conventional full dentures often have problems with retention, implants provide firm hold and security in daily life.

Sudden tooth loss due to an accident, for example from a fall or during sports, is often a major shock for those affected. In such cases, a dental implant can be a sensible solution to close the gap quickly and permanently. An implant can, if the conditions are right, sometimes be inserted relatively soon after the accident. The prerequisite is that there are no acute infections and sufficient bone is present.

The advantage: the implant prevents the jawbone from deteriorating at the accident site, and aesthetics and function are restored. After the implant has healed, there is hardly any noticeable difference from the original tooth. It is important to have the situation assessed individually by the dentist. Sometimes the wound must heal first or bone augmentation must be performed before implantation can take place.

Periodontitis, formerly also called periodontosis, is an inflammatory disease of the gums and jawbone that can lead to tooth loss if left untreated. When teeth have been lost due to periodontitis, an implant can be considered after successful treatment of the disease. Provided that the periodontitis is under control (i.e., the gums are healthy and free of inflammation), implants offer the possibility of filling the gaps created. However, special care is required for patients with a periodontal history: excellent oral hygiene and regular check-ups are essential to avoid inflammation around the implant (peri-implantitis). If these conditions are met, an implant can be an aesthetically and functionally convincing solution even after tooth loss due to periodontitis.

Some people already have tooth replacement, for example a partial denture or full denture, but do not manage well with it. Common problems with conventional removable dentures are insecure retention, pressure points on the gums, difficulties speaking (lisping), or impaired taste sensation because palatal plates cover the mouth area. When such removable tooth replacement does not function satisfactorily or is perceived as bothersome, implants can bring considerable improvement. With one or more implants, a denture can be stabilized so that it clicks firmly into place and no longer shifts. In some cases, thanks to implants, the denture can even be completely replaced by fixed tooth replacement. For patients, this means more comfort, security, and a natural mouth feeling in daily life.

In the visible anterior tooth area (the incisors and often also the front molars), appearance plays a particularly important role. When a tooth is missing here, many patients value a solution that is practically invisible and perfectly restores the natural appearance. An implant offers the possibility of treating a single tooth gap in the anterior area so that the result appears extremely natural. The implant-supported crown emerges directly from the gum, similar to a natural tooth. No metal clasps or conspicuous transitions are visible, as might be seen with a partial denture. Additionally, the neighboring teeth are not affected. With proper planning and execution, an anterior tooth implant achieves aesthetics that are hardly distinguishable from a real tooth. Especially when particular value is placed on aesthetics (for example, in young people or when the missing tooth is very noticeable when speaking and laughing), an implant is often the preferred solution.

Many people fundamentally desire a fixed solution when teeth need to be replaced. The thought of having to remove tooth replacement every night and place it in a glass does not appeal to everyone. An implant comes closest to the feeling of real, fixed teeth. Fixed tooth replacement offers a piece of normality: there is no fear of something shifting while eating, and care is similar to that of natural teeth. If there is a clear desire to replace a gap or even several teeth permanently, implants are often advisable. They make it possible to largely avoid removable dentures. This fulfills the wish of many patients for fixed “new” teeth that are indistinguishable from real ones and always feel secure.

As advantageous as implants are, certain requirements must be met for an implant to heal successfully and be maintained long-term. The most important conditions include:

• Sufficient bone availability: For an implant to hold stably in the jaw, sufficient jawbone must be present. After tooth loss, the bone shrinks over time. If much bone has already been lost, bone augmentation can often be performed to create sufficient substance. Without adequate bone availability, however, an implant is not advisable, as it would not find firm hold.
• Good general health: Although implantations are routine procedures, they are still surgical interventions. The patient should therefore be in a state of health that permits wound healing and stress. Uncontrolled diabetes, severe cardiovascular diseases, a weakened immune system, or the use of certain medications (e.g., immunosuppressive agents or certain osteoporosis medications) can increase the risk of complications.
• Appropriate age: The ideal age for an implant begins when physical growth is complete. In adolescents who are still growing, one usually waits until the jaw and dentition are fully developed, typically until young adulthood. There is practically no rigid upper age limit: seniors can also benefit from implants as long as their health is adequate.
• Excellent oral hygiene: Thorough and regular dental care is essential for implant wearers. Implants can, similar to natural teeth, be affected by inflammation if plaque and bacteria are not consistently removed. Anyone who decides on an implant should be prepared to brush carefully every day and clean the interdental spaces (e.g., with dental floss or interdental brushes). Regular check-up appointments and professional dental cleanings at the dentist also contribute to maintaining oral health. Existing dental diseases such as caries or periodontitis must be treated and healed before implantation so that the implant can heal in a healthy environment.

There are situations in which implantation is rather discouraged or other measures should be taken first. These include in particular:

• Severe general illnesses: Patients with certain severe diseases may not be good candidates for implants. For example, uncontrolled diabetes mellitus can severely impair wound healing. People who take strong immunosuppressants or suffer from certain bone diseases also have an increased risk of implant complications. In such cases, the treating dentist must weigh very carefully and possibly recommend alternatives.
• Insufficient bone availability (without augmentation): As mentioned above, sufficient bone is a must for implants. If the jawbone has receded so severely that reliable hold cannot be achieved even with bone augmentation, an implant is not advisable. Sometimes patients also do not wish to undergo bone augmentation. Then often only alternative treatments remain, as a loose implant would do more harm than good.
• Poor oral hygiene / untreated periodontitis: If daily dental care is neglected or untreated gum inflammation is present, this poses a significant risk for an implant. In a mouth with many bacteria and inflammation, an implant would probably not heal well or could become inflamed later (peri-implantitis). With poor oral hygiene, work should therefore first be done to improve oral health before considering implants. The same applies to active periodontitis: as long as the gum inflammation is not under control, an implant would be at risk.
• Smoking: Smokers statistically have a poorer implant prognosis. The nicotine and other harmful substances contained in cigarettes worsen blood circulation in the gums and can hinder healing. Additionally, smoking promotes inflammation in the mouth. Especially chain or heavy smokers have an increased risk that an implant will not integrate properly or cause problems long-term. Many dentists recommend at least significantly reducing smoking around the time of implantation or ideally giving it up entirely. If someone is not willing to adjust their smoking behavior, careful consideration must be given to whether an implant is the right choice.