Effects of sunitinib targeted chemotherapy on the osseointegration of titanium implants

Effect of agents affecting bone homeostasis on short- and long-term implant failure

OBJECTIVES

To review the current evidence on the relationship between agents that affect bone homeostasis and dental implant failures.

MATERIALS AND METHODS

Electronic searches for bisphosphonates, denosumab, methotrexate, corticosteroids, romosozumab, sunitinib, and bevacizumab were performed using PubMed, MEDLINE (OVID), EMBASE (OVID), Cochrane Central Register of Controlled Trials (Cochrane Library), Cochrane Oral Health Group Trials Register (Cochrane Library) and Web of Science (Thomson Reuters). Manual searches were also conducted to complement the digital searches for recent issues.

RESULTS

Previous publications suggested that bisphosphonates do not compromise the survival of dental implants. However, one study documented an increased risk of implant failure in patients who had received high-dose of intravenous bisphosphonate therapy after implant rehabilitation. There has been an issue of MRONJ around implants in patients who have successfully received implant therapy before and after antiresorptive therapy, leading to late implant failure. Despite evidence on the detrimental effects of denosumab, methotrexate and corticosteroids on bone metabolism, their role in implant survival is not conclusive.

CONCLUSIONS

At present, there is insufficient evidence to establish a potential connection between agents that affects bone homeostasis and implant failure. However, some studies have reported negative results for implant therapy. In addition, implant-related sequestration in patients who received anti-resorptive therapy, despite of successful osseointegration, is also noticeable. Although limited studies are available at present, clinicians should still carefully consider the potential hazards and take appropriate precautions to minimize the risks associated with the medications and implant therapy.

Effects of Drugs and Chemotherapeutic Agents on Dental Implant Osseointegration: Narrative Review

BACKGROUND

Dental implants have been one of the most popular treatments for rehabilitating individuals with single missing teeth or fully edentulous jaws since their introduction. As more implant patients are well-aged and take several medications due to various systemic conditions, clinicians should be mindful of possible drug implications on bone remodeling and osseointegration.

OBJECTIVE

The present study aims to study and review some desirable and some unwelcomed implications of medicine on osseointegration.

METHODS

A broad search for proper relevant studies were conducted in four databases, including Web of Science, Pubmed, Scopus, and Google Scholar.

RESULTS

Some commonly prescribed medicines such as nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), anticoagulants, metformin, and chemotherapeutic agents may jeopardize osseointegration. On the contrary, some therapeutic agents such as anabolic, anti-catabolic, or dual anabolic and anti-catabolic agents may enhance osseointegration and increase the treatment's success rate.

CONCLUSION

Systemic medications that enhance osseointegration include mineralization promoters and bone resorption inhibitors. On the other hand, medications often given to the elderly with systemic problems might interfere with osseointegration, leading to implant failure. However, to validate the provided research, more human studies with a higher level of evidence are required.

Image-based design and 3D-metal printing of a rat hip implant for use in a clinically representative model of joint replacement

The aim of this study was to obtain micro-computed tomography derived measurements of the rat proximal femur, to create parameterized rat hip implants that could be surgically installed in a clinically representative small animal model of joint replacement. The proximal femoral anatomy of N = 25 rats (male, Sprague-Dawley, 390-605 g) was quantified. Key measurements were used to parameterize computer-aided design models of monoblock rat femoral implants. Linear regression analysis was used to determine if rat hip dimensions could be predicted from animal weight. A correlation analysis was used to determine how implants could be scaled to create a range of sizes. Additive manufacturing (3D printing) was used to create implants in medical-grade metal alloys. Linear regressions comparing rat weight to femoral head diameter and neck-head axis length revealed a significant nonzero slope (P < .05). Pearson's correlation analysis revealed five significant correlations between key measurements in the rat femur (P < .05). Implants were installed into both cadaveric and live animals; iterative design modifications were made to prototypes based on these surgical findings. Animals were able to tolerate the installation of implants and were observed ambulating on their affected limbs postoperatively. Clinical significance: We have developed a preclinical rat hip hemiarthroplasty model using image-based and iterative design techniques to create 3D-metal printed implants in medical-grade metal alloys. Our findings support further development of this model for use as a low-cost translational test platform for preclinical orthopaedic research into areas such as osseointegration, metal-on-cartilage wear, and periprosthetic joint infection.