Dental implants in patients affected by systemic diseases - By Dr Amir Mostofi -DDS, Dip. (Ortho.), MSc(Implant.)
Dental implants in patients affected by systemic diseases
The exploration of dental implant success among patients burdened by systemic diseases reveals a realm of nuanced considerations, pivotal for optimising patient care and outcomes. Authored by N. Donos and E. Calciolari and published in the British Dental Journal in 2014, this comprehensive review sheds light on the intersection between systemic health conditions and dental implantology, presenting an invaluable resource for dental professionals worldwide.
Systemic diseases, encompassing a wide array of health conditions, often necessitate medications that could influence or complicate the process of dental implant surgery. Understanding the intricate relationship between these systemic conditions and dental implant success is crucial for clinicians, as it aids in the meticulous planning and execution of implant surgeries, ensuring both the safety and well-being of patients. This narrative delves into the evidence surrounding implant survival and success in patients with systemic diseases, offering practical suggestions for clinicians and highlighting areas necessitating further research.
Dental implants represent a cornerstone in the treatment of edentulism, showcasing high survival rates and offering a semblance of natural dentition. The essence of achieving successful implant outcomes lies in judicious patient selection, entailing a thorough medical history evaluation and a comprehensive assessment of the surgical site's complexity. Certain systemic conditions, underscored by varying levels of evidence, have been identified as potential complicating factors or even contraindications to implant surgery. This increasing prevalence of medically compromised individuals seeking dental implants underscores the importance of understanding the impact of systemic diseases and associated medications on both the surgical procedure and the overall treatment outcome.
Among the systemic conditions deemed as absolute contraindications for implant surgery are recent cardiovascular events, recent major surgeries such as valvular prosthesis placement or organ transplants, heightened risk of bleeding, significant immunosuppression, active cancer treatment, and intravenous bisphosphonate therapy. These conditions pose not only a heightened risk of implant failure but also potential grave risks to the patient's overall health.
The review further explores the effect of various systemic diseases on dental implant outcomes, with a focus on bone diseases such as osteoporosis, medication-related osteonecrosis of the jaws (MRONJ), and other less common bone conditions. Osteoporosis, a prevalent bone disease, poses biological plausibility for impaired bone healing around implants, though evidence remains controversial. Antiresorptive medications, particularly bisphosphonates and denosumab, present a risk for MRONJ, influencing implant success rates and necessitating careful patient management.
Diabetes mellitus, characterised by hyperglycemia, has been shown to negatively impact bone metabolism and may impede osseointegration and implant success. The review emphasises the importance of glycaemic control in diabetic patients undergoing implant therapy, alongside the management of other complications associated with diabetes.
Cardiovascular diseases, bleeding disorders, and specific mucosal diseases such as oral lichen planus and ectodermal dysplasia are also scrutinized for their potential impact on dental implant outcomes. The review suggests tailored approaches and precautionary measures for patients with these conditions, aiming to maximise implant success while minimising risks.
The document culminates in general clinical recommendations, underscoring the limited evidence base concerning the effect of systemic diseases on dental implant success. It calls for larger prospective studies to enhance understanding and provide more definitive guidance. Despite a few conditions being labelled as absolute contraindications, the review advises dental professionals to weigh the benefits and risks of implant therapy carefully, engage in interdisciplinary communication, and adopt stringent follow-up regimens for patients with systemic diseases.
In essence, the review by Donos and Calciolari serves as a testament to the complexity of dental implantology within the context of systemic health. It beckons a holistic approach to patient care, emphasising the need for ongoing research, clinical prudence, and a deep understanding of the interplay between systemic diseases and dental implant outcomes.
