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Samara W, Moztarzadeh O, Hauer L, Babuska V. Dental Implant Placement in Medically Compromised Patients: A Literature Review. Cureus 2024; 16:e54199. [PMID: 38496195 PMCID: PMC10942790 DOI: 10.7759/cureus.54199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
As a discipline of dentistry, oral implantology deals with the diagnosis, design, insertion, restoration, and/or management of alloplastic or autogenous oral structures for the purpose of regaining contour, function, aesthetics, and speech in a partially or completely edentulous patient. The present review aims to provide the currently available knowledge about the impact of certain systemic disorders and the usage of some medications on the survival rate of dental implant therapy and to highlight the importance of patient management under these conditions. Diabetes, osteoporosis, cardiovascular diseases, and the intake of some medications can increase the risk of the failure of a dental implant. Even though there are relatively few medical contraindications to dental implant treatment, certain conditions may increase the risk of failure or complications.
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Affiliation(s)
- Walla Samara
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Czech Republic, Pilsen, CZE
| | - Omid Moztarzadeh
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Czech Republic, Pilsen, CZE
- Department of Anatomy, Faculty of Medicine in Pilsen, Charles University, Czech Republic, Pilsen, CZE
| | - Lukas Hauer
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Czech Republic, Pilsen, CZE
| | - Vaclav Babuska
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine in Pilsen, Charles University, Czech Republic, Pilsen, CZE
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2
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Lemme NJ, Glasser JL, Yang DS, Testa EJ, Daniels AH, Antoci V. Chronic Obstructive Pulmonary Disease Associated with Prolonged Opiate Use, Increased Short-Term Complications, and the Need for Revision Surgery following Total Knee Arthroplasty. J Knee Surg 2023; 36:335-343. [PMID: 34530476 DOI: 10.1055/s-0041-1733883] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a condition which causes a substantial burden to patients, physicians, and the health care system at large. Medical comorbidities are commonly associated with adverse health outcomes in the postoperative period. Here, we present a large database review of patients undergoing total knee arthroplasty (TKA) to determine the effect of COPD on patient outcomes. The PearlDiver database was queried for all patients who underwent TKA between 2007 and the first quarter of 2017. Medical complications, surgical complications, 30-day readmission rates, revision rates, and opioid utilization were assessed at various intervals following TKA among patients with and without COPD. Multivariable regression was used to calculate adjusted odds ratios controlling for age, sex, and medical comorbidities. A total of 46,769 TKA patients with COPD and 120,177 TKA patients without COPD were studied. TKA patients with COPD experienced increased risk of 30-day readmission (40.8% vs. 32.2%, p < 0.0001), 30-day total medical complications (10.2% vs. 7.0%, p < 0.0001), prosthesis explanation at 6 months (0.4% vs. 0.2, p = 0.0130), 1 year (0.6% vs. 0.3%, p = 0.0005), and 2 years (0.8% vs. 0.5%, p = 0.0003), as well as an increased rate of revision (p < 0.0046) compared to TKA patients without COPD. Opioid utilization of TKA patients with COPD was greater significantly than that of TKA patients without COPD at 3, 6, and 12 months. Patients with COPD have an increased risk for medical and surgical complications, readmission, and prolonged opioid use following TKA.
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Affiliation(s)
- Nicholas J Lemme
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jillian Lynn Glasser
- Department of Adult Reconstruction, University Orthopedics, East Providence, Rhode Island
| | - Daniel S Yang
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Edward J Testa
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Spine Surgery, University Orthopedics, East Providence, Rhode Island
| | - Valentin Antoci
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Adult Reconstruction, University Orthopedics, East Providence, Rhode Island
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Burtscher D, Dalla Torre D. Dental implant procedures in immunosuppressed organ transplant patients: a systematic review. Int J Oral Maxillofac Surg 2021; 51:380-387. [PMID: 34274207 DOI: 10.1016/j.ijom.2021.06.008] [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: 01/22/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- D Burtscher
- University Clinic of Prosthodontics, Medical University Innsbruck, Innsbruck, Austria.
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KARADUMAN U, KARADUMAN B, ÇELİK İ, GÜRSEL M. The Effects of Cyclosporine and Tacrolimus on Gingiva and Alveolar Bone of Rats. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.835833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mahri M, Shen N, Berrizbeitia F, Rodan R, Daer A, Faigan M, Taqi D, Wu KY, Ahmadi M, Ducret M, Emami E, Tamimi F. Osseointegration Pharmacology: A Systematic Mapping Using Artificial Intelligence. Acta Biomater 2021; 119:284-302. [PMID: 33181361 DOI: 10.1016/j.actbio.2020.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/25/2022]
Abstract
Clinical performance of osseointegrated implants could be compromised by the medications taken by patients. The effect of a specific medication on osseointegration can be easily investigated using traditional systematic reviews. However, assessment of all known medications requires the use of evidence mapping methods. These methods allow assessment of complex questions, but they are very resource intensive when done manually. The objective of this study was to develop a machine learning algorithm to automatically map the literature assessing the effect of medications on osseointegration. Datasets of articles classified manually were used to train a machine-learning algorithm based on Support Vector Machines. The algorithm was then validated and used to screen 599,604 articles identified with an extremely sensitive search strategy. The algorithm included 281 relevant articles that described the effect of 31 different drugs on osseointegration. This approach achieved an accuracy of 95%, and compared to manual screening, it reduced the workload by 93%. The systematic mapping revealed that the treatment outcomes of osseointegrated medical devices could be influenced by drugs affecting homeostasis, inflammation, cell proliferation and bone remodeling. The effect of all known medications on the performance of osseointegrated medical devices can be assessed using evidence mappings executed with highly accurate machine learning algorithms.
