Dental implant survival, success, and failure in older populations: Beyond chronological age to systemic and local risk profiles

AIM: Assess the effect of chronological aging on dental implant outcomes by reviewing clinical evidence on implant survival, success, failure, and marginal bone loss in elderly populations. METHODS: An electronic literature search of PubMed/MEDLINE and the Cochrane Library identified human studies published from January 1990 to July 2025 evaluating implant outcomes in elderly patients or age-stratified cohorts. Randomized controlled trials, systematic reviews, meta-analyses, cohort, case-control, and cross-sectional studies with ≥6-month follow-up were included. Outcomes assessed were implant survival, success, failure, and marginal bone loss. RESULTS: Across longitudinal and retrospective studies, dental implant survival and success in elderly patients were consistently high and comparable to younger cohorts. Increasing age alone did not affect bone loss or failure, and several studies demonstrated lower early failure rates in older adults. Marginal bone loss was influenced primarily by implant site and gender rather than age. Systemic conditions including diabetes, cardiovascular disease, and osteoporosis were not independent predictors of poor outcomes. Smoking emerged as the most consistent modifiable risk factor. High dose antiresorptive therapy and radiotherapy adversely affected survival, whereas low dose antiresorptives did not. Elderly individuals in long-term care facilities represented a higher-risk subgroup due to reduced hygiene capacity and limited caregiver implant awareness. Orthopedic implant literature demonstrated similar age-related trends, with higher revision risks in younger patients. CONCLUSION: Current evidence suggests that chronological age alone does not independently compromise implant survival, success, failure, or marginal bone loss. Outcomes are driven primarily by local, behavioral, prosthetic, and systemic factors. Elderly patients remain appropriate candidates for implant therapy.