l Written by Dr. Ahn Kwang-sung at Yonsei Bolt Dental Clinic
l Edited by Sia, The Pylon Square
It's completely natural to feel anxious at the thought of dental treatment — and implants, which involve replacing a tooth from the root up, can feel like the most daunting kind of all.
But it's best not to delay a dental implant. Once you lose a tooth, chewing becomes harder, and the bone around the gap keeps changing over time — which is exactly why timing matters.
There are also a few things to watch out for: underlying health conditions and other factors can determine whether — and how — an implant can actually be placed.
What Can Stand in the Way of an Implant
Before dental implants became the standard, bridges and dentures were the main ways to replace a missing tooth. Each of these treatments came with its own trade-offs (a topic for another time), and implants emerged as a way to address those shortcomings.
Now that implant techniques and research have matured into a well-established practice, implants have become the best option for replacing a lost tooth — but depending on the individual case, placement isn't always straightforward.
1. When a Tooth Has Been Missing for a Long Time
Implants rely on a principle called osseointegration, in which a specially treated titanium surface bonds directly with the alveolar bone. Because of this, a minimum bone thickness of about 1–2mm around the implant is generally considered necessary for safety.
But when a tooth has been missing for a long time, the extraction socket and surrounding alveolar bone gradually resorb, reducing both the width and height of the bone. This can leave too little "bone housing" for the implant, making the procedure more difficult.
In these cases, bone augmentation may be needed before the implant can be placed. Results from bone augmentation, however, vary significantly depending on the surgeon's skill, and the process itself can be more demanding than a standard implant placement.
2. When You Have an Underlying Health Condition
For patients with systemic conditions like hypertension or diabetes, overall health on the day of surgery matters a great deal. Diabetes in particular can slow post-surgical recovery, which calls for more careful management.
This slower recovery can also raise the risk of implant failure. If you're planning implant surgery, it's worth keeping two things in mind:
- Manage any underlying condition as well as possible before surgery
- Choose a dentist experienced in treating patients with systemic health conditions
3. When You Have Osteoporosis
With osteoporosis, what matters more than the condition itself is often the medication used to treat it —some of which are also prescribed to certain cancer patients for similar reasons.
Drugs commonly used for osteoporosis, such as bisphosphonates and RANKL inhibitors, work by suppressing bone resorption. That's helpful for managing osteoporosis, but the same mechanism can also slow bone turnover at the implant site.
When that happens, the new bone growth needed for osseointegration may not form properly, and in some cases this can lead to bone necrosis — a condition known as MRONJ (medication-related osteonecrosis of the jaw).
For this reason, patients with osteoporosis should know exactly which medication they're taking. If necessary, your doctor may recommend a temporary pause in the medication or a switch to an alternative before scheduling implant surgery. A consultation with your treating physician beforehand is essential.
4. When You Smoke
Quitting smoking is essential before implant surgery. Smoking introduces carbon monoxide into the bloodstream, which blocks the oxygen and nutrients your body needs for healing.
Around the implant, new bone needs to form and fuse with the surface. But under low-oxygen conditions, fibrous connective tissue can form around the implant instead, preventing proper osseointegration.
Nicotine also inhibits angiogenesis (the formation of new blood vessels) and suppresses the activity of osteoblasts (the cells that build new bone), further interfering with healing.
There's more to consider beyond these four factors — your bite alignment, jaw relationship, habits like teeth grinding or clenching, and even ENT (ear, nose, and throat) conditions like sinus inflammation can all play a role. That's why a detailed consultation with an implant specialist is the best way to make this decision.
There's no arguing that your natural teeth are always the best option. But ignoring a tooth that needs treatment or extraction only makes the condition worse and future treatment more difficult.
So when it's time to consider an implant, choosing the right treatment and approach for your situation — without delay — is the best way to protect your long-term oral health.
Wondering how these factors might apply to your own case?
>Book your visit to Yonsei Bolt Dental Clinic
[FAQ]
Q1. Can I still get an implant even if I lost the tooth a long time ago?
Yes, it's possible — but the longer a tooth has been missing, the more the alveolar bone resorbs, reducing its width and height, which increases the likelihood that bone augmentation will be needed alongside the implant. Because outcomes from bone augmentation vary significantly with the surgeon's skill, it's important to choose a provider experienced in complex implant cases — including bone augmentation — like Yonsei Bolt Dental Clinic.
Q2. Can I get an implant if I have diabetes or high blood pressure?
Yes. That said, your overall condition on the day of surgery and your recovery speed afterward are key factors, so it's important to manage any underlying condition beforehand and choose a provider experienced in treating patients with systemic health conditions.
Q3. I'm taking osteoporosis medication — is it safe to get an implant?
The medication you're taking (such as bisphosphonates or RANKL inhibitors) matters more than the osteoporosis itself. Depending on the drug, you may need a temporary pause or a switch in medication, so a consultation with your prescribing physician beforehand is essential.
Q4. How long should I quit smoking before getting an implant?
There's no single fixed rule, but since smoking is a major risk factor for implant failure, it's best to stop smoking for as long as possible both before and after surgery.
Q5. What happens if I keep putting off my implant?
Your ability to chew stays limited, and ongoing bone resorption can make future treatment more difficult and more costly. Getting a consultation early — before the condition worsens — is the safest approach.