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Dental Implant Failure Rate and Marginal Bone Loss in Transplanted Patients: A Systematic Review and Meta-Analysis. TRANSPLANTOLOGY 2020. [DOI: 10.3390/transplantology1020008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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James M, Matani J, Shahdad S. Prosthetic Rehabilitation of a Patient Diagnosed With Sarcoidosis Using Dental Implants: A Clinical Case Report. J ORAL IMPLANTOL 2020; 46:235-243. [PMID: 32582920 DOI: 10.1563/aaid-joi-d-18-00309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
No previously published studies have reported on the placement and restoration of dental implants in a patient diagnosed with sarcoidosis. Patients with sarcoidosis may develop periodontitis as a manifestation of systemic disease and are therefore at increased risk of tooth loss. These patients are likely to want fixed dental prostheses, which may need to be supported by dental implants. The case presented is that of a 31-year-old female patient presenting with a missing maxillary central incisor and a sarcoidal process affecting the anterior maxilla, which had severely compromised the periodontium of the adjacent lateral incisor. The patient was successfully rehabilitated with an implant-retained prosthesis following a staged horizontal and vertical bone augmentation procedure. At the 4-year review, the implant restoration performed well with stable peri-implant bone levels. We conclude that dental implant rehabilitation in patients with sarcoidosis may be a predictable treatment option, depending on disease stability and concurrent systemic therapy, but these patients will require additional maintenance because of the possibility of an increased risk of peri-implantitis. The effects of sarcoidosis and its management on the success of dental implants are discussed to aid treatment planning for such patients.
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Affiliation(s)
- Martin James
- University Dental Hospital of Manchester, Manchester Universities NHS Foundation Trust, Manchester, United Kingdom
| | - Jay Matani
- Royal London Dental Hospital, Bart's Health NHS Trust, London, United Kingdom
| | - Shakeel Shahdad
- Royal London Dental Hospital, Bart's Health NHS Trust, London, United Kingdom
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Osseointegration of Dental Implants in Organ Transplant Patients Undergoing Chronic Immunosuppressive Therapy. IMPLANT DENT 2019; 28:447-454. [DOI: 10.1097/id.0000000000000916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hernández G, Paredes V, López-Pintor RM, de Andrés A, de Vicente JC, Sanz M. Implant treatment in immunosuppressed renal transplant patients: A prospective case-controlled study. Clin Oral Implants Res 2019; 30:524-530. [PMID: 30980770 DOI: 10.1111/clr.13437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Gonzalo Hernández
- Department of Dental Clinical Specialties, School of Dentistry, Complutense University, Madrid, Spain
| | - Víctor Paredes
- Department of Dental Clinical Specialties, School of Dentistry, Complutense University, Madrid, Spain
| | - Rosa María López-Pintor
- Department of Dental Clinical Specialties, School of Dentistry, Complutense University, Madrid, Spain
| | - Amado de Andrés
- Department of Nephrology, Hospital 12 de octubre, Madrid, Spain
| | - Juan Carlos de Vicente
- Department of Oral and Maxillofacial Surgery, Hospital of Asturias, School of Medicine and Dentistry, Oviedo University, Oviedo, Spain
| | - Mariano Sanz
- Department of Dental Clinical Specialties, School of Dentistry, Complutense University, Madrid, Spain
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Abu Nada L, Al Subaie A, Mansour A, Wu X, Abdallah M, Al‐Waeli H, Ersheidat A, Stone LS, Murshed M, Tamimi F. The antidepressant drug, sertraline, hinders bone healing and osseointegration in rats’ tibiae. J Clin Periodontol 2018; 45:1485-1497. [DOI: 10.1111/jcpe.13015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 08/16/2018] [Accepted: 09/30/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Lina Abu Nada
- Faculty of DentistryMcGill University Montreal Quebec Canada
| | - Ahmed Al Subaie
- Faculty of DentistryMcGill University Montreal Quebec Canada
| | - Alaa Mansour
- Faculty of DentistryMcGill University Montreal Quebec Canada
| | - Xixi Wu
- Faculty of DentistryMcGill University Montreal Quebec Canada
| | - Mohamed‐Nur Abdallah
- Faculty of DentistryMcGill University Montreal Quebec Canada
- Faculty of DentistryUniversity of Toronto Toronto Ontario Canada
| | - Haider Al‐Waeli
- Faculty of DentistryMcGill University Montreal Quebec Canada
| | - Ala’ Ersheidat
- Faculty of DentistryMcGill University Montreal Quebec Canada
| | - Laura S. Stone
- Faculty of DentistryMcGill University Montreal Quebec Canada
- Alan Edwards Center for Research on PainMcGill University Montreal Quebec Canada
| | - Monzur Murshed
- Faculty of DentistryMcGill University Montreal Quebec Canada
- Faculty of MedicineMcGill University Montreal Quebec Canada
- Genetics UnitShriners Hospital for Children Montreal Quebec Canada
