1
|
Hjortholt CO, Andersen SWM, Jensen SS, Kofod T, Gotfredsen K. Dental implant treatment in patients with cancer on high-dose antiresorptive medication: A prospective feasibility study with 2 years follow-up. Clin Oral Implants Res 2024; 35:63-76. [PMID: 37873916 DOI: 10.1111/clr.14197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVES Dental implant treatment is considered contraindicated in patients with cancer on high-dose antiresorptive medication (HDAR). The aim of this prospective, feasibility study was to evaluate implant treatment in patients with cancer on HDAR, in terms of implant survival, implant success, and oral health-related quality of life (OHLQoL) after 2 years of loading. MATERIALS AND METHODS Implants were inserted in three groups of HDAR patients: (1) Previous tooth extraction, no medication-related osteonecrosis of the jaw (MRONJ), (2) Previous MRONJ, now healed, (3) Existing MRONJ, planned surgical resection. Implants were placed without adjunctive bone or soft tissue argumentation. Abutment operation was performed after ≥12 weeks. Prosthetic treatment was initiated ≥14 weeks. Survival and success rate were determined, and OHLQoL was analyzed with OHIP-49 and QLQ-H&N35 questionnaires. Patients were seen for 6 months, 1- and 2 years follow-up. RESULTS Twenty-two patients, 39 implants, completed the implant-based prosthetic treatment. Implant-supported crowns and overdentures were fabricated. Thirteen patients (59%) with 23 implants (59%) completed 2 years follow-up. Overall implant survival and success rate after 2 years of loading were 100% and 97.4%, respectively. OHLQoL for the patients increased in all groups after the treatment, a substantial increase was seen in group 3. Two patients developed MRONJ, but not related to the implant treatment. CONCLUSION Dental implant treatment, with high survival and success rate and increased post-treatment OHLQoL, is feasible in HDAR patients after 2 years of loading. Caution with general recommendations should be exercised.
Collapse
Affiliation(s)
- C O Hjortholt
- Department of Oral & Maxillofacial Surgery, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
- Research Area Oral Rehabilitation, Section for Oral Health, Society and Technology, Faculty of Health and Medical Sciences, Institute of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - S W M Andersen
- Department of Oral & Maxillofacial Surgery, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - S S Jensen
- Department of Oral & Maxillofacial Surgery, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
- Research Area Oral Surgery, Section for Oral Biology and Immunopathology, Institute of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - T Kofod
- Department of Oral & Maxillofacial Surgery, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - K Gotfredsen
- Research Area Oral Rehabilitation, Section for Oral Health, Society and Technology, Faculty of Health and Medical Sciences, Institute of Odontology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
D'Ambrosio F, Amato A, Chiacchio A, Sisalli L, Giordano F. Do Systemic Diseases and Medications Influence Dental Implant Osseointegration and Dental Implant Health? An Umbrella Review. Dent J (Basel) 2023; 11:146. [PMID: 37366669 DOI: 10.3390/dj11060146] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
The aim of this umbrella review is to evaluate what are the most common medications and systemic diseases that can affect bone-implant integration, the success rate and survival rate of dental implants, peri-implant tissue health, and implant loss. Systematic reviews, with meta-analysis or not, about how systemic diseases and medications influence dental implant osseointegration, survival rate, success rate, and peri-implant diseases, published only in the English language, are electronically searched across the most important scientific databases. The present umbrella review includes eight systematic reviews, and osteoporosis and diabetes are the most investigated pathologies. Systemic diseases, such as neurologic disorders, HIV, hypothyroidism, cardiovascular diseases, and drugs, such as beta blockers, anti-hypertensives, or diuretics do not show a decreased rate of implant osseointegration. It seems that drugs, such as proton-pump inhibitors (PPIs) or serotonin reuptake inhibitors (SSRIs), negatively affect implant osseointegration. Few studies compare the effects of drugs and systemic diseases on the parameters considered in this overview. It is important to underline how the results of this review need to be validated with subsequent and more reviews.
