Who Is Suitable for Dental Implants? Gum Disease, Bone Loss and Grafting

Whether you can have an implant comes down to two things: the health of your gums and the amount of bone in your jaw. Active gum disease has to be treated and stabilised before an implant is placed, not afterwards. Too little bone can often be rebuilt with a graft, though that adds cost and months to the timeline. Uncontrolled diabetes, heavy smoking and untreated periodontitis all raise the risk of failure enough that, for some people, a bridge or a denture is the better clinical choice.

This page explains how that judgement is actually made.

Can you have dental implants if you have gum disease?

Not while the disease is active. An implant sits in the same bone that periodontitis destroys, and inflammatory disease can affect the tissues around an implant just as it affects those around a tooth. The condition has a name when it happens around an implant: peri-implantitis.

So the answer is sequential rather than simply yes or no. Active disease is treated first. Once your gums are stable and you can maintain them, implant treatment can usually be reconsidered.

Active disease must be stabilised first

Gum disease starts as gingivitis — the NHS lists the early signs as gums that bleed when you brush, floss or eat hard foods, and gums that become swollen, red and sore. Left untreated it can progress to gums shrinking, teeth becoming loose or falling out, and dental abscesses (NHS, Gum disease).

Treatment usually means hygiene instruction, cleaning below the gumline and, in more advanced cases, further intervention. Our gum disease treatment page covers what that involves. Only once the disease is controlled — and demonstrably staying controlled — does implant planning become sensible.

A treated history of gum disease still matters

This is the part most practices leave out, and it is worth being straight about: even after successful treatment, a history of periodontitis carries measurably higher risk.

A 2025 systematic review and meta-analysis of prospective cohort studies in the Journal of Periodontal Research found that patients with a history of periodontitis had a significantly greater risk of implant loss (hazard ratio 1.75, 95% CI 1.28–2.40) compared with patients without that history. The gap widened over follow-up of ten years or more (HR 2.02, 95% CI 1.06–3.85), and was considerably larger in Grade C (rapidly progressing) periodontitis (HR 6.16, 95% CI 2.53–15.01). The same review found an increased risk of peri-implantitis (3.24, 95% CI 1.58–6.64) and slightly greater bone loss around the implant (mean difference 0.41 mm, 95% CI 0.19–0.63) (Annunziata et al., 2025).

A separate 2024 meta-analysis in Clinical Implant Dentistry and Related Research reached a consistent conclusion on peri-implantitis, reporting a risk ratio of 4.09 (95% CI 1.93–8.58) in patients with a history of periodontitis (Serroni et al., 2024).

Higher risk is not a prohibition. It does mean two things in practice: the disease must be genuinely stable before treatment starts, and you should expect a more demanding maintenance schedule afterwards. For context on what good long-term outcomes look like, see how long dental implants last.

Can you have implants with receding gums?

Usually yes — but the cause of the recession determines everything.

Where recession is a sign of active periodontal disease, you are back to the section above: the disease is treated and stabilised first. Where it is not, recession does not by itself rule out an implant, and the assessment moves on to the bone underneath.

Recession also matters aesthetically. Gum tissue that has receded around neighbouring teeth affects how the finished crown will look, particularly at the front of the mouth, and sometimes the honest answer is that a perfect cosmetic match is not achievable without additional soft-tissue work. That should be discussed before treatment, not discovered afterwards.

Do you have enough bone?

An implant needs bone to hold it — in sufficient height, sufficient width, and of sufficient quality. This is the second gate, and it is the one that most often leads to a graft being suggested.

Why bone disappears after a tooth is lost

Jawbone that no longer supports a tooth root gradually resorbs. The scale is well documented. A systematic review in the Journal of Clinical Periodontology found a weighted mean reduction in alveolar ridge width of 3.87 mm after extraction, with a mean clinical mid-buccal height loss of 1.67 mm and a mean radiographic crestal height change of 1.53 mm (Van der Weijden, Dell’Acqua & Slot, 2009).

That is why timing matters. The longer a gap has been left, the more likely it is that grafting will be needed. It is also why a tooth lost twenty years ago presents a different problem from one lost last year.

How bone is assessed

Assessment begins with a clinical examination and conventional radiographs. Cross-sectional imaging — in practice a CBCT scan, which produces a three-dimensional image allowing bone height and width to be measured directly and structures such as the maxillary sinus and the mandibular canal to be located — is added where those first steps leave a question unanswered.

That order is deliberate. The European Commission’s evidence-based guidelines on cone beam CT reproduce the European Association of Osseointegration position that cross-sectional imaging is applied to cases where more information is required after appropriate clinical examination and standard radiographic techniques have been carried out. The same guidelines set out the specific situations in which it is indicated, including clinical doubt about the shape of the alveolar ridge, the position of the mandibular canal or mental foramen, and the descent of the maxillary sinus (European Commission, Radiation Protection No. 172, 2012).

A cone beam CT scan is from £150 (price correct as of July 2026, subject to clinical assessment).