| | - Faleh Tamimi
- Faculty of DentistryMcGill University Montreal Quebec Canada
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Ozcan-Kucuk A, Alan H, Gul M, Yolcu U. Evaluating the Effect of Resveratrol on the Healing of Extraction Sockets in Cyclosporine A-Treated Rats. J Oral Maxillofac Surg 2018; 76:1404-1413. [PMID: 29605535 DOI: 10.1016/j.joms.2018.02.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/02/2018] [Accepted: 02/27/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE The objective of this study was to investigate the effects of resveratrol on alveolar socket healing after tooth extraction in normal and cyclosporin A (CsA)-treated rats. MATERIALS AND METHODS Seventy-two female Sprague-Dawley rats were separated into 4 groups of 18. Group 1 was injected with a placebo solution intraperitoneally. Group 2 was injected with resveratrol (10 μmol/kg) intraperitoneally. Groups 3 and 4 were injected with CsA (10 mg/kg) subcutaneously for 8 days once daily before tooth extraction. Next, the teeth were extracted and CsA injection continued until the animals were sacrificed. Eight days after commencing the CsA injections, group 4 was injected with resveratrol while continuing with CsA injections. Nine rats from each group were sacrificed on days 14 and 28, and sections were examined to assess the degree of inflammation, formation of connective tissue, and new bone formation. Immunohistochemical analysis was used to evaluate the alveolar socket healing process using osteocalcin and osteopontin markers. A P value less than .05 was considered significant. RESULTS There was more new bone formation in group 2 than in the other 3 groups on day 14 after tooth extraction (P < .05), and there was more new bone formation in group 2 than in groups 3 and 4 on day 28 after extraction (P < .05). Based on the immunohistochemical assessment, the amount of osteocalcin and osteopontin labeling was greater in group 2 compared with the other 3 groups on day 14 (P < .05); however, on day 28 after extraction, it was greater in group 4 compared with group 3 (P < .05). CONCLUSIONS Resveratrol improves alveolar socket healing in normal and CsA-treated rats. Resveratrol also increases levels of osteocalcin and osteopontin in normal and CsA-treated rats. These results suggest that this natural compound is useful for alveolar socket healing after tooth extraction.
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Affiliation(s)
- Ayse Ozcan-Kucuk
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mersin University, Mersin, Turkey.
| | - Hilal Alan
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Inonu University, Malatya, Turkey
| | - Mehmet Gul
- Professor, Department of Histology and Embryology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Umit Yolcu
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Inonu University, Malatya, Turkey
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Matheus HR, Ervolino E, Faleiros PL, Novaes VCN, Theodoro LH, Garcia VG, de Almeida JM. Cisplatin chemotherapy impairs the peri-implant bone repair around titanium implants: An in vivo study in rats. J Clin Periodontol 2017; 45:241-252. [PMID: 28965362 DOI: 10.1111/jcpe.12824] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/15/2022]
Abstract
AIM The purpose of this study in animals was to evaluate the peri-implant bone repair against systemic administration of the antineoplastic agent. MATERIAL AND METHODS We used 84 male rats (Rattus norvegicus, albinus, Wistar), divided into two groups: cisplatin (CIS) and saline solution (SS). The titanium implants were inserted into the right tibia at day 0 in all animals from both groups. Group SS received SS intraperitoneally at 15 and 17 days postoperatively. Group CIS received 5 and 2.5 mg/kg of CIS intraperitoneally at 15 and 17 days postoperatively, respectively. Euthanasia was performed at 22, 30 and 60 days postoperatively. Twenty-four undecalcified specimens were prepared for histometric analysis of bone/implant contact (BIC). Sixty specimens were selected to bone area (BA) measurement, histological analysis and immunohistochemical analysis of RUNX-2, osteocalcin (OCN) and tartrate-resistant acid phosphatase (TRAP). BIC and BA were considered to be the primary outcome parameters. RESULTS Group CIS showed lower BIC (11.87 ± 0.97 mm; 19.19 ± 0.8 mm; 17.69 ± 1.05 mm; p ≤ .05) and BA (3.68 ± 1.29 mm2 ; 3.05 ± 0.88 mm2 ; 3.23 ± 0.67 mm2 ; p ≤ .05), as well as decreased number of RUNX-2 (102.8 ± 27.35 cells/mm2 ; 100.04 ± 8.61 cells/mm2 ; 118.82 ± 21.38 cells/mm2 ; p ≤ .05)- and OCN-positive cells (120 ± 24.5 cells/mm2 ; 102 ± 27.73 cells/mm2 ; 100 ± 14.23 cells/mm2 ; p ≤ .05) at 22, 30 and 60 days, respectively. The animals in group CIS also showed increased number of TRAP-positive cells (86.8 ± 6.37 cells/mm2 ; 71.5 ± 4.72 cells/mm2 ; 92.8 ± 9.52 cells/mm2 ; p ≤ .05) and a persistent and exacerbated inflammatory response in all experimental periods. CONCLUSION Within the limits of this study, it was concluded that the chemotherapeutic CIS negatively affects the bone repair at peri-implant areas, jeopardizing the osseointegration of titanium implants.
