Can you get implants if you smoke or have diabetes?

Both of these come up on nearly every consultation, usually phrased as an apology. Here is what the evidence supports and what we actually do about it.

Dental implants if you smoke

Implant failure rates in smokers run at roughly double those in non-smokers. Published figures vary between studies, but the direction never does, and the effect is dose-related — ten a day is worse than three.

The mechanism is vascular. Nicotine constricts small blood vessels and carbon monoxide reduces the oxygen the blood carries. Healing bone needs both a blood supply and oxygen, and the first weeks after surgery are when it needs them most.

The effect is much greater on grafted sites than on plain implant placement. A graft is dead material that must be colonised by new blood vessels before it can turn into bone, and in a smoker that colonisation is slower and less complete. If your plan includes grafting, smoking matters considerably more.

What we ask

Two weeks before surgery and eight weeks after. That window covers the critical healing period, and it is a request we make of every smoking patient.

Cutting down is not the same. The vascular effect is present at low volumes, and “I only have a few” is not the reassurance people intend it to be.

Vaping is not established as a solution. Nicotine is the vasoconstrictor and vaping delivers nicotine. The evidence base is thinner than for cigarettes, but there is no good reason to expect it to be neutral.

If you are not going to stop

We will usually still treat you, and the plan changes. We may avoid grafting where a shorter implant will do, we may stage the treatment differently, and we will be explicit that the odds are worse.

What we will not do is treat you as though the conversation had not happened. If an implant fails in a patient who continued to smoke through healing, that is not covered by the guarantee, and that is said and written down beforehand rather than produced afterwards.

Diabetes

The picture here is much better than most patients expect, and it turns on one word: control.

Well-controlled diabetes — broadly, an HbA1c under about 58 mmol/mol — carries implant success rates close to those of non-diabetic patients. Healing is somewhat slower, and we allow for that by extending the integration period, but the outcome is comparable.

Poorly controlled diabetes is a genuine problem. High blood glucose impairs the immune response, slows healing and raises infection risk, and implant failure rates rise accordingly.

What we ask

Your most recent HbA1c figure, and roughly what it has been doing over the last year. If you do not know it, your GP surgery will, and it is worth having before the consultation.

If the figure is high, our advice is usually to delay rather than decline. Six months of better control changes the odds materially, and we would rather help someone get there than take payment now and watch the implant fail. That is not a sales-friendly position and it is the correct one.

Diabetic patients here also get a shorter maintenance interval — four months rather than six — because peri-implant disease progresses faster where glucose control is imperfect.

Both together

Smoking and diabetes are not merely additive. Each impairs the small-vessel circulation the other depends on, and the combination pushes failure rates considerably higher than either alone.

For a patient who smokes and has poorly controlled diabetes, we would generally decline to place implants until at least one of those has changed. That is the situation in which we most often say no, and we say it at the consultation rather than after taking a deposit.

Two others worth mentioning

Bisphosphonates, taken for osteoporosis. Oral forms carry a small risk of poor healing in the jaw; intravenous forms carry a higher one. Not an automatic exclusion, but we need the drug name, the dose and how long you have taken it, and sometimes a conversation with your GP.

Gum disease, which is not a medical condition in the usual sense but is the single best predictor of peri-implant problems. Anyone who lost teeth to periodontal disease is at higher risk around implants, and treating the gums comes first. Not as a delaying tactic — as the thing that determines whether the implants last.

The point of all this

A clinic that never mentions these factors is either not asking or not telling. A clinic that refuses outright is being lazy about a manageable risk.

What you should expect is a figure, a reason and an option. If you would like yours, the consultation is £95 and includes a 3D scan and a written plan.