Dental implants remain among the most successful long-term interventions in modern dentistry. Survival rates at ten years consistently exceed 90%,[i] and many dental implants placed in the late 90s and the 2000s remain functional today.[ii] This is, of course, a real clinical achievement, but it has also created a patient population that did not previously exist. As the first wave of widely implanted patients ages into their sixties, and beyond, the dental world faces a new set of considerations that are only just beginning to receive attention.
Managing the ageing dental implant patient is not simply a matter of routine maintenance. It requires an understanding of how physiological change, systemic disease, and polypharmacy interact with peri-implant health over time, as well as a willingness to revisit treatment decisions made when these patients were decades younger.
What does age do to oral structure?
Bone metabolism changes significantly with age. Resorption increasingly outpaces formation, and systemic conditions associated with ageing, such as osteoporosis, type 2 diabetes, and cardiovascular disease, can further compromise bone quality and density around dental implants.[iii] This does not necessarily threaten osseointegration in otherwise healthy, well-maintained dental implants, but it does alter the biological context in which peri-implant disease may develop and progress.
Soft tissue changes are relevant also – gingival recession, reduced keratinised tissue, and altered immune responses associated with ageing may all affect the peri-implant environment. An older patient who maintained good peri-implant health at fifty may present a different picture at seventy-five, even without any change in home care compliance.
Polypharmacy and its implications
Older patients are disproportionately likely to be taking multiple medications, many of which have direct relevance to dental implant health and maintenance. Bisphosphonates and other antiresorptive agents used in the management of osteoporosis and certain malignancies carry a well-established risk of medication-related osteonecrosis of the jaw (MRONJ), which must be considered in any patient with dental implants who may commence or continue such therapy.[iv]
Medications that cause xerostomia, including antidepressants and antihistamines, alter the oral environment in ways that affect biofilm management.[v] A dry mouth is a less self-cleansing mouth, and for a patient whose manual dexterity may be declining, this creates compounding risk. Anticoagulant therapy, increasingly prevalent in older populations managing certain age-related risks, should also be factored into any surgical interventions.[vi]
Maintaining an accurate and regularly updated medical history is therefore not a formality for this group; it is clinically necessary.
The challenge of declining dexterity
Even the most highly motivated older patients may find it increasingly difficult to maintain the oral hygiene standards that were achievable earlier in life. Arthritis, tremors, reduced grip strength, and other conditions that may affect manual control all limit the effectiveness of conventional interdental and peri-implant cleaning.[vii] Recommendations made at dental implant placement – specific brushes, interdental aids, irrigation devices – should be reviewed regularly and adapted as the patient’s physical capabilities change.
This is a conversation in need of sensitivity. Older patients are often acutely aware of their own limitations, and practical, non-judgemental guidance from a clinician they trust will have a truly significant impact on their overall compliance.
Reviewing restorability and patient expectations
There will be cases wherein longstanding dental implants, or the prosthetic work they support, require reassessment. Component failure, prosthetic failure, and changes in occlusion are all possible over a multi-decade dental implant lifespan. So too are changes in patient circumstance – cognitive decline, reduced tolerance to treatment – shifting what may be appropriate and achievable case to case.[viii]
Revisiting a treatment plan made thirty years ago should never be considered a failure; it’s purely pragmatism. The question is not only “can we restore this?” but “should we, and to what extent?”
Continued education
Managing these cases well requires clinicians to keep pace with evolving evidence in both dental implantology and general medicine. The Association of Dental Implantology (ADI) supports professionals at every stage of this journey through its newly restructured Fellowship Pathway, which offers four tiers: Associate Member, Full Member, Associate Fellow, and Fellow, each with its own benefits, resources, and recognition. For those treating increasingly complex patient populations, the structured progression and peer network that the ADI membership provides can be a meaningful asset.
Implant dentistry has always demanded commitment to lifelong learning. As our dental implant patients grow older alongside us, that commitment has never been clearer, or more vital.
For more information, please visit www.adi.org.uk
Join today!
Author: Dr Pynadath George, GDC-registered Specialist Oral Surgeon and President of the ADI (Association of Dental Implantology)
[i] Kupka JR, König J, Al-Nawas B, Sagheb K, Schiegnitz E. How far can we go? A 20-year meta-analysis of dental implant survival rates. Clin Oral Investig. 2024;28(10):541. Published 2024 Sep 21. doi:10.1007/s00784-024-05929-3
[ii] Dental implants still functional after forty years. University of Gothenburg. Published March 3, 2025. https://www.gu.se/en/news/dental-implants-still-functional-after-forty-years
[iii] Gong T, Wang LQ, Tong X, Zhang Y, Shu LJ. Impact of Age-Related Bone Density Variations on Dental Implant Stability and Success Rates: A Retrospective Analysis. Int Dent J. 2025;75(6):103942. doi:10.1016/j.identj.2025.103942
[iv] AlRowis R, Aldawood A, AlOtaibi M, et al. Medication-Related Osteonecrosis of the Jaw (MRONJ): A Review of Pathophysiology, Risk Factors, Preventive Measures and Treatment Strategies. Saudi Dent J. 2022;34(3):202-210. doi:10.1016/j.sdentj.2022.01.003
[v] Xu D, Zhu H, Wu M. Disproportionality analysis of drug-induced dry mouth using data from the United States food and drug administration adverse event reporting system database. Heliyon. 2024;10(19):e38561. Published 2024 Sep 26. doi:10.1016/j.heliyon.2024.e38561
[vi] Lund J, Saunders CL, Edwards D, Mant J. Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study. Open Heart. 2021;8(2):e001737. doi:10.1136/openhrt-2021-001737
[vii] Martin JA, Ramsay J, Hughes C, Peters DM, Edwards MG. Age and grip strength predict hand dexterity in adults. PLoS One. 2015;10(2):e0117598. Published 2015 Feb 17. doi:10.1371/journal.pone.0117598
[viii] Alsaleh A, Kapila A, Shahriar I, Kapila YL. Dental informed consent challenges and considerations for cognitively impaired patients. Periodontol 2000. 2021;87(1):43-49. doi:10.1111/prd.12397
