I. Disclaimer

This document is intended to be used as a reference for VA and non-VA providers. It is not intended to replace clinical judgment when determining care pathways. These guidelines do not guarantee benefits or constitute medical advice. 

Eligibility for VA dental care is defined by statute and is to be provided in accordance with the provisions of existing law and VA regulations, primarily 38 U.S.C. §§ 1710(c), 1712, and 2062 and 38 C.F.R. §§ 17.160 through 17.166

II. Dental Clinical Determinations and Indications

1. Indications for Dental Implant Placement
2. Dental implant placement may be considered clinically necessary when ALL the following criteria are met: 
   • Patients with a low-risk factor score total based on the VA medical/clinical requirements (see section III.a.) 
   • Patients with an established prosthetic plan of care 
   • Patients with sufficient bone volume to achieve primary stability 
   • Cases where conventional fixed or removable prostheses are contraindicated 
   • Cases where more conservative conventional fixed or removable prostheses have failed, as verified by a professional dental evaluation 
   • Patients who meet restorative criteria as outlined in the Clinical Determinations and Indications (CDI) 
     • DNT-0003: Single Unit Implant Crowns and Implant/Abutment Supported Removable Denture (Overdenture) 
     • DNT-0006: Complex Restorations of the Dentition with or without Implants 

2. Limitations/Exclusions
3. Dental implants are not indicated and therefore considered not clinically necessary if any of the following situations or conditions are applicable:
   • Patients with an intermediate or high-risk factor score total based on VA medical/clinical requirements (see section III.a.) 
   • Second molar implants- unless there is an opposing tooth with at least two-thirds of the occlusal table in function 
   • Mini-implants 
4. For all other conditions or indications not listed in section II.a. of this document, dental implants are considered not clinically necessary due to insufficient evidence of efficacy and safety. 

3. Description of Treatment 
4. Dental implants are a strong anchor placed in the patient’s jaw to replace missing teeth. The dentist carefully inserts a small titanium post into the bone, which acts like a tooth root. After healing, this post can hold a new tooth, bridge, or denture, helping the patient chew, speak, and smile confidently. The process is done under local anesthesia and typically requires approximately three to six months of healing before the final restoration is placed.

III. Clinical Decision Support Resources  

1. Implant Risk Indicators
2. The Implant Risk Indicators risk score table below is used to establish a patient’s risk category for successful implant outcomes using medical and clinical indicators.  
4. The patients risk category (see Section III.b.) is determined by the cumulative total of all individual values assigned to each medical and clinical indicator.

Table 1: Implant Risk Indicators – Medical Indicators  

Medical Indicators	Subscales	Points
Absolute clinical contraindications	Allergic or hypersensitive to titanium or other implant materials	11
	Active or recently completed intravenous bisphosphonate therapy	11
	Undergoing active cancer treatment	11
	Cardiac event within the last six months	11
	Immunosuppressed (post-transplant)	11
Smoking	Currently Smoking	6
Diabetes	HbA1c 7- 8% at time of implant placement	3
	HbA1c > 8% at time of implant placement	6
History of same site implant failure	Previous failure at site	11
Use of anti-resorptive agents	Oral anti-resorptive agents	3
	Intravenous anti-resorptive agents for treatment of osteoporosis	4
	Intravenous anti-resorptive agents for treatment of cancer	11
	Patient any stage of medication-related osteonecrosis of the jaw	11
Current use of Selective Serotonin Reuptake Inhibitors	n/a	3
Current use of Proton Pump Inhibitors	n/a	1
History of head and neck radiation	Greater than 55 Gy	11
Poor compliance with dental appointments	Greater than two missed dental appointments	3

Table 2: Implant Risk Indicators – Clinical Indicators

Clinical Indicators	Subscales	Points
Periodontal disease	N/A	Treated/ Inactive	Untreated/ Active
	Slight chronic periodontitis	2	4
	Moderate/severe chronic periodontitis	4	6
	Aggressive periodontitis	6	11
Plaque Levels at exam	Moderate percent plaque index greater than 20%-50%	3
	Heavy percent plaque index greater than 50%	5
Thin tissue biotype	Less than 2mm thickness	2
Bruxism	Yes	3
Maxillary posterior implant position	n/a	3

2. Implant Risk Categories 
   • Low Risk (0-5 points): Patients with no significant systemic or local risk factors. Ideal candidates for implant placement based on a restorative treatment plan. 
   • Intermediate Risk (6-10 points): Patients with modifiable but uncontrolled modifiable risks, such as systemic chronic diseases (e.g., diabetes), history of periodontal disease, or minor bone deficiencies requiring augmentation. Implants should be postponed until improvement to low risk. 
   • High Risk (11+ points): Patients with modifiable and nonmodifiable systemic conditions, history of implant failure, active aggressive periodontal disease, active osteonecrosis of the jaw, or severe bone deficiencies. Implants are not recommended; other restorative options are to be utilized.

IV. Background and Supporting Information

The following information is for reference purposes only in accordance with dental eligibility as defined by statute (law). Each subsection supports VA’s determinations for clinical necessity and alignment with generally accepted standards of dental practice.