Bone grafting explained

A bone graft rebuilds bone where there is not enough for an implant. It is a routine part of implant dentistry rather than an exotic add-on, but it is genuine surgery with genuine trade-offs.

The main types

Socket preservation places graft material into the socket at the time of extraction, to limit the resorption described above before it happens. It is the least invasive option and only available if the tooth has not yet been removed.

Guided bone regeneration builds bone width or height at a site where the tooth is already long gone, typically using graft material under a membrane.

Sinus lift (sinus augmentation) applies to the upper back jaw, where the sinus cavity often sits too low to leave room for an implant. The sinus floor is raised and graft material placed beneath it.

Graft material may be your own bone or a bone substitute. A 2009 Cochrane systematic review of augmentation procedures found that bone substitutes could be a preferable alternative to autogenous bone (Esposito et al., 2009). Which is appropriate depends on the site and the volume needed.

What grafting adds to the timeline and the cost

Grafted bone needs to mature before an implant can be placed into it, or alongside it. Depending on the technique and the amount of bone required, that can mean anything from placing the graft and implant at the same appointment to waiting several months between the two.

At Horsforth Smile Clinic, bone grafting starts from £400 and a single implant from £2,200, both subject to clinical assessment (prices correct as of July 2026). Our full price list sets out the rest, and there is a broader guide to what dental implants cost across the UK if you are comparing quotes. Be aware when comparing that a low headline implant price sometimes excludes grafting entirely.

When grafting is not the right answer

Grafting is not automatically the correct response to insufficient bone, and a good assessment considers whether it can be avoided.

A 2009 Cochrane systematic review of horizontal and vertical bone augmentation concluded that while bone can be regenerated in both directions, it is unclear which techniques are most efficient, and that complications — particularly with vertical augmentation — are common. Notably, the review found that shorter implants placed in resorbed lower jaws produced fewer complications than vertical grafting followed by conventional implants: vertically augmented sites showed significantly more complications (odds ratio 4.97, 95% CI 1.10–22.40) (Esposito et al., 2009).

In plain terms, a shorter implant that avoids a graft is sometimes the better option than a bigger operation. So is a bridge or a denture.

Smoking

Smoking is a modifiable risk factor, and the evidence on it is not marginal.

A 2024 systematic review and meta-analysis in the Journal of Dentistry, covering 32 observational studies, 59,246 implants and 14,115 patients, found smoking associated with roughly two-and-a-half times the odds of early implant failure at implant level (OR 2.59, 95% CI 2.08–3.23) and double the odds at patient level (OR 2.00, 95% CI 1.43–2.80). The effect was more pronounced in the upper jaw (Fan et al., 2024).

Heavy smoking does not automatically rule out treatment, but it changes the risk conversation materially, and it is reasonable for a dentist to recommend stopping first. There is evidence that this helps: an older study in the International Journal of Oral and Maxillofacial Implants found that smokers who followed a cessation protocol had failure rates that did not differ significantly from non-smokers, while those who continued smoking did significantly worse than both groups (Bain, 1996).

Diabetes and other medical conditions

Well-controlled diabetes is not a barrier to implant treatment. Poorly controlled diabetes is a different matter.

A systematic review update in the International Journal of Implant Dentistry found that studies of poorly controlled diabetes with HbA1c above 8% showed increased probing depths, bleeding on probing and peri-implant bone resorption, and that clinical indicators of peri-implantitis deteriorated as HbA1c rose. The authors concluded that implant treatment can be a predictable procedure in patients with diabetes where appropriate precautions are followed and glycaemic control is maintained (Wagner et al., 2022).

The practical implication is that your HbA1c is relevant information at the assessment stage, and that improving glycaemic control before treatment is a legitimate part of the plan rather than a delaying tactic.

Other factors that need discussing include bisphosphonate and related bone medications, radiotherapy to the jaws, immunosuppression, and bruxism (tooth grinding).

Who is not a suitable candidate

Being direct about this matters more than the marketing does. Implants may not be appropriate if you have:

• Untreated or unstable periodontitis — until it is treated and demonstrably controlled.
• Poorly controlled diabetes — the evidence above HbA1c 8% shows measurably worse peri-implant outcomes.
• Heavy ongoing smoking, where you are unwilling or unable to stop around the time of treatment.
• Insufficient bone that cannot be adequately grafted, or where the grafting required is disproportionate to the benefit.
• Certain medications or medical histories, including some bone medications and previous radiotherapy to the jaw.
• Poor oral hygiene that has not improved — implants require ongoing daily cleaning and professional maintenance.
• An incomplete jaw, in growing adolescents whose jaw development is not finished. A review in the Journal of the Indian Prosthodontic Society notes that implants are a reliable option in the growth-completed jaw, while outcomes in growing jaws remain ambiguous (Nithiyarajan, 2020).

Some of these will not change. Most will — they are reasons to do something else first, not reasons to give up on treatment.