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Affiliation(s)
- Henrique Rinaldi Matheus
- Department of Surgery and Integrated Clinic-Periodontics Division, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
| | - Edilson Ervolino
- Department of Basic Science, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
| | - Paula Lazilha Faleiros
- Department of Surgery and Integrated Clinic-Periodontics Division, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
| | - Vivian Cristina Noronha Novaes
- Department of Surgery and Integrated Clinic-Periodontics Division, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
| | - Leticia Helena Theodoro
- Department of Surgery and Integrated Clinic-Periodontics Division, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
| | - Valdir Gouveia Garcia
- Department of Surgery and Integrated Clinic-Periodontics Division, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
| | - Juliano Milanezi de Almeida
- Department of Surgery and Integrated Clinic-Periodontics Division, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
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Paredes V, López-Pintor RM, Torres J, de Vicente JC, Sanz M, Hernández G. Implant treatment in pharmacologically immunosuppressed liver transplant patients: A prospective-controlled study. Clin Oral Implants Res 2017; 29:28-35. [DOI: 10.1111/clr.13035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Víctor Paredes
- Department of Oral Medicine and Surgery; School of Dentistry; Complutense University; Madrid Spain
| | - Rosa María López-Pintor
- Department of Oral Medicine and Surgery; School of Dentistry; Complutense University; Madrid Spain
| | - Jesús Torres
- Department of Oral Medicine and Surgery; School of Dentistry; Complutense University; Madrid Spain
| | - Juan Carlos de Vicente
- Department of Oral and Maxillofacial Surgery; University Hospital of Asturias; School of Medicine and Dentistry; Oviedo Spain
| | - Mariano Sanz
- Department of Oral Medicine and Surgery; School of Dentistry; Complutense University; Madrid Spain
| | - Gonzalo Hernández
- Department of Oral Medicine and Surgery; School of Dentistry; Complutense University; Madrid Spain
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The Use of Dental Implants in Organ Transplant Patients Undergoing Immunosuppressive Therapy: An Overview of Publications. IMPLANT DENT 2017; 25:541-6. [PMID: 27002776 DOI: 10.1097/id.0000000000000417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Immunosuppressive treatment has been commonly considered a contraindication to the use of dental implants. This article is aimed at analyzing the publications related to that issue and answering the question of whether such treatment is viable in patients with organ transplants. MATERIALS AND METHODS The following databases have been searched to find related publications: Clinical Key, Web of Science, Up to date, PubMed, and Medline. Full research paper texts published over the past 15 years have been taken into consideration. The selected publications were divided depending on the type of study material, that is, whether they focused on animal tests or human tests. RESULTS The studies performed on animals showed negative impact of immunosuppression on the bones surrounding the implants. Publications presenting clinical cases of organ transplant patients indicated no significant disorders in the process of implant osseointegration despite the use of immunosuppressive drugs. CONCLUSIONS Despite the negative impact of immunosuppressive drugs on the process of bone healing, it is possible to treat organ transplant patients with intraosseous titanium implants. The key to success is the observance of appropriate treatment procedures and proper hygienic routines. An alteration of medication regimen that currently makes use of immunosuppressive drugs of much lower toxicity is also extremely significant.
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15
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de Molon RS, Sakakura CE, Faeda RS, Sartori R, Palhares D, Margonar R, Marcantonio E. Effect of the long-term administration of Cyclosporine A on bone healing around osseointegrated titanium implants: A histomorphometric study in the rabbit tibia. Microsc Res Tech 2017; 80:1000-1008. [DOI: 10.1002/jemt.22894] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/12/2017] [Accepted: 05/06/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Rafael Scaf de Molon
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara; Sao Paulo State University - UNESP; Araraquara SP Brazil
- Department of Rheumatology; Rheumatology Research and Advanced Therapeutics, Radboud University Nijmegen Medical Centre; 6500 HB Nijmegen The Netherlands
| | - Celso Eduardo Sakakura
- Department of Periodontology; Barretos Dental School, Education Foundation of Barretos - FEB; Barretos SP Brazil
| | - Rafael Silveira Faeda
- Department of Health Sciences; Implantology Post Graduation Course, University Center of Araraquara - UNIARA Dental School; SP Brazil
| | - Rafael Sartori
- Department of Dentistry; Ponta Grossa State University; Ponta Grossa Paraná Brazil
| | - Daniel Palhares
- Department of Periodontology; Barretos Dental School, Education Foundation of Barretos - FEB; Barretos SP Brazil
| | - Rogerio Margonar
- Department of Health Sciences; Implantology Post Graduation Course, University Center of Araraquara - UNIARA Dental School; SP Brazil
| | - Elcio Marcantonio
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara; Sao Paulo State University - UNESP; Araraquara SP Brazil
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16
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Zheng X, Mo A, Wang Y, Guo Y, Wu Y, Yuan Q. Effect of FK-506 (tacrolimus) therapy on bone healing of titanium implants: a histometric and biomechanical study in mice. Eur J Oral Sci 2016; 125:28-33. [PMID: 27935130 DOI: 10.1111/eos.12320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Xiaofei Zheng
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
- Dental Implant Center; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Anchun Mo
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
- Dental Implant Center; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Yuan Wang
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
- Dental Implant Center; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Yuchen Guo
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
- Dental Implant Center; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Yunshu Wu
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
- Dental Implant Center; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Quan Yuan
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
- Dental Implant Center; West China Hospital of Stomatology; Sichuan University; Chengdu China
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Abstract
Several systemic diseases (and relative medications) have been reported to impair or in some cases complicate dental implant surgery. In broader terms, when dealing with patients suffering from systemic diseases, the monitoring of the medical condition and of the related post-operative complications is of great importance in order to avoid risks which could jeopardise the health of the patient. In this review, the available evidence on implant survival/success, as well as relevant surgical recommendations in patients affected by systemic diseases, are evaluated and when possible, practical suggestions for the clinician are provided.