Collapse
Affiliation(s)
- Francesco D'Ambrosio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Alessandra Amato
- Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, 80138 Naples, Italy
| | - Andrea Chiacchio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Laura Sisalli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Francesco Giordano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| |
Collapse
|
3
|
Andersen SWM, Ottesen C, Gotfredsen K, Jensen SS, Kofod T, Schiodt M. Outcome of healing after dental implant placement in patients with cancer on high-dose antiresorptive medications: a prospective feasibility study. Oral Maxillofac Surg 2023; 27:89-100. [PMID: 35084584 DOI: 10.1007/s10006-022-01042-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Implant placement in patients with cancer receiving high-dose antiresorptive medication (HDAR) is considered contraindicated. This prospective, feasibility study tested the hypothesis that dental implants can be placed in such patients by applying a staged implant placement protocol with submerged healing. METHODS Three groups of patients on HDAR were included as follows: group 1: patients who underwent tooth extraction, without the development of medication-related osteonecrosis of the jaws (MRONJ); group 2: patients with surgically treated MRONJ who had demonstrated clinical healing for at least 3 months; group 3: patients with established MRONJ who was planned for surgical resection and simultaneous implant placement. RESULTS A total of 49 implants were placed in 27 patients (group 1: 12, group 2: 7 and group 3: 8). HDAR included bisphosphonates and denosumab. The mean HDAR time was 25 months (SD: ± 18.4, range 3-68 months). An abutment operation was performed 4 months following the implant placement (SD: ± 1.9, range 3-14 months). All patients healed uneventfully. CONCLUSIONS This study demonstrated that it is feasible to insert dental implants and perform an abutment surgery in patients with cancer on HDAR, without the development of MRONJ. CLINICALTRIALS gov Identifier: NCT04741906.
Collapse
Affiliation(s)
- Sanne Werner Møller Andersen
- Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Camilla Ottesen
- Department of Oral Rehabilitation, School of Dentistry, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Alle 20, 2200, Copenhagen N, Denmark
| | - Klaus Gotfredsen
- Department of Oral Rehabilitation, School of Dentistry, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Alle 20, 2200, Copenhagen N, Denmark
| | - Simon Storgård Jensen
- Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Oral Surgery, School of Dentistry, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Alle 20, 2200, Copenhagen N, Denmark
| | - Thomas Kofod
- Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Morten Schiodt
- Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| |
Collapse
|
4
|
Leonard JF, Taxel P, Kuo CL, Da Cunha Godoy L, Freilich M. Dental implant and bone augmentation treatment in bone-compromised patients: Oral health-related quality of life outcomes. J Prosthet Dent 2023:S0022-3913(23)00049-5. [PMID: 36804393 PMCID: PMC10435665 DOI: 10.1016/j.prosdent.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/21/2023]
Abstract
STATEMENT OF PROBLEM Patient-reported outcomes represent an additional and often overlooked measure of dental implant and bone augmentation treatment. Few implant studies have evaluated patient-reported outcomes in those with systemic bone compromise. PURPOSE The purpose of this cohort study was to assess oral health-related quality of life (OHRQoL) outcomes in postmenopausal women receiving dental implants with normal bone density or mild osteopenia ("healthy" group; all DXA T-scores at femoral neck, total hip, and L1-L4 spine>-2.0) versus moderate osteopenia or osteoporosis ("bone compromised" group; any DXA T-score at femoral neck, total hip, or L1-L4 spine≤-2.0). MATERIAL AND METHODS A total of 115 patients were recruited at the University of Connecticut School of Dental Medicine as part of a standard of care, prospective, nonrandomized cohort study. All participants received 1 of 3 bone augmentation procedures with implant placement. At baseline and at various intervals after implant placement, OHRQoL was measured by using the Oral Health Impact Profile-14 (OHIP-14) and surveys of patient expectations and satisfaction. These measures were compared between healthy and bone compromised groups (α=.05). RESULTS For all OHRQoL measures across linear mixed effects models, no significant differences were found between bone groups at baseline and at each time point after implant placement (P>.05). Using the minimally important difference (MID) for OHIP-14, no definitive clinical differences were found in patient outcomes between bone groups at all postimplant time points (P>.05). From baseline to 24 months after implant placement, both healthy and bone compromised groups exhibited significant improvements in OHIP-14 and patient expectations scores (P<.05). While no within group differences were found in patient satisfaction scores, the mean satisfaction score remained high over time in both groups. CONCLUSIONS Patient-reported outcomes as measured through OHIP-14, patient expectations, and patient satisfaction surveys suggest similar postimplant OHRQoL improvement in healthy and bone compromised individuals. OHRQoL improvements between bone groups were similar both in continuity and in scope, with no evidence of statistically significant score differences between groups at 24 months after implant placement across all measures and with no definitive evidence of clinical differences as measured by OHIP-14 MID comparisons across all timepoints.
