Who cannot get dental implants? Medicines, treatments and conditions that change the plan

A contraindication is a reason not to do a treatment. An absolute one means do not proceed; a relative or partial one means proceed only with precautions, or after a delay or a specialist's input.

A 2014 update on medically compromised patients concluded that controlled systemic disease or smoking does not indicate a total or partial contraindication, though the level of evidence is low and there is little information on severe disease. The same review linked smoking and head and neck radiotherapy with more implant loss.

It treated oral bisphosphonates in osteoporosis as a partial contraindication (Gómez-de Diego et al. 2014).

The table sorts the situations covered below. The last column describes the direction these sources point, not a rule for any one person.

Bisphosphonates and denosumab are antiresorptive medicines that slow bone turnover. Medication-related osteonecrosis of the jaw (MRONJ) is a severe, long-lasting condition in which bone in the jaw is exposed and necrotic (Li et al. 2024).

The American oral and maxillofacial surgeons' 2022 position paper on MRONJ is a key clinical reference on the condition (Ruggiero et al. 2022).

Guidance on implants for people taking these medicines is not uniform. Each body below speaks about a different group of patients.

The European Federation of Periodontology's patient FAQ says implants are not suitable for people who take bisphosphonates or denosumab for osteoporosis, because of a higher risk of MRONJ, and that these patients need a consultation before implant placement (EFP FAQs).

A 2011 report from the American Dental Association's Council on Scientific Affairs covered people taking these medicines for low bone mass, not cancer. It concluded that antiresorptive therapy did not appear to be a contraindication for implant placement, and called for larger and longer studies (Hellstein et al. 2011).

For cancer, the ADA's own page on oncology agents and MRONJ reproduces a prevention table from the 2022 AAOMS position paper that lists dental implants as contraindicated during therapy (ADA, updated April 2023; Ruggiero et al. 2022).

In England, the Royal College of Surgeons' Faculty of Dental Surgery guidance on NHS-funded implant treatment (2019) says patients on intravenous bisphosphonates should not normally be considered for implants because of the higher known risk of bone necrosis, and that short-term oral use carries a lower risk (FDS 2019).

Scotland's SDCEP guidance (2017) says implant placement is not currently contraindicated in osteoporosis but patients should be told of the risks, advises avoiding implants during high-dose cancer treatment, and notes there is no implant survival data for denosumab (SDCEP 2017).

If you take one of these medicines for cancer, treat implants during that treatment as off the table until your specialists say otherwise.

A systematic review of nine articles split patients by route. In patients on oral bisphosphonates, 5 of 423 implants failed (98.8%); in patients on intravenous treatment, 6 of 68 failed (91%), all in one patient who had received six years of infusions; controls had 97%.

The authors thought implant placement in orally treated patients could be considered safe with precautions, and noted intravenous patients seemed more likely to develop implant-related osteonecrosis (Gelazius et al. 2018). That is one review's reading; as above, guidance bodies differ even for oral use.

A meta-analysis of 33 publications found higher failure odds for people taking bisphosphonates (odds ratio 1.653), with estimated survival of 94.2% at 5 years and 90.1% at 10 years (Sulaiman et al. 2023).

A review of implants already integrated before antiresorptive treatment (445 implants) found that 23% failed, and 83% of the 92 failures with a known cause were attributed to MRONJ, appearing on average about 34 months after the medicine started. The review was made up mostly of case series, so this is not a population failure rate.

Most patients whose route was reported took the medicine by mouth (54 of 89), so the finding is not limited to intravenous use (Li et al. 2024).

Our clinic's rule is stricter than the guidance above. At Nexwell, Dt. Mehmet Salih Yıldırım does not place implants in anyone who has taken a bisphosphonate, by any route. This is his clinical practice, not a finding from the studies cited here.

Do not stop a bone medicine on your own. The prescribing doctor decides, and the dental team should be told which medicine, by which route and since when.

Radiation changes the blood supply and healing of the jaw. A 2013 systematic review of 15 studies and 10,150 implants found a significantly higher risk of implant failure in irradiated patients (risk ratio 2.74) and in the upper jaw (risk ratio 5.96).

Hyperbaric oxygen therapy did not reduce the risk, but only 3 studies examined it, and most data came from machined-surface implants (Chambrone et al. 2013, abstract only).

