Retrospective study of the success of dental implants placed in HIV-positive patients

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.

Current oral hygiene and recreational behavioral trends in HIV disease

OBJECTIVE

HIV disease is evolving with more HIV+ persons experiencing a high quality of life with well-controlled viremia. We recently enrolled a large cohort of HIV+ and clinically relevant HIV- persons for oral microbiome analyses that included a questionnaire related to oral hygiene and recreational behaviors. Here, the questionnaire responses were analyzed for behavioral trends within the cohort, together with trends over time by comparison to a previous geographically centered HIV+ cohort.

METHODS

Data were collected by questionnaire at baseline visits as cross-sectional assessments. Multivariable analyses were conducted for associations of HIV status as well as age, race, and sex, on oral hygiene/recreational behaviors.

RESULTS

HIV+ subjects had reduced brushing frequency, but increased incidence of past cleanings and frequency of dry mouth, compared to the HIV- subjects. Within the entire cohort, positive associations were identified between age and several oral hygiene practices, and between age, race, and sex for several recreational behaviors. In comparison to the historical cohort, the contemporary HIV+ cohort participated in fewer high-risk behaviors, but with similar trends for smoking and oral hygiene practices.

CONCLUSION

HIV status had little association with oral hygiene and recreational behaviors despite several differences in age, race, and sex. Behavioral trends over time support a higher quality of life in people currently living with HIV.

Dental implants in individuals living with HIV-1: Results from a prospective study in patients undergoing highly active antiretroviral therapy

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.

Longitudinal Study of Dental Implants in HIV-Positive Patients

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.

Prevalence of peri-implantitis in a sample of HIV-positive patients

OBJECTIVES

This study aimed to assess the prevalence of peri-implantitis in human immunodeficiency virus (HIV)-positive patients and the presence of a possible correlation between the immunological profile and serological values, of peri-implantitis, and of possible differences between all-on-4 and single crown/bridge prostheses.

SUBJECTS AND METHODS

This retrospective study included 58 adult HIV-positive patients (222 implants) with either all-in-4 prostheses or single crowns/bridges on at least one dental implant loaded for more than a year who were followed for 3 year (mean follow-up). Data pertaining to the probing pocket depth (PPD), bleeding on probing, and immunological and systemic profile were collected.

RESULTS

Patients with single crown/bridge implant rehabilitation showed higher prevalence of peri-implantitis (34%) than patients with all-on-4 rehabilitation (0%) (p = 0.012). Patients with all-on-4 rehabilitation were significantly older than those with single crowns/bridges (p = 0.004). Patients with peri-implantitis had implants for a significantly longer duration than those without (p = 0.001), implying that the probability of peri-implantitis increases as the age of implant increases.

CONCLUSIONS

The prevalence of peri-implantitis was 26% in the HIV-positive patients population. No correlation was found between patients' immunological and serological factors and peri-implantitis. The most important risk factor for peri-implantitis and mucositis was implant age.

Effects of platelet-rich fibrin combined with guided bone regeneration in the reconstruction of peri-implantitis bone defect

OBJECTIVE

To investigate the clinical effect of platelet-rich fibrin (PRF) combined with guided bone regeneration (GBR) in the reconstruction of peri-implantitis bone defect.

METHODS

This prospective study included 80 patients with peri-implantitis who underwent implant restoration in the Department of Stomatology in our hospital. The eligible patients were randomly divided into control group and observation group, with 40 cases in each group. Patients in the control group were treated with flap curettage combined with GBR, while those in the observation group received a mixture of PRF and bone powder implanted with GBR and covered with PRF biofilm. The differences of pain 24 hours after surgery, bleeding at 7 days after surgery, and the degree of bone defect between the two groups at 60 days after surgery were compared. At 60 days and 120 days after surgery, separately, the regenerated bone density of patients in the two groups was measured, analyzed and compared. The degree of regenerated bone defect in transverse and longitudinal directions after 60 days was compared between the two reconstruction procedures.

RESULTS

The pain at 24 hours after surgery and the bleeding at 7 days after surgery in the observation group were milder than those in the control group (P<0.001). There was significant difference in the degrees of bone defect at 60 days after surgery (P<0.05). Compared with the control group, the regenerated bone density of the observation group was significantly higher both at 60 days and 120 days after surgery (P<0.001).

CONCLUSION

The combination of PRF and GBR technology has an obvious effect in repairing bone defects in patients with peri-implantitis, and can reduce the pain of patients during the repair process.

Medically Complex Dental Implant Patients: Controversies About Systemic Disease and Dental Implant Success/Survival

Advances in dental implant therapy have created choices to enhance the expectations of dental practitioners and their patients with respect to oral rehabilitation at any age after childhood and regardless of, in most cases, medical disabilities. The medical status of the patient however can significantly influence the success rate of dental implant therapy. This article applies the hierarchy of scientific evidence ranging from case reports, retrospective, prospective cohort investigations, systematic reviews, and meta-analyses criteria in order to determine whether dental implant placement in medically compromised patients yields any detrimental sequelae.

Does HIV infection affect the survival of dental implants? A systematic review and meta-analysis

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.