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Nakagawa A, Shitara N, Ayukawa Y, Koyano K, Nishimura K. Implant treatment followed by living donor lung transplant: A follow-up case report. J Prosthodont Res 2014; 58:127-31. [DOI: 10.1016/j.jpor.2013.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/08/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
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Montebugnoli L, Venturi M, Cervellati F, Servidio D, Vocale C, Pagan F, Landini MP, Magnani G, Sambri V. Peri-Implant Response and Microflora in Organ Transplant Patients 1 Year after Prosthetic Loading: A Prospective Controlled Study. Clin Implant Dent Relat Res 2014; 17:972-82. [DOI: 10.1111/cid.12207] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Lucio Montebugnoli
- Section of Oral Science; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Mattia Venturi
- Section of Oral Science; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Fabio Cervellati
- Section of Oral Science; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Dora Servidio
- Section of Oral Science; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Caterina Vocale
- Unit of Microbiology; Regional Reference Centre for Microbiological Emergencies; St. Orsola Malpighi University Hospital; Bologna Italy
| | - Flavia Pagan
- Unit of Microbiology; Regional Reference Centre for Microbiological Emergencies; St. Orsola Malpighi University Hospital; Bologna Italy
| | - Maria Paola Landini
- Unit of Microbiology; Regional Reference Centre for Microbiological Emergencies; St. Orsola Malpighi University Hospital; Bologna Italy
| | - Gaia Magnani
- Cardiovascular Department; University of Bologna; Bologna Italy
| | - Vittorio Sambri
- Unit of Clinical Microbiology; The Hub Laboratory of the Greater Romagna Area; Pievesestina Cesena Italy
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Thoma DS, Martin IS, Mühlemann S, Jung RE. Systematic review of pre-clinical models assessing implant integration in locally compromised sites and/or systemically compromised animals. J Clin Periodontol 2012; 39 Suppl 12:37-62. [PMID: 22533946 DOI: 10.1111/j.1600-051x.2011.01833.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim was to systematically search the dental literature for pre-clinical models assessing implant integration in locally compromised sites (part 1) and systemically compromised animals (part 2), and to evaluate the quality of reporting of included publications. METHODS A Medline search (1966-2011) was performed, complimented by additional hand searching. The quality of reporting of the included publications was evaluated using the 20 items of the ARRIVE (Animals in Research In Vivo Experiments) guidelines. RESULTS One-hundred and seventy-six (part 1; mean ARRIVE score = 15.6 ± 2.4) and 104 (part 2; 16.2 ± 1.9) studies met the inclusion criteria. The overall mean score for all included studies amounted to 15.8 ± 2.2. Housing (38.3%), allocation of animals (37.9%), numbers analysed (50%) and adverse events (51.4%) of the ARRIVE guidelines were the least reported. Statistically significant differences in mean ARRIVE scores were found depending on the publication date (p < 0.05), with the highest score of 16.7 ± 1.6 for studies published within the last 2 years. CONCLUSIONS A large number of studies met the inclusion criteria. The ARRIVE scores revealed heterogeneity and missing information for selected items in more than 50% of the publications. The quality of reporting shifted towards better-reported pre-clinical trials within recent years.
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Affiliation(s)
- Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland.
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21
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Gu L, Yu YC. Clinical Outcome of Dental Implants Placed in Liver Transplant Recipients After 3 Years: A Case Series. Transplant Proc 2011; 43:2678-82. [DOI: 10.1016/j.transproceed.2011.06.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Revised: 05/05/2011] [Accepted: 06/03/2011] [Indexed: 01/13/2023]
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22
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El Hadary AA, Yassin HH, Mekhemer ST, Holmes JC, Grootveld M. Evaluation of the Effect of Ozonated Plant Oils on the Quality of Osseointegration of Dental Implants Under the Influence of Cyclosporin A: An In Vivo Study. J ORAL IMPLANTOL 2011; 37:247-57. [DOI: 10.1563/aaid-joi-d-09-00098] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
Immunosuppressive agents have been recognized as factors that induce changes and modifications in bone metabolism. The purpose of this study was to evaluate the effect of ozonated plant extracts (herein termed ozonated oil) under the influence of Cyclosporin A (CsA) on osseointegration. A total of 20 dental implants were placed in 20 rabbit tibiae assigned to Group A or B. CsA was injected at an immunosuppressive dose in Groups A and B as a single-dose treatment. At the day of surgery, Group A received a single topical ozonated oil treatment (0.55 mL) around dental implants; Group B, the control group, received no ozonated oil. Animals were sacrificed after 8 weeks. Radiographs were obtained at implant surgery and on the day of sacrifice. Bone quality was compared between the 2 groups. Radiographically, osseointegration was microscopically evaluated using scanning electron and light microscopies. In ozonated Group A specimens, light microscopic examination demonstrated evidence of more organized mature bone compared with Group B. Within the limits of this study, the results suggest that short-term administration of CsA, when administered with topical ozonated oil, may influence bone density and the quality of dental implant osseointegration. Therefore, topically applied ozonated oil may influence bone density and the quality of osseointegration around dental implants.