What good outcomes look like when you are suitable

For patients who are suitable and well maintained, the long-term data is genuinely encouraging. A systematic review and sensitivity meta-analysis in the Journal of Dentistry found a 10-year implant-level survival estimate of 96.4% (95% CI 95.2%–97.5%). Importantly, the same review ran a sensitivity analysis accounting for patients lost to follow-up and produced a lower estimate of 93.2% (95% CI 90.1%–95.8%) (Howe, Keys & Richards, 2019). Both figures deserve to be quoted together; the second is the more cautious reading, and any practice citing only the first is telling you half the story.

How suitability is assessed here

An implant assessment at our Horsforth practice involves a full examination of your teeth and gums, a periodontal assessment, review of your medical history and medications, and cross-sectional imaging where it is indicated. The implant consultation is provided free of charge; a general new patient consultation including intra-oral X-rays is from £55 (prices correct as of July 2026, subject to clinical assessment).

If that assessment concludes that implants are not the right answer for you, we will say so and discuss the alternatives. You can read more about dental implants in Leeds and what treatment involves.

Suitability for treatment depends on a clinical assessment. This treatment may not be appropriate for every patient.

Frequently asked questions

Can I have an implant if I’ve already lost bone? Often yes, with grafting. The relevant questions are how much bone is missing, in which dimension, and whether rebuilding it is proportionate to the benefit. Sometimes a shorter implant avoids the graft altogether.

How long after gum disease treatment can I have an implant? There is no fixed interval. What matters is that the disease is stable and that stability has been demonstrated over time at review appointments, not that a particular number of weeks has passed.

Does a bone graft hurt? Grafting is carried out under local anaesthetic; IV sedation is available for anxious patients, subject to clinical assessment. Discomfort afterwards varies with the size and type of graft and is usually managed with ordinary painkillers.

Will my age rule me out? Rarely at the upper end — general health matters far more than the number. At the lower end, implants are not normally placed until jaw growth is complete.

Are dental implants available on the NHS? Very rarely. The NHS states that implants are usually only available privately, and are sometimes available on the NHS for patients who cannot wear dentures for reasons such as mouth cancer or an accident (NHS, Dental treatments).

What if I’m told I’m not suitable? Ask why, and ask what would change the answer. Many exclusions are temporary. Where they are not, bridges and dentures remain effective tooth-replacement options and are sometimes the better clinical choice regardless.

Sources

1. Annunziata M, Cecoro G, Guida A, Isola G, Pesce P, Sorrentino R, del Fabbro M, Guida L. Effectiveness of implant therapy in patients with and without a history of periodontitis: a systematic review with meta-analysis of prospective cohort studies. Journal of Periodontal Research 2025;60(6):524–543. doi:10.1111/jre.13351
2. Serroni M, Borgnakke WS, Romano L, Balice G, Paolantonio M, Saleh MHA, Ravidà A. History of periodontitis as a risk factor for implant failure and incidence of peri-implantitis: a systematic review, meta-analysis, and trial sequential analysis of prospective cohort studies. Clinical Implant Dentistry and Related Research 2024;26(3):482–508. doi:10.1111/cid.13330
3. Fan YY, Li S, Cai YJ, Wei T, Ye P. Smoking in relation to early dental implant failure: a systematic review and meta-analysis. Journal of Dentistry 2024;151:105396. doi:10.1016/j.jdent.2024.105396
4. Bain CA. Smoking and implant failure — benefits of a smoking cessation protocol. International Journal of Oral and Maxillofacial Implants 1996;11(6):756–759. PMID: 8990637
5. Wagner J, Spille JH, Wiltfang J, Naujokat H. Systematic review on diabetes mellitus and dental implants: an update. International Journal of Implant Dentistry 2022;8:1. doi:10.1186/s40729-021-00399-8
6. Esposito M, Grusovin MG, Felice P, Karatzopoulos G, Worthington HV, Coulthard P. The efficacy of horizontal and vertical bone augmentation procedures for dental implants — a Cochrane systematic review. European Journal of Oral Implantology 2009;2(3):167–184. PMID: 20467628
7. Van der Weijden F, Dell’Acqua F, Slot DE. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. Journal of Clinical Periodontology 2009;36(12):1048–1058. PMID: 19929956
8. Howe MS, Keys W, Richards D. Long-term (10-year) dental implant survival: a systematic review and sensitivity meta-analysis. Journal of Dentistry 2019;84:9–21. doi:10.1016/j.jdent.2019.03.008
9. European Commission, Directorate-General for Energy. Radiation Protection No. 172: Cone Beam CT for Dental and Maxillofacial Radiology — Evidence-Based Guidelines. Luxembourg, 2012. https://sedentexct.eu/files/radiation_protection_172.pdf
10. Nithiyarajan N. Dental implants and protocol in growth phase of jaw — a review. Journal of the Indian Prosthodontic Society 2020;20(Suppl 1):S40–S41. doi:10.4103/0972-4052.306424
11. NHS. Gum disease. https://www.nhs.uk/conditions/gum-disease/
12. NHS. Dental treatments. https://www.nhs.uk/live-well/healthy-teeth-and-gums/dental-treatments/