Dental implants are a durable and effective prosthetic solution, but their longevity depends on proper care and avoidance of risk factors. Based on the latest scientific evidence we explain what behaviours to avoid and what to do to ensure that implants serve for many years.
1. Smoking — the most important modifiable risk factor
Smoking is one of the most thoroughly documented risk factors for peri-implant disease. An umbrella review of meta-analyses published in 2024 in the Journal of Dentistry (Koay et al.) confirmed that smoking significantly increases the risk of peri-implantitis — an inflammatory condition leading to progressive bone loss around the implant.
A systematic review and meta-analysis by Reis et al. (2023) likewise demonstrated that smokers have a higher risk of developing peri-implantitis compared with non-smokers. The evidence indicates that tobacco smoke impairs the immune response and vascular supply, which inhibits healing and bone regeneration.
What to do: Ideally, quit smoking altogether. Studies suggest that the sooner the patient quits, the better the prognosis for the implant. If complete cessation is not possible, reducing the number of cigarettes and maintaining meticulous oral hygiene are the minimum steps.
2. Neglecting oral hygiene
Bacterial biofilm — the layer of bacteria that accumulates around implants — is the main cause of peri-implantitis, an inflammatory condition leading to progressive bone loss and, in severe cases, implant failure.
Studies emphasise that the lack of regular biofilm control and failure to adhere to the schedule of preventive appointments are associated with a higher risk of peri-implant complications.
What NOT to do:
✗ Do not skip brushing teeth and implants — a minimum of twice daily
✗ Do not forgo cleaning the interdental spaces — interdental brushes, a water flosser or floss
✗ Do not use metal instruments to clean implants — they can scratch the surface
✗ Do not use toothpastes with coarse abrasives — they can damage the surface of prosthetic crowns
What to do:
✓ Brush with a soft toothbrush (manual, electric or sonic) 2–3 times daily
✓ Use interdental brushes or a water flosser — studies indicate the effectiveness of a water flosser in reducing inflammation around implants
✓ Use chlorhexidine rinses as directed by the clinician
3. Skipping follow-up appointments
Regular dental appointments are key to the early detection of peri-implant problems. A systematic review by Araujo et al. (2024) confirmed that patients who do not attend regular follow-up visits have a significantly higher risk of developing peri-implantitis.
Recommended schedule: follow-up appointments every 3–6 months (more frequently in patients with risk factors: smoking, diabetes, a history of periodontal disease). Each visit should include plaque assessment, probing depth measurement around the implant and professional cleaning.
4. Teeth grinding and clenching (bruxism)
Bruxism can generate forces many times greater than normal chewing loads. In the case of implants — which, unlike natural teeth, lack a periodontal ligament to cushion forces — these loads are transmitted directly to the bone and the prosthetic restoration, increasing the risk of screw loosening, ceramic fracture or prosthetic complications.
What to do: If you grind your teeth, be sure to inform the implantologist. A custom-made occlusal splint (relaxation splint) worn at night reduces the load on the implants and protects the prosthetic restoration.
5. Biting hard objects and an inappropriate diet
Prosthetic crowns on implants are highly robust, but they are not indestructible. Biting very hard objects can lead to chipping or fracture of the ceramic, screw loosening or damage to the prosthetic structure.
What to avoid:
✗ Biting ice cubes, hard sweets, nuts in their shells
✗ Opening packages, bottles or sachets with the teeth
✗ Biting pens, pencils and nails
✗ Tearing thread with the teeth
6. Ignoring systemic diseases
Diabetes (especially poorly controlled and unstabilised) is a documented risk factor for peri-implantitis. A 2024 scientific review confirmed that patients with uncontrolled diabetes have a higher risk of peri-implant complications and impaired healing.
Certain medications also warrant attention. Bisphosphonates (used, among other things, in the treatment of osteoporosis) can in rare cases lead to medication-related osteonecrosis of the jaw (MRONJ). Every medication should be reported to the dentist before implant-related procedures.
Risk factor table for dental implants
The table below summarises the key risk factors for implant longevity, based on current systematic reviews.
| Risk factor | Level of evidence | Effect on implants | How to minimise? |
| Smoking | High | higher risk of peri-implantitis | Smoking cessation |
| History of periodontal disease | High | higher risk of peri-implantitis | Periodontal treatment before implant placement, regular follow-up visits |
| No follow-up visits | High | No early detection of inflammation | Visits every 3–6 months |
| Diabetes (poorly controlled) | Moderate | Impaired healing, higher risk of peri-implantitis | HbA1c control, collaboration with the diabetologist |
| Poor oral hygiene | High | Biofilm accumulation → peri-implant mucositis → peri-implantitis | Daily hygiene, interdental brushes, water flosser |
| Bruxism | Limited | Mechanical overload, risk of prosthetic fractures | Occlusal splint, occlusion check |
| Bisfosfoniany / leki antyre-sorpcyjne | Limited | Risk of MRONJ (osteonecrosis of the jaw) | Informing the clinician, caution with procedures |
What is peri-implantitis and why is prevention important?
Peri-implantitis is an inflammatory condition of the tissues surrounding the implant, leading to progressive bone loss. It is the main cause of late implant failure. Current EFP S3 guidelines (Herrera et al., 2023) emphasise that prevention — including regular hygiene and follow-up visits — is significantly more effective and less costly than treating established peri-implantitis.
