Dental implants: contraindications, age limits, MRI and risks

Dental implants: what are the real contraindications?

Permanent contraindications to dental implants are rare. Most situations that worry patients, such as older age, well-controlled diabetes, smoking or osteoporosis, are relative contraindications: they raise certain risks and call for precautions, but they do not automatically rule treatment out. The decision rests on a full medical and dental assessment, sometimes in liaison with your doctor.

Three questions guide the assessment:

• Can your body cope with minor surgery and heal well? This is about general health, not the age on your passport.
• Can the bone receive and keep an implant? Volume, quality, medicines that affect bone turnover, any history of radiotherapy.
• Will you be able to look after the implant every day? Hygiene, follow-up, control of gum disease.

Honest answers to these three questions make it possible to choose between an implant, an implant with specific precautions, postponing treatment or a non-surgical solution.

Absolute and relative contraindications: the difference

An absolute contraindication means the risk clearly outweighs the benefit, at least for the time being. The situations usually mentioned are:

• a serious, unstable general illness, or a recent heart attack or stroke;
• ongoing chemotherapy or heavy immunosuppressive treatment;
• intravenous bisphosphonates or denosumab at cancer-treatment doses, because of the risk of osteonecrosis of the jaw;
• jaw growth that is not yet complete in a teenager;
• inability to cooperate with treatment and aftercare.

Many of these situations are temporary: once the illness is stable or treatment has ended, the plan can be reconsidered.

Relative contraindications, which are more common, require adjustments: smoking, diabetes, osteoporosis treated with tablets, a history of periodontitis, bruxism, anticoagulants, past radiotherapy away from the jaw. They are discussed case by case, sometimes with a delay, a graft, a different number of implants or closer follow-up.

Implants over 60, 70 or 80: age is not the issue

There is no upper age limit for implants. People over 80 in good general health receive implants, often to stabilise a denture that no longer stays in place. What matters is your health, your medicines, the volume of bone and your ability to clean the implant.

In older patients, a few points are examined with particular care:

• healing may be slower, which is built into the timeline;
• there are often more medicines, so bring an up-to-date list;
• manual dexterity may decline over time, so easy-to-clean solutions are preferred, such as a removable denture on two implants rather than a complex bridge;
• bone has often shrunk after years without teeth, which may require a bone graft or implants of a suitable size.

At the other end, in young people the implant waits for jaw growth to finish, because an implant does not grow with the jaw and would end up out of line with the neighbouring teeth. The end of growth varies from person to person and is assessed by examination, sometimes with comparative X-rays.

Diabetes, smoking, osteoporosis, radiotherapy: cases that need precautions

These situations do not close the door, but they change how treatment is carried out:

• Diabetes: well-controlled diabetes generally allows implants to be placed in near-normal conditions. Poorly controlled diabetes slows healing and encourages infection, so the first step is to improve control with your doctor. Our article on diabetes and gum health explains the link.
• Smoking: it increases the risk of the implant failing to integrate and of inflammation around it in the long term. Smokers are not excluded, but stopping, at least around the time of surgery, is strongly advised.
• Osteoporosis and bisphosphonates: osteoporosis itself does not prevent implants. Oral bisphosphonates carry a low but real risk of osteonecrosis of the jaw, which rises with the length of treatment. The dentist assesses this risk, sometimes with your doctor. Never stop this treatment on your own.
• Head and neck radiotherapy: irradiated bone heals poorly and can develop osteoradionecrosis. Implants are not always ruled out, but the decision is made with the oncology team, depending on the area and dose received.
• Anticoagulants: they do not rule out implants; the approach is agreed with the prescribing doctor, without improvised interruption.

Pregnancy, MRI, allergy: frequent questions

During pregnancy, implant placement is a planned procedure that is usually postponed until after the birth. Not because it is impossible, but because there is no reason to add surgery, X-rays and non-urgent medicines during this period. Urgent dental care remains possible.

Implants and MRI: the titanium used for implants is not magnetic. An implant poses no danger during an MRI scan and does not prevent the examination. It can, however, create small artefacts, meaning a less sharp area of the image around the jaw, which mainly affects MRI of that region. Tell the radiologist about your implants. A removable denture, and especially one held by magnets, must be taken out before the scan. Airport metal detectors do not usually cause problems.

Titanium allergy: it is considered very rare. For people with multiple metal allergies or who prefer a metal-free solution, ceramic implants are an option, presented in our article zirconia or titanium implant.

Dental implants: dangers and drawbacks you should know

A dental implant is a reliable treatment when properly indicated, but it remains surgery. Risks are low when the assessment is thorough, and it is normal to know them before you agree:

• during surgery: bleeding, injury to the nerve of the lower jaw (numbness of the lip or chin, most often temporary), an opening into the sinus in the upper jaw;
• during healing: swelling, infection, failure of the implant to integrate with the bone, which means removing it and often placing a new one later;
• in the long term: inflammation of the gum around the implant (mucositis), then bone loss (peri-implantitis), a loosened screw or fractured crown, gum recession in visible areas.

Practical drawbacks matter too: treatment in several stages, a wait before the final tooth, sometimes a graft beforehand, a higher cost than a removable denture, and the need for lifelong care and regular check-ups. The word "rejection" is misleading: an implant is not rejected like a transplanted organ; it may fail to integrate or lose its bone, most often for infectious or mechanical reasons.

The medical assessment before an implant in Agdal

The assessment is when these general questions become an answer for your own case. Bring a complete list of your medicines, including any injections or infusions you have received for your bones, your latest blood tests if you have diabetes, and any reports of radiotherapy or surgery.

At German Dental Clinic in Agdal, the clinical examination and panoramic X-ray are supplemented with three-dimensional imaging when needed, and placement can be planned with guided surgery where indicated. If contact with your doctor would help, the practitioner will suggest it. If you live in Rabat and wonder whether an implant is possible in your situation, you can book an appointment to discuss it.