A 2021 meta-analysis of 660 patients and 2,602 implants reported survival of 97% in non-irradiated patients and 91.9% in irradiated ones, with osteoradionecrosis in 3% (Toneatti et al. 2021). It called osteoradionecrosis rare but a serious complication.

So implants after radiotherapy can be possible, but the risk is higher and the timing and surgery need to be planned with the oncology team.

Studies of the corticobasal approach (developer-linked series) did not test this group: one excluded people who had radiotherapy within the last two years (Patel et al. 2025) and another excluded recent head and neck radiotherapy within 6 months (Jani et al. 2022).

Our guide to CBCT scans for dental implants explains the imaging used before any plan is made.

At Nexwell, Dt. Yıldırım does not place implants during active chemotherapy or radiotherapy. In his experience active courses are often around eight weeks, so treatment is usually planned after they finish. That is his practice, and the oncology team still sets the timing.

Independent systematic reviews on this group were not found in the sources used for this guide, so this section is short and carries no failure rates. A foundation consensus on corticobasal implants lists ongoing or recently finished chemotherapy, radiation therapy, and permanent medication that influences bone physiology or lowers resistance to infection among medical conditions that may call for specialist advice.

It adds that the decision should be made case by case with the treating specialist, and that physician consultation should come before treatment (Ihde 2019). That consensus was issued by the developers' own foundation.

Series of corticobasal implants excluded people who were immunocompromised (Patel et al. 2025) or on chemotherapy (Jani et al. 2022). The honest reading is that these groups are not well studied, so an implant plan should wait for your oncology or transplant team's view. Ask your specialist, not only the dental clinic.

Blood thinners are often continued during implant surgery. A 2021 systematic review of 8 studies, 1,467 participants and at least 2,366 implants looked at oral anticoagulants. It found an increased risk of bleeding when implants were placed during anticoagulation (risk ratio 2.30), but the bleeding events were not clinically significant (Dawoud et al. 2021).

The authors noted that implant surgery ranges from minor to extensive and that simple local measures to stop bleeding reduce the risk. The decision to stop an anticoagulant before surgery needs a risk-balance assessment that considers the patient and the surgery (Dawoud et al. 2021). Do not stop a blood thinner without the doctor who prescribes it.

That review covers oral anticoagulants; the sources used here do not give separate evidence for antiplatelet medicines, so ask your doctors about those.

At Nexwell, Dt. Yıldırım asks for a report in English from your own internal medicine physician or cardiologist. It must carry a handwritten signature, confirm that you are fit for more extensive surgery and set out whether and how your medicine should be adjusted. Any change to the medicine stays with that doctor.

For how the operation itself runs, see dental implant surgery step by step.

Osteoporosis itself is a different question from taking a bone medicine. A 2013 meta-analysis found that osteoporosis had a direct but not statistically significant effect on implant failure (risk ratio 1.09, 4 studies, which did not separate patients by medication) (Chen et al. 2013). The medicines used to treat it are the issue covered above.

If you have taken a bisphosphonate for osteoporosis, Nexwell's rule in the bone-medicines section applies.

For people with heart disease, the foundation consensus lists cardiological conditions among medical conditions needing consultation with your physician before implant treatment starts (Ihde 2019). The sources used here give no waiting period after a heart attack or stroke, so no time is quoted. Ask your cardiologist, and bring the dates.

At Nexwell, after a heart attack or stroke Dt. Yıldırım asks for the same signed English report from your own physician or cardiologist, covering surgical approval and whether any medicine needs adjusting, before any surgery is planned.

Diabetes and smoking have their own guide: dental implants for diabetics and smokers. Active gum disease is another common issue and is covered in periodontal treatment before implants. Bone quality and quantity also matter; see bone density for dental implants.

Basal and corticobasal implants can avoid bone grafting in some people, but they do not remove medical contraindications. One large series excluded bisphosphonate users, immunocompromised patients and radiotherapy within two years (Patel et al. 2025).

Another excluded ongoing bisphosphonate treatment, chemotherapy and head and neck radiotherapy in the previous 6 months (Jani et al. 2022). A third rejected three patients with a history of intravenous bisphosphonate treatment but treated others on oral bisphosphonates (Lazarov 2019).

The developers' own foundation says intravenous bisphosphonates, with a half-life of more than 10 years, mean that treatment with any kind of dental implant should be postponed significantly (Ihde 2019).

