Challenges of Dental Implants in Systemically Compromised Patientes:

A Critical Narrative Review

Abstract

Systemic medical conditions play a decisive role in the prognosis and long-term success of dental implants, affecting primary stability, osseointegration, peri-implant health, and long-term survival rates. This structured narrative review synthesizes the most recent evidence published between 2018 and 2024 regarding the influence of diabetes mellitus, osteoporosis, head and neck radiotherapy, biological/immunosuppressive therapies, and nutritional factors on implant outcomes. Current data indicate that poorly controlled diabetes significantly increases the risk of peri-implant complications and implant failure, whereas osteoporosis alone does not appear to compromise implant survival when adequate surgical planning is implemented. Radiotherapy remains one of the most critical systemic factors, leading to impaired bone vascularity and a heightened risk of osteoradionecrosis. Emerging molecular findings highlight the relevance of osteoimmune modulation, including SIRT1 activation, particularly in diabetic osteoporosis. Overall, the literature supports that dental implants can achieve survival rates comparable to those in healthy individuals when systemic conditions are properly assessed, controlled, and managed through individualized surgical and prosthetic planning. Careful patient selection and medical optimization remain essential for predictable implant therapy in medically compromised populations.