I have diabetes. Can I have implants?
Often, yes: diabetes itself is not a closed door; what decides it is how well your sugar is controlled. If it is, the plan is close to anyone else's; if not, control comes first, and the decision is made at the examination with your own doctor.
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The full answer
Diabetes on its own does not rule out an implant. An implant is a titanium root placed in the jawbone; the bone knits around it over months, and then the crown goes on top. That knitting is the part diabetes touches. It does not stop it, but high sugar can slow it down.
So the real question is not “diabetes or not”. It is “controlled or not”. When someone with controlled diabetes is compared with someone without it, the difference in healing is small. The big difference shows up with uncontrolled sugar: infection comes more easily and healing is slower.
And all of that is decided at the examination, with a scan and your blood results, and in coordination with your own doctor. Not over the phone, not by email from abroad, and not from an article, including this one.
If your sugar is controlled
The plan is close to anyone else's: an examination, a scan of the bone, treatment of any gum inflammation first, then the implant. The difference is that the doctor asks for your HbA1c, the three-month sugar average, before he starts, follows you more closely afterwards, and may give the implant longer to heal before the crown goes on. That is not caution for its own sake. That is what lowers the risk of the implant not taking.
If it is not controlled, or you are not sure
We do not place implants on high sugar. An implant is a small wound in the bone, and a wound on high sugar heals more slowly, gets infected more easily, and may not take hold of the implant. So the first step happens with your diabetes doctor: control, a blood test, and then we come back to the implant. That is not a pointless delay. That is what protects the implant afterwards. And if you do not know whether you have diabetes at all, the examination asks from the start, and a simple lab test, read by your own doctor, answers it; the doctor may ask for a simple lab test, read by your own doctor, before deciding.
What diabetes changes
What changes is not the implant. It is your body. High sugar affects four things an implant depends on:
Healing
After the implant is placed, the bone knits around it over months and the gum closes over it within a week or two. High sugar slows both, because it weakens the small blood vessels and the defence cells that do the work in a wound. That is why the doctor may give the implant longer before it carries a crown.
Infection
A wound on high sugar gets infected more easily, and infection itself pushes sugar up. A circle. And once the implant is stable, the gum and bone around it can still become inflamed if cleaning is neglected, and someone with diabetes is more prone to it. So the follow-up visits after an implant are not a courtesy.
Gums
Diabetes and gum disease run in both directions: high sugar makes the gums inflame faster, and inflamed gums make sugar harder to control. An implant is not placed next to inflamed gum. So if your gums bleed or have pockets, they are treated first, and then we talk about the implant. So healthy gums are not a luxury before an implant; they are part of controlling your sugar too.
Bone
An implant needs enough bone to hold it. If the tooth has been missing for years, the bone in that spot shrinks over time in everyone, and diabetes can affect its quality too. The scan decides: enough bone, we place the implant; too little, it may need building up first, which is an extra stage with its own healing time. And the implant system follows your bone, not a brand name: Implant types: what really differs.
And smoking?
If you smoke and have diabetes, the two together weigh on an implant more than either alone: smoking cuts the blood reaching the gum and bone, and high sugar slows healing. What cutting down or stopping changes before and after the implant, you hear at the examination, honestly and without a lecture.
What changes in the plan
An implant with diabetes has the same stages: examination and scan, the root placed in the bone, healing, then the crown. What changes is what surrounds those stages:
- A blood test before we start. The doctor asks for your HbA1c, the test that shows your average sugar over the last two to three months, not today's reading. The level he is comfortable with, he tells you at the examination.
- Coordination with your own doctor. If something needs settling first, or a medicine needs arranging around the day of the procedure, that happens between the doctor and your diabetes doctor, not on your shoulders alone. If your diabetes doctor is abroad, bring your latest results and a way to reach them. Blood pressure, blood thinners and the other chronic conditions: bring them up at the examination in the same way.
- Gums first. Any gum inflammation is treated before the implant, and you may need cleaning more often than usual.
- Sometimes a longer healing time. Between placing the root and fitting the crown there is a waiting period for every patient, and with diabetes the doctor may extend it. How long exactly is decided by your case and told to you before you start, not afterwards. If you are only in Amman for a stretch, say so at the first visit, because that healing time is not shortened for travel.
- A preventive medicine if it is needed. In some cases the doctor decides on a medicine before or after the procedure. He decides it and tells you why. It is not something to pick up from a pharmacy on your own.
- Closer follow-up. The check-ups after the implant come closer together, so any inflammation is caught while it is small.
And if it is not possible right now?
It happens. Sugar not yet controlled, bone that needs time, gums that need treatment. Then the answer is not “no”. It is “not yet”. You hear what has to happen for it to become possible, and what the options are until then: a bridge, a denture, or waiting. Implant or bridge: what actually differs.
What to do from today
- 1
Say you have diabetesFrom the first visit: for how long, and what your treatment is, tablets or injections. The doctor cannot tell on his own, and it changes the order of the steps.
- 2
Bring your latest results and your doctor's contactYour latest HbA1c if you have it, and every medicine you take written down, not just the ones for diabetes. And a way to reach your diabetes doctor, here or back home, in case we need to coordinate.
- 3
Your medicine is not your decision alone, before the implant or after itNot before the appointment and not after it. If the procedure needs anything arranged around your medicine, the doctor arranges it with your own doctor and tells you exactly what to do and when.