Collapse
Affiliation(s)
- Jonathan F Leonard
- Predoctoral Dental Student, University of Connecticut School of Dental Medicine, Farmington, Conn.
| | - Pamela Taxel
- Professor, Division of Endocrinology and Metabolism, University of Connecticut School of Medicine, Farmington, Conn
| | - Chia-Ling Kuo
- Professor, Public Health Sciences, University of Connecticut School of Medicine, Farmington, Conn
| | | | - Martin Freilich
- Professor, Department of Reconstructive Sciences, University of Connecticut School of Dental Medicine, Farmington, Conn
| |
Collapse
|
5
|
Ottesen C, Andersen SW, Jensen SS, Kofod T, Gotfredsen K. Medication-related osteonecrosis of the jaw and successful implant treatment in a patient on high-dose antiresorptive medication: A case report. Clin Exp Dent Res 2022; 8:1059-1067. [PMID: 35894761 PMCID: PMC9562562 DOI: 10.1002/cre2.620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Oral rehabilitation can be a challenge in patients on high-dose antiresorptive medication (HDAR), especially if the alveolar anatomy has changed due to previous medication-related osteonecrosis of the jaw (MRONJ) resection. In healthy patients, dental implant treatment has found wide acceptance in prosthetic rehabilitation as it increases the patient's oral health-related quality of life. However, it is considered contraindicated in patients on HDAR due to the risk of MRONJ, although a recent feasibility study indicates that implant treatment may indeed be an option in these patients. The aim of the present case report is to illustrate the risk of MRONJ in a patient with cancer on HDAR and to discuss the reasons behind the outcomes of the implant treatment. MATERIALS AND METHODS A patient with prostate cancer with bone metastases on high-dose denosumab therapy with previous MRONJ had four implants inserted bilaterally in the maxilla (14, 13, 23, 24). Two identical implant-supported screw-retained cantilever bridges were fabricated. The patient was followed for more than 1 year. RESULTS AND CONCLUSION Peri-implantitis, and/or MRONJ, was diagnosed around two of the implants (23, 24), probably induced by crestal bone trauma from a healing abutment and/or a misfitting prosthetic reconstruction. A peri-implantitis operation was performed, but without the desired response, and the two implants (23, 24) were later removed in an MRONJ resection. The implants on the other side of the maxilla (14, 13) remained without complications. Dental implant treatment is feasible in patients on HDAR, but comorbidities (e.g., diabetes mellitus) and polypharmacy (e.g., chemotherapy and steroids) may add to the risk of implant failure. Minimal trauma surgery and prosthodontics are crucial to increase the chance of successful healing in an HDAR patient.
