Implant Therapy and Frailty: Outcomes, Risk Stratification, and Decision Algorithms

As global populations transition into an era of super-aging, implant therapy increasingly extends to older adults with multiple comorbidities and functional decline. Traditional reliance on chronological age as a determinant of treatment eligibility is gradually being replaced by a more holistic understanding of frailty, a multidimensional measure of biological resilience and vulnerability. Recognizing frailty as a dynamic continuum rather than a fixed state can reshape decision-making in implant dentistry, emphasizing patient-centered care over procedural ambition. Contemporary evidence suggests that while implant survival in older adults remains favorable, outcomes are significantly influenced by frailty status, systemic health, and the capacity for long-term maintenance. Incorporating brief frailty assessment tools such as the Clinical Frailty Scale (CFS) or Edmonton Frail Scale (EFS) into preoperative planning enables risk stratification, better communication with caregivers and physicians, and alignment of treatment goals with patient quality of life. This editorial advocates for a paradigm shift from age-based to frailty-based decision algorithms, promoting minimally invasive protocols, simplified prosthetic designs, and proactive maintenance strategies. Integrating geriatric principles into implant therapy not only enhances clinical predictability but also reinforces ethical stewardship in delivering personalized, sustainable care for the aging population.