Your First Implant Consultation: Three Separate Questions, Answered in Order

An implant consultation is often described as a conversation about whether you are "suitable" for implants. That framing makes it sound like a single verdict. In practice the appointment is working through three distinct questions, and they have different answers, different evidence and different remedies when the answer is no.

Knowing which question is being asked at any moment makes the whole appointment easier to follow — and makes it much easier to ask useful questions of your own.

This is anatomy, and it is the question most people expect.

An implant is a titanium screw placed into bone. It needs enough bone in three dimensions — height, width and depth — positioned where the tooth root used to be, and it needs to avoid things that must not be touched.

What is looked at:

• Bone height and width. Bone resorbs after a tooth is lost, quickly at first and then more slowly, and it narrows from the outer surface inwards. A gap that has been empty for years often has less bone than expected.

• Bone density. Dense bone grips well but has less blood supply; soft bone is well vascularised but grips poorly. Neither is disqualifying; both change the protocol.

• The inferior alveolar nerve in the lower jaw, which supplies sensation to the lip and chin and must be given clearance.

• The maxillary sinus in the upper back jaw, whose floor often sits low over the back teeth. Our article on implants and the sinuses covers this.

• Adjacent tooth roots, which converge into the space more often than people assume.

• Gum thickness and the band of firm attached tissue, which affects long-term stability of the seal around the implant.

What provides the evidence: a clinical examination, plus three-dimensional imaging. A standard dental radiograph shows height but not width, and cannot show the nerve's exact path. A cone beam CT scan shows all of it, at a radiation dose considerably lower than a medical CT, and it is what allows planning to be done properly rather than approximately.

If the answer is not straightforward: grafting, sinus augmentation, a narrower or shorter implant, or a different position. Our article on whether you need a bone graft and our article on implants in a thin jawbone cover the options.

This is biology, and it is the question most likely to change the plan.

An implant integrates only if bone can form against it. Anything that impairs healing, bone turnover or infection control affects the outcome — sometimes enough to change the timing, occasionally enough to change the recommendation.

Medical history matters specifically, not generally:

• Smoking and vaping. The strongest modifiable factor. Reduced blood flow, impaired healing and higher long-term failure rates. Our article on implants for smokers sets out what is realistic.

• Diabetes. Well-controlled diabetes is usually compatible with implant treatment; poorly controlled diabetes impairs healing and raises infection risk. Control, not diagnosis, is the variable. Our article on diabetes and implant eligibility covers this.

• Antiresorptive medication — bisphosphonates and related drugs for osteoporosis or certain cancers — which affects bone turnover and requires careful assessment. Our article on implants and osteoporosis medication covers the considerations.

• Previous radiotherapy to the head and neck.

• Immunosuppression, and some autoimmune conditions.

• Anticoagulants, which affect surgical planning rather than integration.

Gum disease is the one that surprises people. Active periodontal disease must be brought under control first. The same bacteria that destroy bone around teeth destroy bone around implants, and peri-implantitis is harder to treat than gum disease. An implant placed into an uncontrolled mouth is an implant placed at a disadvantage. Our article on implants when you have gum disease covers the sequencing, and gum disease treatment is often the first stage of an implant plan.

Bruxism does not prevent treatment but changes the design and usually means a protective guard.

This is the question most patients do not know is being asked, and it is arguably the most important.

Implants are planned backwards. The clinician decides where the crown needs to sit for it to look right and function correctly, and the implant position follows from that. An implant placed wherever the bone happens to be most convenient can integrate perfectly and still produce a restoration that is the wrong shape, hard to clean, or angled so that force is applied unfavourably.

What is assessed:

• Space between the adjacent teeth, and whether teeth have drifted into the gap.

• Space to the opposing teeth. A long-standing gap often allows the opposing tooth to over-erupt, leaving insufficient height for a crown and an abutment.

• The bite, including how the teeth move against each other sideways and forwards.

• The gum and lip line, which determines how visible the junction between crown and gum will be.

• Whether the position is cleanable once restored.

This is why the consultation includes scans or impressions of both arches and a bite record, and why the plan may involve orthodontic movement or adjustment of other teeth before an implant is placed.

It is also why the honest answer is sometimes that an implant is not the right option here. Our article on deciding between implants, bridges and dentures covers the comparison, and our article on borderline candidates covers the grey areas.

Expect around forty-five minutes to an hour. A medical history review, a discussion of what you want and why, an examination of teeth, gums and bite, photographs, a scan of your mouth, and a CBCT if indicated. Nothing surgical is done.

Then a discussion of findings, the options including the option of doing nothing, the sequence and timeline, and the fees. You should leave with a written treatment plan and costs, and be under no obligation to proceed. Our pricing page sets out fee structures, and our team page lists registration details.

Timing is a common question in its own right. Our article on whether to have an implant now or wait covers the trade-offs, since bone loss continues while a gap is left.

• How much bone is there, and did the scan show anything that changes the plan?

• Which implant system will be used, and is it one with long-term published data and readily available components?

• Who is placing the implant, who is restoring it, and what are their registration details?

• What is the total fee, what does it include, and what happens if a graft is needed?

• What is the expected timeline from placement to final crown?

• What is the plan if it does not integrate?

• What maintenance will it need, and at what interval?

• The consultation answers three separate questions: anatomy, healing capacity, and restorative planning.

• Three-dimensional imaging is what makes accurate planning possible.

• Smoking control, diabetes control and resolved gum disease materially affect outcomes.

• Implants are planned backwards from where the crown needs to sit.

• No treatment is carried out at the consultation, and you should leave with a written plan and costs.

If you are considering implant treatment, an assessment can establish what is involved in your particular situation and what the alternatives are. You can contact our team or read about dental implants.

This article is provided for general information only and does not constitute dental or medical advice. Implant suitability depends on individual clinical and medical assessment, and outcomes vary. Discuss your medical history and medication fully with your clinician before treatment.

Next review due: 11 August 2027