Collapse
Affiliation(s)
- Camilla Ottesen
- School of Dentistry, Section for Oral Health, Society and Technology, Institute of Odontology, Research Area Oral Rehabilitation, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Sanne W. M. Andersen
- Department of Oral & Maxillofacial SurgeryCopenhagen University HospitalCopenhagenDenmark
| | - Simon S. Jensen
- Department of Oral & Maxillofacial SurgeryCopenhagen University HospitalCopenhagenDenmark,Section for Oral Biology and Immunopathology, Institute of Odontology, Research Area Oral Surgery, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Thomas Kofod
- Department of Oral & Maxillofacial SurgeryCopenhagen University HospitalCopenhagenDenmark
| | - Klaus Gotfredsen
- School of Dentistry, Section for Oral Health, Society and Technology, Institute of Odontology, Research Area Oral Rehabilitation, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|
6
|
Stefos S, Kourtis S, Vrekoussis T, Augoulea A, Kalantaridou S. Quality of Life in Menopausal Women with Dental Restorations and Implants. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2203151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim:
This multicenter study examined the relationship, possible interactions, and intermittent effects that dental implants and prostheses can have on menopausal women’s quality of life as well as provided information regarding the possible side effects of therapeutic regimens on menopause and osteoporosis or osteopenia.
Materials and Methods:
Questionnaires consisted of selected quality of life questions based on specific and additional medical and dental (mainly prosthodontic) questions, which were administered to 100 Greek menopausal/post-menopausal women (Age: Mean Value=63,62 years old) with osteopenia or with or without osteoporosis, with dental implants and implant restorations, or conventional prosthetic restorations visiting two University Hospitals. Menopausal/post-menopausal status was judged on the basis of either secondary, definitive amenorrhoea or based on follicular stimulation hormone (FSH) values, estradiol, and clinical risk factors.
Results:
Participants had a statistically significantly better “functional” and “psychological” feeling after prosthodontic rehabilitation with and without implants. Three out of four reported that their dentist informed them of the possible implant problems that might arise from osteoporosis and its treatment (medications). Moreover, osteopenia was found to be associated with a very lower problem percentage. The bisphosphonate treatment had the highest rate (80%) of reported implant problems than non-bisphosphonate treatment (30%). The hormone replacement therapy (HRT) for menopause was reported to be more associated with problems in implant placement (19%) than in those without treatment (27.3%).
Conclusion:
The questionnaires revealed a significant improvement concerning women’s life quality and well-documented information about the problems their dental implants and restorations may cause in association with menopause and/or osteoporosis.
Collapse
|
7
|
Papadakis I, Spanou A, Kalyvas D. Success Rate and Safety of Dental Implantology in Patients Treated With Antiresorptive Medication: A Systematic Review. J ORAL IMPLANTOL 2021; 47:169-180. [PMID: 32663267 DOI: 10.1563/aaid-joi-d-19-00088] [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] [Indexed: 11/22/2022]
Abstract
There is no agreement of data on the subject of implant failure and the development of osteonecrosis in patients receiving antiresorptive agents. The purpose of this systematic review is to evaluate whether dental implants placed in patients on antiresorptive medication have an increased failure rate and whether the implant placement or the implant existence are risk factors for developing medication-related osteonecrosis of the jaw (MRONJ). An electronic search was conducted in PubMed/Medline, and all publications fulfilling the inclusion criteria were included. The search was completed by a hand research of the references cited in all electronic identified publications, resulting in 411 articles. Based on the inclusion criteria, 32 studies were included, with a total of 5221 patients, 12 751 implants, 618 cases of implants loss, and 136 cases of MRONJ analyzed. Because of the small number of studies, most of which were characterized by a low level of quality, it cannot be established that the use of antiresorptive medication affects dental implant survival rates. The risk of MRONJ as an early or late complication is also not well established. Therefore, successful dental implant procedures in patients receiving antiresorptive medication might be possible, but more studies need to be carried out in the future to verify this topic. Apart from intravenous antiresorptive drugs, which remain an absolute contraindication, the use of antiresorptive medication is not a contraindication to dental implantology, but it must be accompanied by careful treatment planning, informing patients about possible complications, and essential long follow-up periods.
