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Treatment Algorithm · Module
Is this patient a candidate?
Risk stratification before committing to implant therapy — separating the few true contraindications from the many modifiable risks. Most systemic conditions raise risk rather than prohibit treatment.
Use: Pre-treatment screening
Principle: Few absolutes, many modifiers
Output: Proceed / optimize / decline
01 — Screening
Sort risks into three buckets
A clean medical history is rarely a yes/no question. Classify findings as true contraindications, modifiable risks, or local-site issues — each routes differently.
Absolute / defer
- High-dose IV bisphosphonates / antiresorptives (oncologic)
- Recent head & neck radiotherapy to site
- Recent MI/stroke, unstable cardiac disease
- Active malignancy under treatment
- Skeletal immaturity (growth incomplete)
Modifiable / optimize
- Smoking (RR ≈ 1.9 for failure)
- Diabetes — target HbA1c ≤ 7–8%
- Oral bisphosphonates (MRONJ ≈ 0.5%)
- Untreated periodontitis
- Poor oral hygiene / compliance
Local / site
- Insufficient bone volume / quality
- Proximity to nerve / sinus
- Limited inter-arch / mesiodistal space
- Active infection at site
02 — Decision Pathway
Interactive candidacy selector
Run the patient against the three buckets in order. A single absolute finding stops the pathway; modifiable risks route to an optimization phase before proceeding.
Tap the highest-tier finding present in this patient.
Step 1 — What is the dominant risk finding?
LOW RISK
Healthy, non-smoker, adequate bone
No systemic flags; good hygiene.
MODIFIABLE
Smoking / diabetes / perio / oral BP
Risk present but controllable.
ABSOLUTE / HIGH
IV antiresorptive, recent RT, unstable medical
Treatment contraindicated or must defer.
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03 — Quick Reference
Common conditions at a glance
Most conditions modify rather than prohibit. Verify each against current medical guidance and the patient's physician where indicated.
| Condition | Status | Action |
|---|
| Smoking | Modifiable | Cessation counseling; document elevated failure risk |
| Diabetes (well-controlled) | Proceed | Confirm HbA1c ≤ 7–8%; routine protocol |
| Diabetes (poorly controlled) | Optimize first | Defer until glycemic control improved |
| Oral bisphosphonates | Caution | Consent for MRONJ (~0.5%); atraumatic technique |
| IV / oncologic antiresorptives | Avoid | Generally contraindicated; coordinate with oncology |
| Head & neck radiotherapy | High risk | Site/dose-dependent; specialist referral, ORN risk |
| Treated periodontitis | Optimize first | Stabilize before placement; strict maintenance |
Reference
Sources & clinical disclaimer
For licensed clinicians — educational use only. This algorithm summarizes published evidence and is not a substitute for individual clinical judgment, examination, medical consultation, or the standard of care in your jurisdiction. Coordinate complex medical cases with the patient's physician. Risk figures are population estimates, not individual predictions.
- Chrcanovic BR, et al. Smoking, radiotherapy, diabetes and osteoporosis as risk factors for dental implant failure: a meta-analysis. PLoS One. 2013;8(8):e71955.
- Diz P, Scully C, Sanz M. Dental implants in the medically compromised patient. J Dent. 2013;41(3):195–206.
- Ruggiero SL, et al. AAOMS position paper on medication-related osteonecrosis of the jaw — 2022 update. J Oral Maxillofac Surg. 2022.
Last reviewed: June 2026 · Next review due: June 2027 · Version 1.0