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Mosaddad SA, Talebi S, Keyhan SO, Fallahi HR, Darvishi M, Aghili SS, Tavahodi N, Namanloo RA, Heboyan A, Fathi A. Dental implant considerations in patients with systemic diseases: An updated comprehensive review. J Oral Rehabil 2024; 51:1250-1302. [PMID: 38570927 DOI: 10.1111/joor.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/27/2023] [Accepted: 03/02/2024] [Indexed: 04/05/2024]
Abstract
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.
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Affiliation(s)
- Seyed Ali Mosaddad
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
- Department of Conservative Dentistry and Bucofacial Prosthesis, Faculty of Odontology, Complutense University of Madrid, Madrid, Spain
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
| | - Sahar Talebi
- Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seied Omid Keyhan
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
- Department of Oral & Maxillofacial Surgery, Gangneung-Wonju National University, Gangneung, South Korea
- Department of Oral & Maxillofacial Surgery, College of Medicine, University of Florida, Jacksonville, FL, USA
- Iface Academy, Istanbul, Turkey
| | - Hamid Reza Fallahi
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
- Department of Oral & Maxillofacial Surgery, Gangneung-Wonju National University, Gangneung, South Korea
- Department of Oral & Maxillofacial Surgery, College of Medicine, University of Florida, Jacksonville, FL, USA
- Iface Academy, Istanbul, Turkey
| | - Mohammad Darvishi
- Faculty of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Seyedeh Sara Aghili
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narges Tavahodi
- Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Artak Heboyan
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
- Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Fathi
- Department of Prosthodontics, Dental Materials Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Barros AWP, Sales PHDH, Feitosa LSG, Carvalho AAT, Leão JC. Is HIV positive a risk factor or contraindication in dental implant therapy? AIDS 2023; 37:2100-2101. [PMID: 37755429 DOI: 10.1097/qad.0000000000003669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
HIV pathogenesis affects TCD4+ lymphocytes, causing impairment of the immune system. Thus, the consequent immunological fragility of individuals with the disease and the absence of studies that serve as a guide for clinicians' decision-making make many healthcare professionals recognize it as a synonym of contraindication for oral rehabilitation treatments with dental implants.
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Vidal F, Peres RV, de Souza RC, Gonçalves C, Pavan P, Gonçalves LS. Dental implants in individuals living with HIV-1: Results from a prospective study in patients undergoing highly active antiretroviral therapy. SPECIAL CARE IN DENTISTRY 2021; 42:112-119. [PMID: 34537992 DOI: 10.1111/scd.12646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/29/2021] [Accepted: 08/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess survival and success rates of dental implants and the occurrence of peri-implant diseases (mucositis/peri-implantitis) in HIV-1-infected individuals. MATERIAL AND METHODS In this prospective study, 13 HIV-1-infected individuals undergoing highly active antiretroviral therapy (with undetectable plasma HIV RNA levels, and CD4+ T cells > 350/mm3 ) were followed after implant placement, as well as 13 non-HIV-1-infected matched controls. Patients enrolled in this study were followed up to 120 months (mean = 40.6 months; standard deviation = 22.2; range 18 -120 months). Twenty-five implants were placed in pristine healed sites for each group and bone augmentation procedures, when needed, were done only for contour augmentation. Patients were enrolled in a strict periodontal/peri-implant supportive therapy protocol with three recalls per year. The two groups were compared regarding subject-level characteristics (age, gender, smoking, diabetes) and implant-level characteristics (marginal bone level, peri-implant health status). RESULTS All the implants healed uneventfully and reached 100% survival rates (after at least 18 months) in both groups. There were no significant differences between groups for peri-implant diseases (mucositis/peri-implantitis) and for all subject-level co-variables (p > .05). Only the variables dental implant prosthesis type (DIPT) (p = .021, d = .86) and follow up (p = .011, d = .77) showed statistically significant differences between groups. CONCLUSION The findings suggest that well-controlled HIV-1-infected individuals are eligible to undergo implant therapy, achieving survival and success rates comparable to non-HIV-1-infected controls.
