Risk factors for implant problems: what the reviews measured
Some things raise the odds of implant failure or of inflammation around implants. Some of them you can change. Here is what systematic reviews found, as numbers.
Medically reviewed by Dt. Hüseyin Yavuz Özbek, implant surgeon · Updated October 2026In systematic reviews, smoking roughly doubled the crude implant failure rate (6.35% against 3.18%), teeth grinding was linked with about twice the odds of failure (odds ratio 2.189), and a history of periodontitis with a higher risk of failure after five years (risk ratio 2.26) and about four times the risk of peri-implantitis. Diabetes did not significantly change failure rates, though bone loss was slightly greater. A 10-year review estimated lower survival in people aged 65 or over.
Reading the numbers on this page
Most results here are ratios. A risk ratio or odds ratio of 1.0 means no difference between two groups; 2.0 means roughly double. The whiskers on the chart show the 95% confidence interval: if a whisker crosses 1.0, the review could not rule out no difference.
Show the numbers as a table
| Item | Ratio | Range | Source |
|---|---|---|---|
| Diabetes: implant failure (RR) | 1.07× | 0.8–1.44× | Chrcanovic et al., 2014 |
| Bruxism: implant failure (OR) | 2.189× | 1.337–3.583× | Häggman-Henrikson et al., 2024 |
| Gum disease: failure >5 yrs (RR) | 2.26× | 1.12–4.53× | Serroni et al., 2024 |
| Gum disease: peri-implantitis (RR) | 4.09× | 1.93–8.58× | Serroni et al., 2024 |
RR = risk ratio, OR = odds ratio; they are close but not identical measures. Each bar comes from a different review, so compare each with 1.0, not with each other.
Each bar comes from a different review with different patients and methods, so compare each bar with 1.0, not with the other bars.
Smoking
A meta-analysis of 107 studies counted 19,836 implants placed in smokers, of which 1,259 failed (6.35%), and 60,464 in non-smokers, of which 1,923 failed (3.18%). Smoking significantly affected failure rates, post-operative infections and marginal bone loss Chrcanovic et al., 2015.
Show the numbers as a table
| Item | Implants failed | Source |
|---|---|---|
| Smokers (19,836 implants) | 6.35% | Chrcanovic et al., 2015 |
| Non-smokers (60,464 implants) | 3.18% | Chrcanovic et al., 2015 |
Crude pooled counts from Chrcanovic 2015; the authors warn of uncontrolled confounding.
In the 18-year four-implant study, smoking was also associated with bone loss of more than 3 mm (odds ratio 2.72) and with biological complications (odds ratio 1.75) Maló et al., 2019. The authors of the meta-analysis caution that smokers and non-smokers differ in other ways too, so not all of the difference is caused by tobacco.
Tell your surgeon exactly what and how much, including vaping. Ask how long before and after surgery they advise stopping. It is not a moral question; it is one of the few risk factors you can change in weeks.
Diabetes
A systematic review found no significant effect of diabetes on implant failure (risk ratio 1.07, 95% CI 0.80 to 1.44). People with diabetes did have slightly more marginal bone loss, a mean difference of 0.20 mm Chrcanovic et al., 2014. The review was small (14 publications) and few studies reported both groups separately. The 2017 World Workshop judged the evidence on diabetes as a risk factor for peri-implantitis inconclusive Schwarz et al., 2018. In practice, how well diabetes is controlled matters more than the diagnosis itself.
Teeth grinding (bruxism)
Bruxism puts repeated heavy force on implants and the bridge. A 2024 review of 27 studies (2,105 implants in probable bruxers, 10,264 in non-bruxers) found a higher risk of failure in bruxers, with an odds ratio of 2.189 (95% CI 1.337 to 3.583), regardless of follow-up time Häggman-Henrikson et al., 2024. In a full-arch cohort, bruxism and not wearing a night guard were associated with more chipping of the tooth material Papaspyridakos et al., 2020.
A history of gum disease (periodontitis)
Many people who need full-arch treatment lost their teeth to periodontitis. A 2024 review of 12 prospective cohort studies found a history of periodontitis was linked with a higher risk of implant failure beyond five years (RR 2.26, 95% CI 1.12 to 4.53), much more peri-implantitis (RR 4.09, 95% CI 1.93 to 8.58) and 0.75 mm more marginal bone loss on average Serroni et al., 2024. The evidence certainty was graded low, because randomised trials are not possible here.
