Before Dental Implant Treatment: Questions to Ask the Clinic

Questions about you

Is an implant the right option for this gap? An implant is one way to replace a missing tooth; a bridge, a denture or leaving the gap are others, each with its own trade-offs. Ask why the dentist recommends an implant for you. Our article on alternatives to dental implants compares them. How do my habits and health change the risk? Tell the dentist everything, and ask what it means for you:

• Smoking. In people smoking more than 20 cigarettes a day, implant loss was about 2.5 times as likely per implant² as in non-smokers.
• Gum disease. In people treated for periodontitis, implants were lost at about 1.75 times the rate³. Active gum disease is treated first.
• Clenching or grinding. Across 27 studies, the odds of failure per implant were about 2.2 times higher⁴. Whether a night guard prevents this was not tested.
• Diabetes. The findings are mixed: two of three reviews found no significant difference in implant loss (2021 review⁵; 2016 review⁶), one found a higher rate⁷, and all three found more bone loss around implants. Blood sugar control and follow-up matter.
• Bone-strengthening medicines. Bisphosphonates have been linked with implant loss and with jaw osteonecrosis, the death of jaw bone⁸, on evidence of very low certainty. Tell the dentist about any bone medicine, such as a bisphosphonate or denosumab, past or present, and why you take it; this is decided with your treating doctor, case by case.

What did the examination show? Ask what the X-rays or other imaging show about your bone, and what that means for the plan. Our consultation checklist explains what a consultation should cover.

Our article on who should not have dental implants goes through the risk factors in more detail.

Questions about the treatment

• Do I need bone grafting or a sinus lift, and why? Some plans add a procedure to build up bone before or during implant placement. Ask what it involves, how long healing takes, what complications it can have, and what happens if you do not have it. A Cochrane review found it unclear which bone-building techniques are the most efficient⁹, and a sinus-lift review¹⁰ found no difference in implant loss between the patient's own bone and bone substitutes, so ask why this technique and material were chosen for you. Building bone up in height has frequent complications⁹, and for a lower jaw that has lost bone height the same Cochrane review found that short implants appear to be a better option. Our bone grafting page explains the options.
• When will the implant go in? If a tooth still has to come out, the implant may be placed on the same day or after the socket has healed. Implants placed into a fresh extraction socket had 95.2 per cent survival, against 98.4 per cent in healed bone¹¹. Ask why the timing proposed suits you.
• When will the tooth go on? Some plans fit a temporary tooth soon after surgery (immediate loading); others wait for healing. In selected patients immediate loading can work well, but the findings are mixed: one review of 39 trials reported slightly lower implant survival with it¹². Ask whether you are suitable, and why.
• What complications matter at this site? Ask about the risks of your own surgery: for example infection and bleeding, the nerve in the lower jaw, or the sinus in the upper jaw, depending on where the implant goes.
• Will I have sedation, and what does it need? If you are offered sedation other than nitrous oxide, you need an escort to take you home¹³ under the UK sedation standard, and you should get instructions on eating and drinking beforehand and written instructions for afterwards. Our sedation page explains it.
• Who does each step? Ask who places the implant and who makes and fits the crown. You have the right to know the names, roles and titles¹⁴ of the people who treat you. Implantology is not one of the nine dental specialties in Turkish law, and the rules forbid specialist titles based on certificates, under any name¹⁵. So ask about training and how often the dentist places implants, rather than relying on a title. Our article on dental titles explains them.
• Which implant will I get, and will I have a record of it? Ask for the implant system and the parts used, in writing. It matters for repairs years later. Our article on choosing an implant system explains why.

Before surgery you are owed an explanation of the options, risks and possible complications, and a consent form of which you keep a copy¹⁶.

Questions about the figures you are shown

Clinics and adverts often quote success rates. Ask what a figure measures and where it comes from.

• Staying in place is not the same as trouble-free. In pooled studies, about 97 in 100 single implants were still in place after five years and about 95 in 100 after ten. The crowns on them were replaced more often¹: about 96 in 100 were still in use at five years and about 89 at ten. Over five years, screws loosened on 8.8 in 100 implants¹ and crowns came off on 4.1.
• A published rate is not a clinic's result. Such figures are averages¹ from studies in different countries, patient groups and years. Ask whether a rate is per implant, per crown or per patient, how it was defined and over how many years.
• "For life" is not a figure. The reviews quoted here report figures up to ten years and give no pooled figures beyond that; no figure can promise that an implant will last for life. Our article on how long implants last has the details.

Questions about afterwards

• What follow-up is planned? When the crown is fitted, an X-ray and gum measurements should be taken as a baseline¹⁷, so that later changes around the implant can be seen. Ask how often you will be reviewed and who will do it, and ask to be shown how to clean around the implant at home. Inflammation with bone loss around an implant (peri-implantitis) was found in about 20 in 100 patients¹⁸ in a 57-study review; the figure depends on how it is defined. Regular reviews are where it can be found early.
• Who deals with problems, and on what terms? Ask who fixes a loose screw, a broken or loose crown, or inflamed gum around the implant, and on what written terms. A warranty is a term of your agreement with the clinic, so ask for it in writing and read what it covers and what it asks of you, such as check-ups. It is separate from your rights under the law. If consumer law applies to your treatment, which is a legal question, claims for a defective service become time-barred two years after the service¹⁹, unless a longer period applies or the defect was concealed by gross fault or fraud.
• Will I get my records? You can take a copy of your file and records¹⁴. Ask for your X-rays, the treatment record and the implant details, so that any dentist can help later.

For licences, the information you are owed and where to complain, see our article on choosing a dental clinic.

When to see a dentist

Before treatment, a dentist's examination is where these questions get answered. After implant surgery, contact your dentist if you notice:

• pain or swelling that gets worse after the first few days instead of better
• bleeding that does not stop with pressure
• numbness of the lip, chin or tongue that lasts after the anaesthetic should have worn off
• an implant, crown or screw that feels loose
• bleeding, swelling or pus around an implant, at any time later

Emergencies. Difficulty breathing or swallowing, rapidly spreading swelling of the face or neck, or a high fever are serious signs. Go to the nearest emergency department or call 112.

Frequently asked questions