Periodontal disease is one of the most common oral diseases, caused by a combination of poor oral hygiene and host defense response. It can be infl uenced by genetic, environmental and/or developed conditions such as smoking and diabetes mellitus. Periodontitis leads to bone resorption and has a reported relationship with peri-implantitis development and implant failure. However, when sugar levels are controlled, even diabetic patients can have a long-term success and survival of dental implants. In addition, the patient’s ability to maintain a good oral hygiene has been reported as a critical factor to achieve that goal. Dental implants are a good option for these patients, although there are some factors that should be ensured prior to the treatment, such as improvement and maintenance of oral hygiene levels, compliance in disease-control and quitting or reducing of smoking. The purpose of this case report with 5 years follow-up is to review the importance of motivation, education and maintenance in a patient who received dental implants as a type I diabetic with a history of chronic heavy smoking and poor oral hygiene.