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Affiliation(s)
- Amany A. El Hadary
- Department of Prosthodontics, Faculty of Dentistry, October 6 University, Egypt
| | - Hala H. Yassin
- Department of Oral Medicine & Periodontology, Faculty of Dentistry, Pharos University, Egypt
| | - Sameh T. Mekhemer
- Department of Oral & Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| | | | - Martin Grootveld
- Chemical Pathology and Biomedical Materials, Centre for Materials Research and Innovation, University of Bolton, UK
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Carvas JSB, Pereira RMR, Caparbo VF, Fuller P, Silveira CA, Lima LAP, Bonfa E, Mello SBV. A single dose of zoledronic acid reverses the deleterious effects of glucocorticoids on titanium implant osseointegration. Osteoporos Int 2010; 21:1723-9. [PMID: 19997905 DOI: 10.1007/s00198-009-1125-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 10/26/2009] [Indexed: 11/25/2022]
Abstract
UNLABELLED This study evaluates the effect of zoledronic acid (ZOL) on the osseointegration of titanium implants in rabbits with glucocorticoid (GC)-induced bone loss, and our findings demonstrated that a single dose of ZOL is able to reverse the detrimental effects of GCs on the osseointegration of titanium implants. INTRODUCTION The purpose of this study is to evaluate the effect of ZOL on the osseointegration of titanium implants in rabbits with GC-induced bone loss. METHODS Three groups of six NZW rabbits were treated for 18 weeks with saline (SALINE), GC (methylprednisolone, 0.35 mg/kg three times a week), or GC + ZOL (methylprednisolone + single dose of ZOL, 0.1 mg/kg). The animals received a titanium implant in the left tibia after 6 weeks and were killed at the 18th week. Bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry at baseline, eighth week (W8), and 18th week (W18) after treatment to determine the change upon treatment (BMD). Histomorphometric and serum bone alkaline phosphatase analysis (BAP) were also performed. RESULTS At W8, GC group had a significant reduction in lumbar spine and tibia BMD compared with SALINE (p = 0.003 and p = 0.000), as also observed for GC + ZOL group (p = 0.014 and p = 0.003) just 2 weeks after ZOL treatment. In contrast, at W18, the GC + ZOL had an evident BMD rescue with similar lumbar spine and tibia BMD compared with SALINE (0.043 +/- 0.006 vs. 0.055 +/- 0.009 g/cm(2), p = 0.457 and 0.027 +/- 0.003 vs. 0.041 +/- 0.011 g/cm(2), p = 0.232) and a significantly higher BMD compared with the GC (p = 0.024 and p = 0.001). Histomorphometry revealed that osseointegration was significantly reduced in GC (tibia cortical thickness and diameter, bone-implant contact, total and peri-implant bone area) whereas GC + ZOL had these parameters similar to SALINE (p > 0.05). Likewise, ZOL reversed the BAP alteration induced by GC. CONCLUSIONS Our findings demonstrated that a single dose of ZOL is able to reverse the detrimental effects of glucocorticoids on the osseointegration of titanium implants, suggesting that ZOL therapy may improve the outcome of bone implants in patients with glucocorticoid-induced osteoporosis.
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Affiliation(s)
- J S B Carvas
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3 masculine andar, Reumatologia, São Paulo, SP, 0124-6903, Brazil
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Gomoll AH, Madry H, Knutsen G, van Dijk N, Seil R, Brittberg M, Kon E. The subchondral bone in articular cartilage repair: current problems in the surgical management. Knee Surg Sports Traumatol Arthrosc 2010; 18:434-47. [PMID: 20130833 PMCID: PMC2839476 DOI: 10.1007/s00167-010-1072-x] [Citation(s) in RCA: 246] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 01/15/2010] [Indexed: 12/24/2022]
Abstract
As the understanding of interactions between articular cartilage and subchondral bone continues to evolve, increased attention is being directed at treatment options for the entire osteochondral unit, rather than focusing on the articular surface only. It is becoming apparent that without support from an intact subchondral bed, any treatment of the surface chondral lesion is likely to fail. This article reviews issues affecting the entire osteochondral unit, such as subchondral changes after marrow-stimulation techniques and meniscectomy or large osteochondral defects created by prosthetic resurfacing techniques. Also discussed are surgical techniques designed to address these issues, including the use of osteochondral allografts, autologous bone grafting, next generation cell-based implants, as well as strategies after failed subchondral repair and problems specific to the ankle joint. Lastly, since this area remains in constant evolution, the requirements for prospective studies needed to evaluate these emerging technologies will be reviewed.
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Affiliation(s)
- Andreas H Gomoll
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA 02467, USA.
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25
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Patient Medical History for Dental Implant Surgery. IMPLANT DENT 2010. [DOI: 10.1016/b978-0-323-05566-6.00003-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Katranji A, Fotek P, Wang HL. Sinus Augmentation Complications: Etiology and Treatment. IMPLANT DENT 2008; 17:339-49. [DOI: 10.1097/id.0b013e3181815660] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Abstract
The literature contains numerous observations on the significance of systemic disorders as contraindications to dental endosseous implant treatment, but the justification for these statements is often apparently allegorical. Although implants are increasingly used in healthy patients, their appropriateness in medically compromised patients is less equivocal. Perhaps surprisingly, the evidence of their efficacy in these groups of patients is quite sparse. Indeed, there are few if any randomized controlled trials (RCTs) in this field. Furthermore, any health risks from the placement of implants are unclear. We review the current evidence for the risks associated with endosseous implants in a range of systemic disorders. There is clearly a need for prospective systematic trials. The degree of disease-control may be far more important that the nature of the disorder itself, and individualized assessment, including the medical condition, quality of life and life expectancy is indicated. The benefits of implants to many of these patients may outweigh any risks. However, proper informed consent is mandatory.