For the wider picture, see basal implants vs conventional implants, dental implants without bone grafting and cortical anchorage. The effect of surface design on gum inflammation is in implant surface and peri-implantitis.

A no or a delay for implants does not leave you without options. Our guide to dentures vs dental implants sets the choices side by side, and types of dentures explains overdentures and partial dentures. Implant-supported dentures combine implants with a removable prosthesis.

A dental bridge vs implant comparison covers tooth-supported options, and mini dental implants are a smaller option with their own limits. Whether any of them suits you depends on your examination. For timing after a tooth is lost, see tooth extraction and implant timing.

A good review starts with accurate information. At Nexwell, Dt. Yıldırım does not place implants in anyone who has taken a bisphosphonate, or during active cancer treatment, so tell us about these first. Bring:

1. a full medication list with doses and start dates, especially bone medicines and blood thinners; 2. the area, dose and date of any radiotherapy; 3. your current cancer treatment status, if any; 4. your latest HbA1c if you have diabetes; 5. dates of any heart attack or stroke; 6. your smoking status; 7. existing scans, such as a CBCT or panoramic X-ray; 8. after a heart attack or stroke, or if you take blood thinners, a signed English report from your own physician or cardiologist that covers approval for more extensive surgery and whether any medicine needs adjusting.

If you would like us to read your history against this list, you can request a case review.

Nexwell reads this evidence as follows. A plan that says yes to everyone has not looked closely enough. We would rather tell you which part of your history needs a specialist's answer before any date is set. This is editorial framing, not a quotation from a study or a clinician.

PubMed links open the PubMed record; other links open the issuing body's own page or document, read on 1 November 2026. Chambrone 2013 is cited from its abstract only, and Ruggiero 2022 is named as a reference without figures; its implant statement is taken from the ADA page that reproduces it.

1. Gómez-de Diego R, et al. Med Oral Patol Oral Cir Bucal 2014;19(5):e483-489. PubMed 24608222, PMC4192572.

2. Gelazius R, et al. J Oral Maxillofac Res 2018;9(3):e2. PubMed 30429962, PMC6225599.

3. Sulaiman N, et al. Materials (Basel) 2023;16(18). PubMed 37763356, PMC10532755.

4. Li JTW, et al. J Clin Med 2024;13(7). PubMed 38610856, PMC11012270.

5. Ruggiero SL, et al. J Oral Maxillofac Surg 2022;80(5):920-943. PubMed 35300956.

6. Chambrone L, et al. J Dent Res 2013;92(12 Suppl):119S-130S. PubMed 24158336.

7. Toneatti DJ, et al. Clin Oral Investig 2021;25(10):5579-5593. PubMed 34401944, PMC8443505.

8. Dawoud BES, et al. Int J Implant Dent 2021;7(1):82. PubMed 34430994, PMC8385035.

9. Chen H, et al. PLoS One 2013;8(8):e71955. PubMed 23940794, PMC3733795.

10. Ihde S. Indications and treatment modalities with corticobasal jaw implants (consensus document). Ann Maxillofac Surg 2019;9(2):379-386. PubMed 31909019, PMC6933979.

11. Patel KB, et al. Ann Maxillofac Surg 2025;15(1):56-60. PubMed 40765890, PMC12321181.

12. Jani M, et al. Healthcare (Basel) 2022;10(4):598. PubMed 35455776, PMC9024819.

13. Lazarov A. Ann Maxillofac Surg 2019;9(1):78-88. PubMed 31293933, PMC6585197.

14. Hellstein JW, et al. J Am Dent Assoc 2011;142(11):1243-1251. PubMed 22041409.

15. European Federation of Periodontology. FAQs (patient information on dental implants). efp.org/faqs.

16. American Dental Association. Oncology Agents and Medication-Related Osteonecrosis of the Jaw, updated 10 April 2023. ada.org.

17. Faculty of Dental Surgery, Royal College of Surgeons of England. Guidance on the standards of care for NHS-funded dental implant treatment, March 2019. rcseng.ac.uk.

18. Scottish Dental Clinical Effectiveness Programme. Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw, March 2017. sdcep.org.uk.

This page was prepared by the Nexwell Team on 1 November 2026. Medically reviewed by Dt. Mehmet Salih Yıldırım, DDS, PhD.