Collapse
Affiliation(s)
- Ioannis Papadakis
- Department of Oral and Maxillofacial Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Spanou
- Department of Oral and Maxillofacial Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Demos Kalyvas
- Department of Oral and Maxillofacial Surgery, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
8
|
Quality of Life and Poor Oral Health: A Comparison of Postmenopausal Women. Dent J (Basel) 2016; 4:dj4040044. [PMID: 29563486 PMCID: PMC5806948 DOI: 10.3390/dj4040044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/14/2016] [Accepted: 11/16/2016] [Indexed: 11/25/2022] Open
Abstract
Inter-relationships between traditional dental variables are becoming more evident in far reaching aspects of life, such as psychosocial interaction, self-esteem, overall health and even occupational performance. This study compares quality of life (QoL) in postmenopausal women (PMW) with poor oral health (POH) with QoL in PMW with good oral health. A total of 200 randomly recruited PMW received a dental evaluation and completed the Utian Quality of Life Survey. The participants were divided into POH and healthy groups based on a dental exam. Mean scores were calculated for each QoL item, domain and the overall summary score. For each of the four parameters for periodontitis diagnosis, periodontitis b s patients’ QoL outcomes were compared to those of healthy patients using a T-test with a threshold of significance at p < 0.05. QoL in all fields measured was significantly poorer in the POH patients compared to the healthy patients: occupational score (19.95 ± 5.35 vs. 27.56 ± 6.13), health score (18.02 ± 8.23 vs. 26.59 ± 6.45), emotional score (15.68 ± 10.22 vs. 21.15 ± 9.15), sexual score (6.2 ± 5.98 vs. 10.02 ± 5.35), and total score (60.21 ± 25.85 vs. 84.26 ± 22.35). This study finds that PMW with POH report significantly poorer quality of life. Clinicians caring for PMW should be aware that oral health impacts QoL and make appropriate referral decisions for patients’ dental care.
Collapse
|
9
|
Dental implants in patients treated with antiresorptive medication - a systematic literature review. Int J Implant Dent 2016; 2:9. [PMID: 27747701 PMCID: PMC5005701 DOI: 10.1186/s40729-016-0041-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
Objective Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is triggered by inflammatory processes. Typical trigger factors are periodontal disease, denture pressure sores, and surgical interventions such as tooth extractions. Unfortunately there is only little data on how to proceed with implant therapy in patients with bisphosphonate treatment. This topic is not addressed in the German guidelines on medication-associated osteonecrosis. Therefore a systematic literature review was performed. Methods The PICO design was used: (Patients) For which subclientel of patients with antiresorptive therapy (intervention) do dental implants have a benefit (control) compared to forgoing dental implants (outcome) in regards to oral rehabilitation and quality of life without having a substantial risk of BP-ONJ development? A PubMed search was performed including all studies dealing with this topic. Case reports and studies with less than 5 cases were excluded. Results There is only very little data available, mostly retrospective case series. 50 articles were analyzed in detail. BP-ONJ can be triggered by dental implants and by dentures in patients with benign and malignant primary diseases. In most studies, analyzing osteoporosis patients only, no cases of BP-ONJ were observed in patients with implant therapy in the time span observed. There are no studies about implant therapy in patients with malignant diseases. Many case series analyzing the trigger factors for BP-ONJ describe dentures as one of the main causes. Perioperative antimicrobial prophylaxis has a benefit in the prevention of BP-ONJ development. Conclusion Successful implant therapy is possible in patients receiving antiresorptive therapy. The possibility of osteonecrosis development needs to be explained to the patient. An individual risk assessment is essential, taking the primary disease with the medication and further wound-healing-compromising diseases and medications into account. If possible, bone augmentations should be avoided, and a perioperative antimicrobiological prophylaxis is strongly recommended in these patients.
Collapse
|