Implant treatment in pharmacologically immunosuppressed liver transplant patients: A prospective-controlled study

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.

Biomarkers from subcutaneous engineered tissues predict acute rejection of organ allografts

Invasive graft biopsies assess the efficacy of immunosuppression through lagging indicators of transplant rejection. We report on a microporous scaffold implant as a minimally invasive immunological niche to assay rejection before graft injury. Adoptive transfer of T cells into Rag2-/- mice with mismatched allografts induced acute cellular allograft rejection (ACAR), with subsequent validation in wild-type animals. Following murine heart or skin transplantation, scaffold implants accumulate predominantly innate immune cells. The scaffold enables frequent biopsy, and gene expression analyses identified biomarkers of ACAR before clinical signs of graft injury. This gene signature distinguishes ACAR and immunodeficient respiratory infection before injury onset, indicating the specificity of the biomarkers to differentiate ACAR from other inflammatory insult. Overall, this implantable scaffold enables remote evaluation of the early risk of rejection, which could potentially be used to reduce the frequency of routine graft biopsy, reduce toxicities by personalizing immunosuppression, and prolong transplant life.

Clinical analysis of the tooth-implant papilla for two narrow-diameter titanium-zirconium implants in the anterior area: prospective controlled clinical study

BACKGROUND

Rehabilitation of the anterior area when the mesio-distal space is reduced is a challenge for the clinician, due to the patient's anatomical limitations and aesthetic requirements. Narrow Diameter Implants (NDI) are an option of treatment when the standard diameter implant is not possible, but the evidence is scarce. This prospective clinical study aims to analyze the formation of the tooth-implant papilla between the implant and the adjacent natural tooth in the maxillary lateral incisors and mandibular incisors.

METHODS

A total of 40 patients treated with NDI, of titanium-zirconium (Ti-Zr) alloy i.e., 2.9 mm Test Group (TG) and 3.3 mm Control Group (CG), were included. The mesiodistal distance between the adjacent natural teeth was used for implant selection, maintaining 1.5 mm between the fixation and the adjacent tooth. Clinical assessment was performed by a clinical examiner at 6 and 12 months after the final prosthesis. The primary variable was the Jemt Papillary Index. Also, implant survival rate (SR), complications, Implant Stability Quotient (ISQ), and patient-reported outcomes measures (PROMs) such as aesthetics, chewing, phonation, comfort, and self-esteem were analyzed.

RESULTS

A significant amount of papilla filling was observed concerning the baseline, with a trend towards more formation of the papilla in the TG, with a JPI score of 3. No significant differences were observed between the two groups regarding implant SR, clinical parameters, and complications. In terms of PROMs, a higher satisfaction in the TG was observed, with significant intergroup differences for aesthetics, comfort, self-esteem, and primary stability ISQ (TG: 59.05 (SD: 5.4) vs. CG: 51.55 (SD: 5.7)).

CONCLUSIONS

The 2.9 mm diameter Ti-Zr implants achieved a formation of papilla similar to 3.3 mm implants in the anterior region at 12 months of follow-up after the final prosthetic restoration. The use of Ti-Zr implants with a diameter of 2.9 mm to rehabilitate single teeth in areas of the anterior region, where the mesiodistal distance is limited, showed favorable clinical results and a high degree of satisfaction during 1 year of observation similar to 3.3 mm dental implants.

TRIAL REGISTRATION

This study was retrospectively registered in ClinicalTrials.gov with the number NCT05642520, dated 18/11/2022.

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.

Implant-based oral rehabilitation in systemic sclerosis patients: a systematic review

Systemic sclerosis is a rare multisystem autoimmune disorder that significantly impacts the orofacial region. Several oral features including microstomia and increased tooth loss contribute to the mouth-related disability. Prosthetic rehabilitation is very challenging in these patients. As the spectrum of dental implants indications has been recently extended to patients with various systemic disorders, the aim of this systematic review was to evaluate the outcome of dental implants in patients with systemic sclerosis. A literature search was conducted in Medline/PubMed database to identify eligible case-reports. 10 publications were included in qualitative synthesis. A total of 71 implants have been reported in 10 patients with systemic sclerosis with a mean of 7.1 +/- 3.8 implants per patient. Pre-implant surgeries have been described for 3 patients. Implant survival rates were higher than 98% but the mean follow-up time was only 28.3 +/- 18.6 months. Complications have been observed in 3 patients with 1 implant failure and peri-implant bone resorption in 2 patients. Although implant survival rates were high, an individualized assessment of risk-benefit balance is mandatory before indicating implant-based rehabilitation in patients suffering from systemic sclerosis and a scrupulous maintenance program has to be implemented. Further studies are strongly required to establish clinical guidelines.

Dental Implant Failure Rate and Marginal Bone Loss in Transplanted Patients: A Systematic Review and Meta-Analysis

This systematic review investigates the failure rate and marginal bone loss (MBL) of dental implants placed in patients undergoing solid-organ transplant (SOT) compared to healthy controls. Three databases (PubMed, Web of Sciences, and the Cochrane Library) were searched up to June 2020 (PROSPERO CRD42019124896). Case-control and cohort studies reporting data failure rate and marginal bone loss (MBL) of dental implants placed in SOT patients were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Four case-control studies fulfilled the inclusion criteria; all had low risk of bias. Meta-analyses revealed consistently lower implant failure rate than control populations at patient and implant levels. SOT patients had a significant difference of −18% (p-value < 0.001) MBL compared to healthy patients. SOT status poses no serious threat to implant survival. Overall, this group of patients presented lower levels of dental implant failure rate and marginal bone loss compared to otherwise healthy patients. Further intervention trials with larger sample size and longer follow-ups are necessary to confirm these summarized results.

Implant treatment in immunosuppressed renal transplant patients: A prospective case-controlled study

OBJECTIVES

The aim of this clinical study was to evaluate long-term outcomes of implant therapy in a cohort of immunosuppressed renal transplant patients compared with a matched control group.

MATERIAL AND METHODS

Pharmacologically immunosuppressed renal transplant patients received dental implant treatment between 2001 and 2011. Periodontal, clinical and radiographic parameters were prospectively measured with a mean follow-up of 116.8 months (range from 84 to 192 months). A matched controlled non-transplant sample receiving similar implant treatment in the same time was included as a control group.

RESULTS

Implant survival rate was over 98% in both test and control groups (100% and 98.84%, respectively). Peri-implant mucositis was diagnosed in 46.80% of the implants in the study group and in 48.80% in the control group. Peri-implantitis occurred in 5.10% of the implants in the study group and in 8.10% of the controls. Wound healing and post-operative pain were similar in both groups.

CONCLUSIONS

Despite the limitations of this study, pharmacological immunosuppression in renal transplant patients did not affect implant outcomes. Renal transplant patients should be carefully controlled periodically after implant treatment.

CLINICAL IMPLICATIONS

The results from this investigation justify the use of dental implants for the dentalrehabilitation of immunosuppressed patients after renal transplantation provided they follow the necessarylong-term monitoring and regular maintenance of their oral and systemic health.