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Affiliation(s)
- C Scully
- Eastman Dental Institute, University College London, London, UK.
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Spolidorio LC, Marcantonio E, Spolidorio DMP, Nassar CA, Nassar PO, Marcantonio RA, Rossa C. Alendronate therapy in cyclosporine-induced alveolar bone loss in rats. J Periodontal Res 2007; 42:466-73. [PMID: 17760825 DOI: 10.1111/j.1600-0765.2007.00970.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Cyclosporine A is an immunosuppressive drug that is widely used in organ transplant patients as well as to treat a number of autoimmune conditions. Bone loss is reported as a significant side-effect of cyclosporine A use because this can result in serious morbidity of the patients. As we have shown that cyclosporine A-associated bone loss can also affect the alveolar bone, the purpose of this study was to evaluate the effect of the concomitant administration of alendronate on alveolar bone loss in a rat model. MATERIAL AND METHODS Forty Wistar rats (10 per group) were given cyclosporine A (10 mg/kg, daily), alendronate (0.3 mg/kg, weekly), or both cyclosporine A and alendronate, for 60 d. The control group received daily injections of sterile saline. The expression of proteins associated with bone turnover, including osteocalcin, alkaline phosphatase and tartrate-resistant acid phosphatase (TRAP), and also the calcium levels, were evaluated in the serum. Analysis of the bone volume, alveolar bone surface, the number of osteoblasts per bone surface and the number of osteoclasts per bone surface around the lower first molars was also performed. RESULTS The results indicate that cyclosporine A treatment was associated with bone resorption, represented by a decrease in the bone volume, alveolar bone surface and the number of osteoblasts per bone surface and by an increase in the number of osteoclasts per bone surface and TRAP-5b. These effects were effectively counteracted by concomitant alendronate administration. CONCLUSION It is concluded that concomitant administration of alendronate can prevent cyclosporine A-associated alveolar bone loss.
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Affiliation(s)
- L C Spolidorio
- Department of Physiology and Pathology, Dental School of Araraquara, State University of São Paulo (UNESP), Araraquara, São Paulo, Brazil.
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Lu SY, Huang CC. Resolution of an Active Peri-Implantitis in a Chronic Steroid User by Bone Augmentation With PepGen P-15 and a Barrier Membrane. J ORAL IMPLANTOL 2007; 33:280-7. [DOI: 10.1563/1548-1336(2007)33[280:roaapi]2.0.co;2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Borsari V, Fini M, Giavaresi G, Rimondini L, Consolo U, Chiusoli L, Salito A, Volpert A, Chiesa R, Giardino R. Osteointegration of titanium and hydroxyapatite rough surfaces in healthy and compromised cortical and trabecular bone: in vivo comparative study on young, aged, and estrogen-deficient sheep. J Orthop Res 2007; 25:1250-60. [PMID: 17474132 DOI: 10.1002/jor.20413] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The osteointegration rate of titanium (Ti; TI01) and duplex Ti plus HA (HT01) coating systems with high surface roughness was investigated in healthy, aged, and oestrogen-deficient sheep. After having evaluated the bone quality, TI01 and HT01 rods were implanted in the tibial diaphyses (two implants for each tibia) and epiphyses (1 implant for each tibia) of five young (YOUNG), five aged (AGED), and five aged and ovariectomized (OVX) sheep. The iliac crest trabecular bone volume (BV/TV) and number (Tb.N) in OVX sheep were respectively 33.5% and 28.5% lower than in YOUNG sheep (p < 0.005) and lower than in the AGED group (BV/TV, -17%; Tb.N, -13.5%; not significant); in the OVX group the trabecular separation was 77.9% higher than in YOUNG (p < 0.05) and 30.9% higher than in AGED animals. Lumbar vertebrae L5 bone mineral density was significantly lower in AGED (8.9%, p < 0.05) and OVX sheep (19.3%, p < 0.0005) when compared with YOUNG animals. Five samples of five sheep from each group were analyzed for each observation. At 3 months, in cortical bone both affinity index and pushout test results showed no significant differences between the two materials in each group of animals. In trabecular bone, the affinity index of HT01 was significantly higher than that of TI01 in each group of animals (YOUNG, 90.7%; AGED, 76.9%; OVX, 49.9%) with no significant differences between groups. In conclusion, the performance of TI01 and HT01 surfaces was high not only in YOUNG, but also in OVX animals and, therefore, they might be useful for aged and osteoporotic patients.