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Affiliation(s)
- Fábio Vidal
- Postgraduation Program in Dentistry, Estácio de Sá University, Rio de Janeiro, Brazil
| | - Rafael Vidal Peres
- Postgraduation Program in Dentistry, Estácio de Sá University, Rio de Janeiro, Brazil
| | | | - Cristiane Gonçalves
- Postgraduation Program in Dentistry, Estácio de Sá University, Rio de Janeiro, Brazil
| | - Priscila Pavan
- Postgraduation Program in Dentistry, Estácio de Sá University, Rio de Janeiro, Brazil
| | - Lucio Souza Gonçalves
- Postgraduation Program in Dentistry, Estácio de Sá University, Rio de Janeiro, Brazil
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Neumeier TT, Reddy M, Geurs N, Hill J, Neumeier H. Longitudinal Study of Dental Implants in HIV-Positive Patients. J Prosthodont 2021; 31:115-120. [PMID: 34496113 DOI: 10.1111/jopr.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study compared the clinical outcome of dental implants and their implant-supported restorations over a 3-year period involving patients both positive and negative for the human immunodeficiency virus. MATERIALS AND METHODS Twenty patients testing positive for the human immunodeficiency virus were recruited for this study. Twenty-one negative control patients were also selected, for a total of forty one patients. Diagnostic impressions were collected and cone beam computed tomography images were obtained. Implant size and positioning were planned using cone beam computed tomography software. Two stage or single surgery was performed as determined by the surgeon (periodontist). After a 6-month healing period, definitive impressions were fabricated using polyvinyl siloxane impression material. Implant stability quotient values were obtained at the time of surgery and placement of the restoration. Screw-retained custom titanium abutments were designed, milled, and placed with 25 N·cm torque using a calibrated torque controller. Porcelain fused-to-metal complete coverage restorations were then cemented with elastomeric resin implant cement. Implants and restorations were assessed at 6-month intervals over a period of 3 years for stability, peri-implant health, and patient satisfaction. RESULTS Over the 3-year period, 25 of 42 implants placed in the negative control group were assessed, and 17 of 27 implants placed in the positive control group were evaluated. The overall patient retention rate was 77%. At the 3-year follow up, restorations examined were fully functional and causing no pain. Overall implant retention within the positive group was 96%. Implant retention within the negative control group was 100%. No differences were noted between groups for bone loss based on statistical tests. CONCLUSION Within the limitations of this clinical investigation, the presence of human immunodeficiency virus per se was not a contraindication to dental treatment with implant-supported restorations.
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Affiliation(s)
- Toni Tien Neumeier
- School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Michael Reddy
- School of Dentistry, University of California San Francisco, San Francisco, CA
| | - Nicolaas Geurs
- School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Jeff Hill
- School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
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Does HIV infection affect the survival of dental implants? A systematic review and meta-analysis. J Prosthet Dent 2020; 125:862-869. [PMID: 32694022 DOI: 10.1016/j.prosdent.2020.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022]
Abstract
STATEMENT OF PROBLEM Immunosuppression and coinfections associated with human immunodeficiency virus (HIV) infection pose a relative contraindication for dental implant therapy. However, although implants have been placed in patients with HIV with reasonable success, how HIV infection affects their survival is unclear. PURPOSE The purpose of this systematic review of the literature and meta-analysis was to analyze the data on the survival of dental implants in patients with HIV. MATERIAL AND METHODS A search for relevant articles published up to November 2019 was performed in PubMed/Medline and Cochrane databases, Clinicaltrials.gov, and Google Scholar. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adopted for the conduct of the systematic review. The most pertinent data were extracted and pooled for qualitative and quantitative analyses with 95% confidence intervals. Heterogeneity was analyzed by using I-squared statistics. RESULTS A total of 8 studies involving 411 individuals with HIV and 1109 implants were included in the meta-analysis. The mean follow-up period was 2.8 years. A pooled estimate of 95% of implant survival rate with 95% confidence interval(92% to 96%) was noted. Heterogeneity across the 8 studies was found to be 41% with moderate true variability. CONCLUSIONS This systematic review demonstrated that HIV infection does not pose a serious threat to implant survival on short-term evaluation, but the evidence is of low quality.