- 4
Do not change your eating or medicine routine on your own before the appointmentIf anything needs arranging, the doctor tells you beforehand, together with your own doctor. Skipping food while on diabetes medicine can drop your sugar while you are in the chair, and that is not something we want to go through. Keep something sweet in your pocket, just in case.
- 5
Start cleaning your gums todayA soft brush twice a day, and floss between the teeth. Healthy gums before an implant are the condition that depends most on you, not on the doctor.
- 6
If you smoke, say soNot so we can lecture you, but so it is counted in the plan properly. Cutting down before the implant and after it makes a difference to healing.
- 7
After the implant, watch your sugar more than usual, in both directionsThe procedure and any inflammation can push your readings up for a few days, and eating less after the implant while taking the same medicine can push them down. If your readings leave your usual range, or you cannot eat normally, tell your diabetes doctor the same day before you adjust anything yourself, and let us know.
When to call
Most of what happens after an implant is expected: some discomfort and mild swelling for the first few days, then it eases. But some things do not wait for the follow-up appointment:
- Swelling that grows after the second or third day instead of easing.
- Bleeding that does not stop with gentle pressure on gauze.
- Pain that grows over the days instead of easing, or a throbbing pain at night.
- A bad taste or smell from the implant site, or discharge.
- A fever, or a feeling that the implant or the cap over it has moved.
- High sugar readings that do not return to your usual, or a low (shaking, sweating, dizziness) while you are eating less than usual: those go to your diabetes doctor the same day, and let us know.
Call and we will find you the earliest slot, and tell you what to do until you arrive. If the swelling has reached your eye, or it has become hard to swallow or breathe, that is a hospital emergency, not an appointment. And if the clinic is closed and the bleeding will not stop with pressure, or the swelling is growing, or you have a high fever, go to the nearest hospital emergency department, and let us know as soon as we open.
And who treats you?
The clinic has a team of dentists, Dr. Adnan Alakhras among them. At the first visit you hear exactly what you have and what state your bone and gums are in, before you hear any plan. His qualifications are on his page: Read about the doctor and the clinic.
Questions people ask
Can someone with diabetes have dental implants?
Often, yes. Diabetes on its own is not a closed door; uncontrolled sugar is, because it slows healing and makes infection easier. If your sugar is controlled, the plan is close to anyone else's, with closer follow-up. If it is not, it is brought under control first with your own doctor, and then we place the implant. The decision is made at the examination, with a scan and your blood results.
Do I stop my diabetes medicine before the implant?
Not on your own. Anything around your medicine is decided by the doctor together with your diabetes doctor. If the procedure needs anything arranged around your medicine, the doctor coordinates it with your diabetes doctor and tells you exactly what to do and when. On the day, do not change your eating or medicine routine on your own; if anything needs arranging, the doctor tells you beforehand.
Are dental implants painful? Is it worse with diabetes?
The implant is placed under local anaesthetic, which works for you too; the doctor chooses the type and amount for your case at the examination. During the procedure you should feel pressure and movement rather than pain, and if you do feel anything you raise your hand and the anaesthetic is topped up. Once it wears off there is some discomfort for a few days, and a suitable painkiller the doctor decides on. What differs with diabetes is not the pain. It is the follow-up afterwards: pain that grows over the days instead of easing is a reason to call, not to wait it out.
How long does it take with diabetes, and can it be done in one trip to Amman?
The same stages, but the wait between placing the root and fitting the crown may be longer with diabetes, and it is not shortened for travel. So it is rarely one trip: if you are flying in, say so at the first visit and we plan the stages around it, as far as the healing allows. How long exactly is told to you before you start, as an expectation, not a promise.
I have diabetes. Implant or bridge?
Diabetes alone does not settle it. A bridge rests on the teeth either side of the gap and has nothing to do with bone healing; an implant stands on its own but needs healing and controlled sugar. So if your sugar is controlled, both options are open and the difference comes down to the state of the neighbouring teeth and the bone. If it is not controlled right now, there are interim options until it is: usually a removable one, or a bridge if that is what you and the doctor decide at the examination, and the implant is discussed after that if that is what you and the doctor decide at the examination. Implant or bridge: what actually differs.
I have diabetes. Will my implant last less long than other people’s?
There is no number for anyone. What shortens the life of an implant, in everyone, is inflammation of the gum and bone around it, and someone with diabetes is more prone to it when sugar is high or cleaning is neglected. So what protects your implant is what protects your teeth: controlled sugar, brushing, and check-ups. What makes an implant last, and what shortens it.
I'm nervous about implants anyway, and the diabetes makes it worse
That is normal, and you say so from the first moment. The first visit has no implant in it; it has a scan and a conversation: you hear what you have, what the steps are and what happens if you wait, or what is still missing to decide, and you go home to think. For those who need it, there is laughing gas: a small mask over the nose, you stay awake and can talk, and the level is adjusted during the appointment. When the visit is hard.
Your next step
An examination and a scan, with your latest blood results. You come in, you are examined, and you leave knowing what has to happen first, whether the implant is now or after control, or what is still missing to decide. Bring your medicines written down and your doctor's contact, in case we need to coordinate.
Pages that go with this one
This is general information, not a diagnosis of your case. The decision is made at the examination, in coordination with your diabetes doctor.