Most adults missing one or more teeth are candidates for dental implants. The three requirements are adequate jawbone volume, healthy gums free of active periodontal disease, and reasonably controlled overall health. Age is not a barrier. Patients who fall short in one area, whether that's thin bone, gum disease, or uncontrolled diabetes, often qualify after preparatory treatment.

At Fresh Smile Dental Care on Royal Lane, we hear the same worry almost every week. Someone was told years ago they weren't a good candidate, and they've been living with a bridge, a partial, or an empty space ever since. In most of those cases, the answer today is different. Imaging is better. Grafting is more predictable. And the criteria are clearer than they used to be.

Here's what actually matters.

What actually makes someone a candidate for dental implants?

Candidacy comes down to three pillars: bone, gums, and systemic health. If all three are in reasonable shape, you're a candidate. If one is weak, we plan around it.

Age is not on that list. There's no upper age cutoff, and peer-reviewed geriatric dentistry literature is consistent on this. A healthy 78-year-old is often a better candidate than a poorly controlled 45-year-old. The only lower limit is jaw maturity, which is usually around age 18, since placing an implant into a growing jaw can leave the tooth looking sunken later.

Most adults missing teeth qualify. Some qualify right away. Some qualify after a few months of prep. A small minority need to look at alternatives.

Do I have enough jawbone for an implant?

An implant is a titanium post that fuses into your jawbone. That post needs enough bone height and width around it, or it won't stay stable long-term.

Here's the catch. Bone starts shrinking the moment a tooth is lost. According to research published in the Journal of Clinical Periodontology (Schropp et al.), alveolar bone resorption begins within weeks of extraction, with the greatest volume loss happening in the first 6 to 12 months. A tooth that came out five years ago has left a very different ridge than one that came out five months ago.

We don't guess at this. The American Academy of Oral and Maxillofacial Radiology recommends cone-beam CT (CBCT) as the standard imaging tool for pre-implant bone assessment, and that's what we use in our office. A CBCT scan shows the exact height, width, and density of your bone in three dimensions.

If the scan shows thin bone, we're not out of options. Bone grafting or a sinus lift can rebuild the site, usually with a healing window of three to six months before the implant goes in. Plenty of patients who were told "you don't have enough bone" a decade ago are walking around with implants today.

What condition do my gums need to be in?

Healthy gums are non-negotiable. Active periodontal disease has to be treated before an implant is placed, full stop.

The American Academy of Periodontology is clear on why: untreated gum disease significantly raises the risk of peri-implantitis, which is the leading cause of late implant failure. The same bacteria that break down bone around natural teeth will attack the bone around an implant.

The pre-implant path for someone with gum disease usually looks like this: a deep cleaning (scaling and root planing), a healing period of a few weeks, then a re-evaluation. If pocket depths have come down and inflammation is resolved, we can move forward. If not, we do more work first.

After the implant is in, daily hygiene and regular cleanings become permanent commitments. That part matters just as much as the surgery.

Which medical conditions affect implant candidacy?

Most systemic conditions don't disqualify you. They just change how carefully we plan.

• Diabetes. Well-controlled diabetes shows implant success rates comparable to non-diabetic patients, according to Journal of Dental Research data. Uncontrolled diabetes (elevated HbA1c) is the problem, because it slows healing.

• Osteoporosis and bisphosphonates. Oral bisphosphonates usually require caution but are manageable. IV bisphosphonates are a different story: the AAOMS position paper on medication-related osteonecrosis of the jaw documents a real risk after invasive procedures, and we coordinate closely with your physician.

• Autoimmune conditions and immunosuppression. Case by case. Many patients on stable regimens do fine.

• Head and neck radiation history. A significant risk factor. This needs specialist coordination and sometimes hyperbaric oxygen prep.

• Heart conditions and blood thinners. Almost always manageable with medical clearance and coordinated timing.

Bring your full medication list to the consult. That one detail changes plans more often than anything else.

How do smoking, grinding, and lifestyle affect my chances?

Habits matter more than most patients realize.

Smoking significantly raises failure risk, especially in the first year of healing. We've covered that in depth in a dedicated post, but the short version is: cutting back or quitting around the surgical window changes outcomes.

Untreated bruxism (grinding and clenching) can overload an implant. The implant doesn't have a periodontal ligament to cushion force the way a natural tooth does. A custom night guard is often required as part of the treatment plan for known grinders.

Heavy alcohol use, poor nutrition, and inconsistent hygiene all reduce long-term success. None of these are automatic disqualifiers. They're conversations.

What if I'm told I'm not a candidate? What are my options?

"Not a candidate" almost always means "not a candidate right now." Here's what usually opens the door:

• Bone grafting or a sinus lift to rebuild volume

• Treating gum disease first, then reassessing in three to six months

• Getting a medical condition better controlled with your physician (lowering HbA1c, adjusting a medication)

• Quitting or reducing tobacco use around the surgery window

If implants truly stay off the table, alternatives include fixed bridges, partial dentures, and full dentures. None of those are consolation prizes. For the right patient, they're the right answer.

What does a candidacy evaluation actually involve?

A first-visit evaluation at our office runs about an hour. It includes:

• A full oral exam and detailed medical history review

• A 3D CBCT scan for bone assessment

• Photos, digital impressions, and a bite analysis

• A conversation about timeline, cost, and any prep procedures

Consider a patient we saw recently, a 58-year-old woman from Preston Hollow who commutes down Royal Lane for work in the Asian Trade District. Her old dentist told her seven years ago she didn't have enough bone for an implant on a missing molar. She'd been wearing a partial ever since. Her CBCT showed she was actually a candidate for a graft-and-implant plan, done in stages. She scheduled the graft the same week.

That kind of story is common. Second opinions matter.

We run bilingual consultations in English, Korean, and Spanish, which reflects the community we serve here in the Koreatown Dallas corridor. Patients come to us from Farmers Branch, Addison, Carrollton, and Irving, and many use the Royal Lane DART Green Line Station two blocks from the office.

Frequently Asked Questions

Is there an age limit for dental implants?

No upper age limit exists for dental implants. Systemic health and healing capacity matter far more than a birthday on a chart. We've placed implants successfully in patients well into their 80s. The only lower limit is jaw maturity, typically around age 18.

Can I get an implant if I've had a tooth missing for years?

Usually yes, though the plan often includes bone grafting to rebuild the ridge. Bone shrinks after a tooth is lost, especially in the first year, so a long-empty site typically needs some preparation. A CBCT scan tells us exactly what we're working with.

Will my insurance decide if I'm a candidate?

No. Insurance decides what it will pay for. Clinical candidacy is a separate question determined by your exam, imaging, and health history. Many patients are excellent candidates for treatment their insurance covers only partially.

How long does the candidacy evaluation take?A typical evaluation at Fresh Smile Dental Care runs about an hour. That includes the exam, CBCT scan, and a full conversation about your options, timeline, and any preparatory steps you might need before the implant itself.

What is the success rate for well-selected implant candidates?

Peer-reviewed systematic reviews (Moraschini et al., Journal of Oral Implantology) document long-term success rates above 95% in appropriately selected patients. Careful candidacy screening is a big part of why that number stays so high. Skipping the workup is where problems start.

If you've been told you're not a candidate, or if you've been wondering without asking, we're happy to give you a straight answer. Call Fresh Smile Dental Care at (214) 623-0880 to schedule a candidacy evaluation, or book online through Zocdoc. We'll show you your own scan and walk you through what's actually possible.