The disease often develops in a non-linear fashion and is initially asymptomatic — hence the great importance of prevention. Treating peri-implantitis is more complex and less predictable than preventing it, which is why the entire effort should be focused on early detection and control of risk factors.
What to avoid in the first weeks after implant placement?
Immediately after implant placement additional restrictions apply that support correct healing and osseointegration. In addition to the general rules described above, during the first days and weeks the following should be avoided:
✗ Vigorous rinsing of the mouth for the first 24–48 h (risk of dislodging the blood clot)
✗ Drinking through a straw (negative pressure may damage the clot)
✗ Consuming hot foods and drinks (they worsen swelling and bleeding)
✗ Intense physical exertion for 7–10 days (raises blood pressure)
✗ Touching the wound area with the tongue or fingers
✗ Sauna, solarium and hot baths for the first 7 days
✗ Consuming alcohol for a minimum of 48–72 h (impairs healing, interacts with medications)
Long-term implant care — golden rules
After healing is complete and the prosthetic crown has been fitted, the implant requires systematic, long-term care. The patient's hygiene protocol should include the following elements:
| Don't do this ✗ | Do this instead ✓ |
| Do not use metal scalers on implants | Use plastic or titanium tips |
| Do not skip the interdental spaces | Clean daily with an interdental brush or water flosser |
| Do not ignore bleeding gums around the implant | Book a follow-up appointment — this may be peri-implant mucositis |
| Do not skip dental appointments | Follow-up appointments every 3–6 months + professional cleaning |
| Do not bite hard objects | Crack nuts with a nutcracker, crush ice in a blender |
| Do not conceal systemic diseases from the dentist | Report diabetes, bisphosphonates, medications and changes in health status |
Frequently Asked Questions (FAQ)
Can I eat normally with implants?
Yes — after healing is complete and the prosthetic crown has been placed, you can eat virtually anything. You should, however, avoid biting very hard objects (ice, hard sweets, nuts in shells) and foods that can trap between the implant and the gum. A balanced diet supports the health of the tissues surrounding the implant.
Does smoking damage implants?
Yes — smoking is one of the most important risk factors for peri-implantitis. Meta-analyses indicate that smokers have a significantly higher risk of peri-implant complications and implant failure. If you cannot quit entirely, reducing the number of cigarettes and meticulous hygiene are the minimum steps.
How often should I have check-ups with implants?
Follow-up appointments every 3–6 months are recommended. In patients with a higher risk (smokers, diabetes, a history of periodontal disease) appointments should be more frequent. Each visit should include professional cleaning and an assessment of peri-implant tissue condition.
Is bruxism a contraindication to implants?
Bruxism is not an absolute contraindication, but it must be taken into account in the treatment plan. Patients with bruxism should usually wear a custom-made occlusal splint at night to protect the implants and the prosthetic restoration against overloading.
Can I have an MRI with dental implants?
Yes — titanium implants are safe in the MRI environment because titanium is not ferromagnetic. They may, however, cause artefacts (distortions) in the image in the jaw area. Always inform the radiologist about the implants before the examination.
How long do dental implants last?
With proper care, implants can serve for decades — many studies report survival rates above 95% at 10 years. The key factors are: oral hygiene, regular follow-up visits, the absence of smoking and the control of systemic diseases.
What should I use to clean implants at home?
For daily hygiene use a soft toothbrush (manual, electric or sonic), interdental brushes and/or a water flosser. Studies indicate that a water flosser is particularly effective in reducing inflammation around implants. Use chlorhexidine rinses only as directed by the clinician — not continuously.
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Sources
1. Koay CG, Veettil SK, Menon RK „Risk factors for Peri-implantitis: An umbrella review of meta-analyses of observational studies and assessment of biases.” J Dent. 2024.
Link: https://pubmed.ncbi.nlm.nih.gov/38762079/
2. Reis INR, Amaral GCLS, Hassan MA et al. „The influence of smoking on the incidence of peri-implantitis: A systematic review and meta-analysis.” Clin Oral Implants Res. 2023 Jun;34(6):543-554.
Link: https://pubmed.ncbi.nlm.nih.gov/36939434/
3. Herrera D, Berglundh T, Schwarz F et al. „Prevention and treatment of peri-implant diseases – The EFP S3 level clinical practice guideline.” J Clin Periodontol. 2023;50(Suppl 26):4–76.
Link: https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13823
4. Araujo TG, Moreira CS, Neme RA et al. „Long-term Implant Maintenance: A Systematic Review of Home and Professional Care Strategies in Supportive Implant Therapy.” Braz Dent J. 2024;35:e24-6178.
Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC11506129/
5. Soares PM, Silveira GA, Gonçalves LS et al. „Maintenance protocols for implant-supported dental prostheses: A scoping review.” J Prosthet Dent. 2024;132(1):59–71.
Link: https://pubmed.ncbi.nlm.nih.gov/36535881/
6. Alterman M et al. „Dental implant risk factors for peri-implant disease: a narrative review.” Front Oral Maxillofac Med. 2022;4:18.
Link: https://fomm.amegroups.org/article/view/67357/html
Information on content and responsibility
This article is intended solely for informational and educational purposes and does not constitute medical advice, a diagnosis or a treatment recommendation. It does not replace a consultation with a dentist or other qualified specialist. Despite every effort to ensure accuracy, the authors accept no liability for decisions made by readers on the basis of the information contained herein.