Osseointegration of Dental Implants in Organ Transplant Patients Undergoing Chronic Immunosuppressive Therapy

Dental implants in solid organ transplant recipients: A systematic review and meta-analysis

PURPOSE

It remains to be determined whether dental implantation treatment in solid organ transplant (SOT) recipients and non-organ transplant patients yields similar clinical outcomes. This review summarizes related data for existing cases and presents a meta-analysis of the outcomes of dental implants in SOT recipients and non-organ transplant patients.

MATERIAL AND METHODS

An electronic literature search was conducted in the PubMed, Web of Sciences, Cochrane Library and China National Knowledge Infrastructure databases covering articles published from inception to December 2024. This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was designed based on the Population, Intervention, Comparison, Outcome and Study design (PICOS) framework. The risk of bias was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist or the Newcastle-Ottawa Scale (NOS). The certainty of findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Meta-analysis was performed using a fixed effects model to estimate the combined performance measures and 95% confidence intervals for the implant survival rate, marginal bone loss (MBL), and probing depth (PD).

RESULTS

A total of 12 articles were included in the systematic review. The implant survival rate of 290 implants in 110 SOT recipients was 99.3%. The meta-analysis of four case-control studies revealed no significant differences in the implant survival rate and PD between SOT recipients and non-organ transplant patients (P=0.45 and P=0.49, respectively), while there was slightly less MBL in SOT recipients (P=0.02), possibly caused by confounding factors and bias.

CONCLUSIONS

Organ transplantation does not impair implant survival in the short and mid-long term. Dental implantation can serve as a treatment option for tooth loss in SOT recipients.

Dental implant considerations in patients with systemic diseases: An updated comprehensive review

BACKGROUND

Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise.

AIM

The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population.

METHODS

The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts.

RESULTS

In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study.

CONCLUSION

In treating patients with systemic conditions, the cost-benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.

Implant Survival in Patients with Chronic Kidney Disease: A Case Report and Systematic Review of the Literature

BACKGROUND

The aim of this systematic review and case reports was to evaluate osseointegration and implant survival rate in patients with chronic kidney disease.

METHODS

The paper screening process was conducted on electronic databases in order to identify clinical studies concerning the study topic. The literature data were evaluated for eligibility and studies were included for the qualitative synthesis. The case report concerned a male subject affected by renal disorders, a candidate for full arch immediate loading procedure.

RESULTS

The article screening process reported a total of 54 manuscripts and one paper identified through the manual search. At the end of the review process, a total of 45 articles were excluded while nine manuscripts were included for the descriptive synthesis. No significant complications or events were present during the intraoperative/post-operative phases. The clinical course reported no significant inflammation or symptoms. At follow-up, the rehabilitation was found to be functionally and aesthetically integrated with no complications, probing, or bone resorption.

CONCLUSIONS

The available evidence supports the clinical efficacy of the early implant placement protocol. Present findings indicate that the early implant placement protocol results in implant outcomes similar to immediate and delayed placement protocols and a superior stability of peri-implant hard tissue compared with immediate implant placement.

Dental implant procedures in immunosuppressed organ transplant patients: a systematic review

During the last decades, the number of immunosuppressed organ transplant patients has increased consistently. Nevertheless, immunosuppression has been discussed as a contraindication for dental implant procedures for many years. Hence, the purpose of this systematic review was to assess the survival rate and outcomes of dental implants after solid organ transplantation. An electronic and manual literature search was conducted up to March 2021. Publications describing dental implants placed in patients after organ transplantation were included without any limitations regarding study design or date of publication. Ten articles met the inclusion criteria, leading to a sample of 93 patients with 249 implants. Implant survival rates were 100% over a mean follow-up of 60 months. In every case, implant surgery was performed under antibiotic coverage. No major medication-related complications were reported. Despite the limited amount of evidence in the literature, implant procedures seem to be a safe treatment option in immunosuppressed organ transplant patients. The observance of appropriate treatment protocols including a strict maintenance programme seems to be crucial for the long-term success of such treatments. However, stringent data regarding various influencing factors such as the prevalence of peri-implantitis are still missing.

New Surgical Technique Using Xenograft as a Microinvasive Method to Avoid Extensive Bone Reconstruction in Patients With Compromised General Health: Promising Surgical Methodology and First Clinical Results

The innovative microinvasive immediate implantation technique of dental implants insertion was described. The technique uses bovine xenograft material to restore the bone defect resulting from teeth pathologies and subsequent extraction. Ten patients had extractions of their premolar upper teeth and immediate implantations with xenograft socket augmentation. This unique procedure allowed primary stability of implant above 70 implant stability quotient in all cases. All of the implants healed without complications and were restored with screwed ceramic crowns. Two-year uneventful follow-ups confirmed alveolar xenograft condensation technique as a microinvasive and safe technique, especially for patients with compromised general health who may not undergo complicated restorative operations.

The feasibility of using computer-based models for reducing the risks of complications associated with temporary dentures

Contemporary prosthetic dentistry has a vast arsenal of solutions for completely edentulous patients. However, it is crucial to consider a variety of factors that can cause complications in patients wearing temporary dentures in the osseointegration period. The aim of this study was to retrospectively analyze the medical records of completely edentulous patients wearing temporary removable or fixed dentures in the osseointegration period, to identify the risk factors for complications and to calculate the odds of adverse events. We performed a multivariate analysis and developed a computerized algorithm that could be used to facilitate selection of the proper denture type and material. The algorithm demonstrates high sensitivity and specificity: 94.37 (76.2 : 98.7) and 92.56 (79.8 : 97.6), respectively; the AUC value is 0.921 (0.843 : 0.963). We are planning to develop a software based on the proposed algorithm that would help the dentist to make a more objective decision when selecting the type of temporary denture and its material.