1. Background Information
2. Dental implants serve as a durable and functional solution for the replacement of missing teeth, designed to integrate with the jawbone and provide a stable foundation for prosthetic restorations. Prior to implantation, a comprehensive Dental Implant Risk Assessment is conducted to evaluate patient-specific risk factors, such as smoking, diabetes (HbA1c levels), periodontal disease, or history of anti-resorptive therapy, which may compromise osseointegration or long-term implant success. This assessment assigns risk scores to guide treatment planning, ensuring that high-risk conditions (e.g., active cancer treatment, recent cardiac events, or immunosuppression) are addressed or alternative treatments are considered. The procedure involves the surgical insertion of a biocompatible implant fixture into the alveolar bone, which undergoes osseointegration, ensuring firm anchorage. After a healing period of approximately three to six months, the implant fixture is connected to an abutment that protrudes through the gingiva, serving as the attachment for the final prosthetic restoration. Dental implants are superior in preserving the surrounding bone structure, preventing bone resorption, and maintaining facial aesthetics compared to traditional fixed partial dentures or complete dentures. Successful outcomes depend on meticulous patient selection informed by the risk assessment, thorough pre-operative evaluation, and precise surgical and prosthetic planning to optimize implant stability and longevity.

3. Research, Clinical Trials, and Evidence Summaries
4. Research supports high success rates for dental implants when patient selection and treatment planning are optimized. Studies demonstrate that implants placed in patients with low-risk profiles, adequate bone volume, and controlled systemic conditions achieve survival rates exceeding 95% over 5-10 years (Albrektsson & Zarb, 2018; Becker et al., 1999). Strategic occlusal load management and immediate placement techniques enhance esthetic and functional outcomes while minimizing bone loss (Cosyn & Blanco, 2023; Waasdorp et al., 2010). However, risk factors such as smoking, uncontrolled diabetes, and poor oral hygiene significantly increase failure rates, particularly in maxillary molar regions where bone quality is less favorable (Chrcanovic et al., 2015; Zhou et al., 2019). Mini-implants show lower stability and survival compared to standard implants, especially in load-bearing areas (de Souza et al., 2015). These findings underscore the importance of comprehensive risk assessment and adherence to evidence-based protocols to ensure long-term implant success.
6. VA generally only approves use of medical devices that have received at least Food & Drug Administration (FDA) clearance for 510(k) Premarket Notification. The FDA regulates dental implants as Class II medical devices through the Center for Devices and Radiological Health (CDRH). The FDA has determined these Class II devices are substantially equivalent (SE) to legally marketed predicate devices, in terms of safety and effectiveness, and may be marketed in the U.S. Manufacturers must adhere to FDA regulations on labeling, manufacturing practices, and post-market surveillance. The FDA monitors adverse event reports and can mandate recalls. Manufacturer’s Instructions for Use (MIFU) must be followed.
8. To search for devices that have received FDA 510(k) clearance or Premarket Approval (PMA), please visit the FDA Devices database.

3. American Dental Association Current Dental Terminology Coding Information
4. The following CDT codes listed in this section are provided for informational purposes only. Inclusion or exclusion of a code does not constitute or imply VA coverage or provider reimbursement. The list of codes may not be all-inclusive since the American Dental Association (ADA) code updates may occur more frequently than dental CDI updates. Please refer to section II.a. in this document to review indications and clinical criteria for clinical necessity.

CDT Code	Description
D6010	Surgical placement of implant body: endosteal implant
D6011	Surgical access to an implant body (second stage implant surgery); This procedure, also known as second stage implant surgery, involves removal of tissue that covers the implant body so that a fixture of any type can be placed
D7993	Surgical placement of craniofacial implant – extra oral; Surgical placement of a craniofacial implant to aid in retention of an auricular, nasal, or orbital prosthesis
D7994	Surgical placement: zygomatic implant; An implant placed in the zygomatic bone and exiting through the maxillary mucosal tissue providing support and attachment of a maxillary dental prosthesis

Current Dental Terminology (CDT), Copyright ^© 2026 American Dental Association. All rights reserved.

V. Definitions

Term	Definition
Dental implant	A biocompatible medical device surgically placed into or onto the jawbone to serve as an artificial root for supporting a prosthetic tooth restoration
HbA1C	A blood test that shows the average blood sugar (glucose) level over the past two to three months. Also referred to as hemoglobin A1C
Mini-implant	A smaller-diameter dental implant (typically less than 3 mm)

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Zhou, N., Dong, H., Zhu, Y., Liu, W., Li, X., Xing, X., Zhang, X., & Cao, Y. (2019). Analysis of implant loss risk factors especially in maxillary molar location: A retrospective study of 6977 implants in Chinese individuals. Clinical Implant Dentistry and Related Research, 21(1), 138–144.

Zhou, W., Wang, F., Monje, A., Elnayef, B., Huang, W., & Wu, Y. (2016). Feasibility of Dental Implant Replacement in Failed Sites: A Systematic Review. The International journal of oral & maxillofacial implants, 31(3), 535–545.

VII. Dental CDI History/Revision Information

Date	Summary of Update(s)
06/01/2026	New dental CDI created describing clinically necessary and not clinically necessary indications

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