05 February 2021

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Dental implant failure: beware of medication!

Alessandra Abbà

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Although dental implants have become a common choice among the treatment options for missing teeth rehabilitation, previous reports of failure rates range from 1% to 19%. 

Early failure occurred before the application of functional loading while late implant failure occurred after applying occlusal loading and represents the failure of either the established osseointegration or function of dental implants. So late implant failure could derive either from biologic or mechanical complications and generally more efforts are needed to resolve the condition. Therefore, identifying risk factors related to implant failurecould help in predicting the treatment outcomes.

Peri-implantitis and implant overloading are recognized risk factors, but little is known about other factors affecting the maintenance of osseointegration of dental implants.
Some medical conditions have effects at local or systemic level and have been associated with an increased risk of collapse of the peri‐implant tissues.Many chronic diseases induce a low‐grade systemic inflammatory condition associated with high levels of circulating pro‐inflammatory cytokines. These may activate a process which leads to bone loss and peri‐implant disease.
In addition to uncontrolled systemic diseases itself, the systemic intake of medication have shown to further modulate bone metabolism.
Drugs inducing disruption of osteocyte metabolic activities, anti‐hypertensive medication (such as beta‐blockers or angiotensin‐converting enzyme inhibitors), serum serotonin reuptake inhibitors (SSRIs), are examples of medication involved in bone metabolism alterations. 

Therefore, because of the importance of this aspect in an aging population, the aim of this systematic review was to investigate the association between the intake of medication that may affect bone metabolism. and implant failure.

Material and methods
This systematic review was conducted according to the guidelines of the Preferred Reporting Items of Systematic Reviews and Meta‐analyses (PRISMA) statement.
Electronic and manual literature searches were conducted in several databases. Moreover, the authors conducted manual searches in selected journal issues published between January 2017 and August 2017. Implant failure (IF) was the primary outcome, while biological/mechanical and the causes/timing associated with IF were set as secondary outcomes. The odds ratio of IF in the test group (individuals in‐taking medication) vs. IF in the control group (individuals not taking any known relevant medication) was analyzed with a meta-analyses.

Results
A final selection of 17 articles was screened for qualitative assessment and then pooled according to the following medication category: non‐steroidal anti‐inflammatory drugs (NSAIDs), selective serotonin reuptake inhibitors (SSRIs), proton pump inhibitors (PPIs), bisphosphonates (BPs) and anti‐hypertensives (AHTNs).

- NSAIDs, five studies: no significance differences found.

- SSRIs, two studies: IF significantly higher in the individuals taking SSRIs (p < 0.5), with a difference of 7.5% estimated.

- PPIs, two studies: a difference of IF rates of 4.3% was estimated, indicating significantly higher IF rates in the test compared to the control group (p < 0.5). 

- BPs, seven studies: no significance differences found.

- AHTNs, one study: this study revealed an increased survival rate of AHTN medication, but no meta-analysis could be carried out.

Conclusions
The present systematic review highlighted a correlation between the use of PPIs, used to block the enzyme in the wall of the stomach that produces acid, and SSRIs, used for depression and anxiety conditions, and an increased implant failure rate. Nevertheless findings from this study cannot be conclusive and further studies in this direction are needed as clinicians should be aware of possible medication‐related implant failure. 

For further information: Medication‐related dental implant failure: Systematic review and meta‐analysis