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Duttenhoefer F, Fuessinger MA, Beckmann Y, Schmelzeisen R, Groetz KA, Boeker M. Dental implants in immunocompromised patients: a systematic review and meta-analysis. Int J Implant Dent 2019; 5:43. [PMID: 31776815 PMCID: PMC6881487 DOI: 10.1186/s40729-019-0191-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/16/2019] [Indexed: 01/26/2023] Open
Abstract
Objective Impaired health conditions and related lack of adequate host healing are among the most important conditions that account for dental implant failure. Today clinicians face an increasing number of immunocompromised patients requesting implant-based rehabilitation. To provide clinical evidence for prospective decision-making, the aim of this systematic review and meta-analysis was to analyse the influence of immunodeficiency on dental implant survival. Methods The study was conducted according to the PRISMA Statement and the principles of the Cochrane Collaboration. MEDLINE and Web of Science were searched. Results were calculated by the pooled incidence of implant loss. Reported odds ratios (OR) from fully adjusted models were preferred. Distinct risk estimates were synthesised with 95% confidence intervals. Results A total of 62 publications including 1751 endosseous implants placed in immunocompromised patients were included. For the follow-up of 24 months and longer, the mean survival rate of implants in patients with HIV was 93.1%, chemotherapy was 98.8%, autoimmune disease was 88.75%, after organ transplantation was 100%. Crohn’s disease showed a significant effect on early implant failure and resulted in increased, however not significant, implant loss. Conclusion No significant effect of immunocompromised conditions on implant survival was detectable. Implant-based therapy in immunocompromised patients should not aggravate the general morbidity and must not interfere in life-saving therapies. A careful risk stratification prior implant therapy is fundamental. To further decipher the role of immunosuppression on dental implantology, more data from controlled and randomised studies are needed.
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Affiliation(s)
- Fabian Duttenhoefer
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Marc Anton Fuessinger
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Yasmin Beckmann
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Knut A Groetz
- Department of Oral and Maxillofacial Surgery, HELIOS Dr. Horst-Schmidt-Kliniken, Academic Teaching Hospital University Mainz, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Germany
| | - Martin Boeker
- Institute of Medical Biometry and Statistics, Medical Data Science, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Sabbah A, Hicks J, MacNeill B, Arbona A, Aguilera A, Liu Q, Gelfond J, Gardner W. A retrospective analysis of dental implant survival in HIV patients. J Clin Periodontol 2019; 46:363-372. [PMID: 30702762 DOI: 10.1111/jcpe.13077] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 01/11/2019] [Accepted: 01/26/2019] [Indexed: 11/28/2022]
Abstract
AIM This 5 years retrospective cohort survival study compared failure rates of dental implants placed in HIV (+) and HIV (-) patients relative to several risk factors. MATERIALS AND METHODS Between 2006 and 2015, 484 implants placed in HIV (+) patients and 805 implants placed in HIV (-) patients were assessed for survival. The effects of HIV were estimated using propensity weighting. The effects of age, smoking status, diabetes, restoration status, gender, implant type, placement site, hepatitis C status, baseline CD4 count and CD4%, post-placement average CD4%, nadir CD4%, nadir CD4 count and antiviral therapy were analysed. RESULTS Implants placed in HIV (+) patients and HIV (-) patients had similar failure rates (HR = 1.4, p = 0.34). Increased failure rates were observed in HIV (+) patients with baseline CD4% ≤20 (HR = 2.72, p = 0.04), post-placement CD4% average ≤20% (HR = 2.71, p = 0.04), protease inhibitor administration (HR = 2.74, p = 0.04), smoking (HR = 2.61, p = 0.05) and anterior maxillary placement (HR = 5.82, p < 0.01). Hepatitis C coinfection, viral titre, baseline CD4 count, gender, implant type and restoration type were non-contributory. CONCLUSION Implants placed in HIV (+) patients had similar survival rates as HIV (-) patients. Failure rates increase significantly when confounding risk factors are present in HIV (+) patients.
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Affiliation(s)
- Ahmed Sabbah
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, San Antonio, Texas
| | - Jeffery Hicks
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, San Antonio, Texas
| | - Barbara MacNeill
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, San Antonio, Texas
| | - Antonio Arbona
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, San Antonio, Texas
| | - Alfonso Aguilera
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, San Antonio, Texas
| | - Qianqian Liu
- Department of Epidemiology and Biostatistics, School of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Jonathan Gelfond
- Department of Epidemiology and Biostatistics, School of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Wayne Gardner
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, San Antonio, Texas
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