The 2017 World Workshop rated the evidence as strong for three risk factors for peri-implantitis: a history of chronic periodontitis, poor plaque control and no regular maintenance after implant therapy Schwarz et al., 2018. In a Swedish population sample, people with periodontitis and those with four or more implants had higher odds of moderate or severe peri-implantitis Derks et al., 2016.
Age
A 2019 review of 10-year implant survival estimated 93.2% overall in an analysis adjusted for drop-outs, and 91.5% for people aged 65 or over, which the authors describe as a possible doubling of the risk of implant loss in older age groups Howe et al., 2019. Age often travels with other factors: medicines, general health, dexterity for cleaning. Those are worth discussing directly.
Factors you can change, and factors you cannot
Stopping smoking; keeping diabetes well controlled; cleaning under the bridge every day; attending maintenance visits; wearing a night guard if you grind; treating gum disease in any remaining teeth before surgery.
Your history of gum disease; your age; the shape and density of your jaw bone; the anatomy of your sinus and nerve. These shape the plan rather than rule it out. See bone-loss stages.
Our candidate checker goes through these factors one at a time and suggests questions to take to your consultation. It is a guide, not a diagnosis.
Common questions
Can I have full-arch implants if I smoke?
Often yes, but the risk is higher. Across 107 studies, 6.35% of implants in smokers failed against 3.18% in non-smokers, and smoking also affected infection and bone loss. Stopping before surgery and during healing is one of the most useful things you can do. Tell your surgeon honestly how much you smoke or vape.
Does diabetes rule out implants?
Usually not. A review found no significant difference in implant failure between people with and without diabetes (risk ratio 1.07), but slightly more bone loss around implants in people with diabetes (0.20 mm on average). Good control matters, so bring your recent HbA1c result to the consultation.
I grind my teeth. Does it matter?
Yes. Implants in probable bruxers had about twice the odds of failure in a 2024 review, and in a full-arch cohort grinding without a night guard was linked to more chipping. Your dentist may suggest a different material, a bite design that spreads force, and a night guard.
I lost my teeth to gum disease. Am I at higher risk?
Yes, and it is worth knowing. A 2024 review of prospective studies found a history of periodontitis raised the risk of implant failure after five years (RR 2.26) and of peri-implantitis (RR 4.09). It does not rule out implants, but it makes cleaning and maintenance visits non-negotiable.
Am I too old for implants?
Age alone is rarely the deciding factor. A 2019 review estimated 10-year implant survival of 91.5% in people aged 65 or over, against 93.2% overall in the same adjusted analysis. Health, medication, dexterity for cleaning and the ability to attend check-ups usually matter more.
Sources
- Chrcanovic BR, Albrektsson T, Wennerberg A. Smoking and dental implants: A systematic review and meta-analysis. J Dent 2015. PMID 25778741
- Chrcanovic BR, Albrektsson T, Wennerberg A. Diabetes and oral implant failure: a systematic review. J Dent Res 2014. PMID 24928096
- Häggman-Henrikson B, Ali D, Aljamal M, Chrcanovic BR. Bruxism and dental implants: A systematic review and meta-analysis. J Oral Rehabil 2024. PMID 37589382
- Serroni M, Borgnakke WS, Romano L, et al. 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. Clin Implant Dent Relat Res 2024. PMID 38720611
- Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Clin Periodontol 2018. PMID 29926484
- Howe MS, Keys W, Richards D. Long-term (10-year) dental implant survival: A systematic review and sensitivity meta-analysis. J Dent 2019. PMID 30904559
- Maló P, de Araújo Nobre M, Lopes A, Ferro A, Botto J. The All-on-4 treatment concept for the rehabilitation of the completely edentulous mandible: A longitudinal study with 10 to 18 years of follow-up. Clin Implant Dent Relat Res 2019. PMID 30924309
- Derks J, Schaller D, Håkansson J, Wennström JL, Tomasi C, Berglundh T. Effectiveness of Implant Therapy Analyzed in a Swedish Population: Prevalence of Peri-implantitis. J Dent Res 2016. PMID 26701919
- Papaspyridakos P, Bordin TB, Kim YJ, El-Rafie K, Pagni SE, Natto ZS, Teixeira ER, Chochlidakis K, Weber HP. Technical Complications and Prosthesis Survival Rates with Implant-Supported Fixed Complete Dental Prostheses: A Retrospective Study with 1- to 12-Year Follow-Up. J Prosthodont 2020. PMID 31650669
Checked October 2026. Where we give our own view as a clinic, we say so.
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