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Affiliation(s)
- Veronica Borsari
- Laboratory of Experimental Surgery, Research Institute Codivilla-Putti, Rizzoli Orthopaedic Institute, Bologna, Italy
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Spolidorio LC, Nassar PO, Nassar CA, Spolidorio DMP, Muscará MN. Conversion of immunosuppressive monotherapy from cyclosporin a to tacrolimus reverses bone loss in rats. Calcif Tissue Int 2007; 81:114-23. [PMID: 17612778 DOI: 10.1007/s00223-007-9040-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 05/02/2007] [Indexed: 11/30/2022]
Abstract
Tacrolimus is used for transplant patients with refractory graft rejection and those with intolerance to cyclosporin (CsA), without the disfiguring adverse effects frequently attributed to CsA therapy. Since we have shown that CsA-associated bone loss can also affect alveolar bone, the purpose of this study was to evaluate the effects of conversion of monotherapy from CsA to tacrolimus on alveolar bone loss in rats. Groups of rats were treated with either CsA (10 mg/kg/day, s.c.), tacrolimus (1 mg/kg/day, s.c.), or drug vehicle for 60 and 120 days, and an additional group received CsA for 60 days followed by conversion to tacrolimus for a further 60-day period. Bone-specific alkaline phosphatase (BALP), tartrate-resistent acid phosphatase (TRAP-5b), calcium (Ca(2+)), interleukin (IL)-1beta, IL-6, and tumor necrosis factor alpha (TNF-alpha) concentrations were evaluated in the serum. Analyses of bone volume, bone surface, number of osteblasts, and osteoclasts were performed. Treatment with CsA for either 60 or 120 days was associated with bone resorption, represented by lower bone volume and increased number of osteoclasts; serum BALP, TRAP-5b, IL-1beta, IL-6, and TNF-alpha were also higher in these animals. After conversion from CsA to tacrolimus, all the altered serum markers returned to control values in addition to a significant increase of bone volume and a lower number of osteoclasts. This study shows that conversion from CsA to tacrolimus therapy leads to a reversal of the CsA-induced bone loss, which can probably be mediated by downregulation of IL-1beta, IL-6, and TNF-alpha production.
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Affiliation(s)
- Luís C Spolidorio
- Department of Physiology and Pathology, Dental School of Araraquara, State University of São Paulo, Rua Humaitá 1680, CEP 14901-803, Araraquara, São Paulo, Brazil.
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Mair B, Fuerst G, Kubitzky P, Tangl S, Bergmeister H, Losert U, Watzek G, Gruber R. The anti-angiogenic substance TNP-470 impairs peri-implant bone formation: a pilot study in the rabbit metaphysis model. Clin Oral Implants Res 2007; 18:370-5. [PMID: 17298491 DOI: 10.1111/j.1600-0501.2006.01319.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To study the osseointegration of dental implants under the conditions of impaired blood vessel formation in a rabbit model. MATERIAL AND METHODS Twenty-four titanium implants were placed in the diaphyses of 12 rabbits, two in each tibia. After 2 days, six animals received TNP-470, an anti-angiogenic substance, 10 mg/kg body weight, three times a week, by subcutaneous injection. The remaining six animals served as controls. All animals were sacrificed 6 weeks post implantation. RESULTS The amount of newly formed bone (NFB) within a peri-implant distance of 0.2 mm and the percentage of bone-to-implant contacts (BIC) were determined in undecalcified ground sections. In both groups, appositional bone growth originating from the cortex was associated with a dense network of blood vessels. Within 1 mm apical from the implant shoulder, NFB was 29.3+/-6.7% in TNP-470 treated animals vs. 44.2+/-13.1% in the controls (P=0.03). In the adjacent cortical area NFB was 46.1+/-10.0% in TNP-470 treated animals and 58.4+/-3.0% in the control group (P=0.02). In the endosteal area, 3 mm from the implant shoulder NFB was 24.8+/-11.8% in TNP-470-treated animals and 27.0+/-9.6% in controls (P=0.73) and in the most apical peri-implant area corresponding to the bone marrow cavity 4.3+/-3.2% in TNP-470-treated animals and 10.5+/-5.2% in the controls (P=0.03). No decrease in BIC in response to TNP-470 was observed. CONCLUSION The data suggest that TNP-470 decreases the formation of peri-implant bone, whereas BIC overall are not affected by it. The rabbit model presented here supports the importance of angiogenesis in the process of peri-implant bone formation.
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Affiliation(s)
- Birgit Mair
- Department of Oral Surgery, Medical University of Vienna, Vienna, Austria
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Sakakura CE, Marcantonio E, Wenzel A, Scaf G. Influence of cyclosporin A on quality of bone around integrated dental implants: a radiographic study in rabbits. Clin Oral Implants Res 2007; 18:34-9. [PMID: 17224021 DOI: 10.1111/j.1600-0501.2006.01253.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the influence of cyclosporin A (CsA) administration on bone around integrated dental implants assessed by a bone quality index and by quantitative subtraction radiography. MATERIAL AND METHODS A total of 36 machine surface commercial implants were placed in 18 adult rabbits. After a 3-month healing period without any disturbance, the animals were randomly divided into three groups of six animals each. Group A was sacrificed at this time. CsA was injected subcutaneously in an immunosuppressive dose of 10 mg/kg/day in a test group (Group T), and a Group B served as a control, receiving only vehicle. After 3 months of cyclosporin administration, the animals of both Groups B and T were sacrificed. Radiographs were obtained at implant surgery and at the day of sacrifice with a CMOS sensor. Bone quality around the implants was compared between the groups using a bone quality index and quantitative subtraction radiography. RESULTS The bone analysis showed that in Group T, the bone quality changed dramatically from a dense cortical to a loose trabecular bone structure (P<0.0001, chi(2) test) while in Groups A and B there were no significant differences. Quantitative digital subtraction radiography showed significantly (P<0.05) lower gray shade values (radiographic density) in a region of bone formation around the implants in Group T (118+/-12) than in Groups A (161+/-6) and B (186+/-10). CONCLUSION Within the limits of this study, CsA administration has a negative effect on the quality of bone around integrated dental implant.
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Affiliation(s)
- Celso Eduardo Sakakura
- Department of Oral Diagnosis and Surgery, School of Dentistry, State University of São Paulo, UNESP, Araraquara, SP, Brazil
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Sakakura CE, Margonar R, Sartori R, Morais JAND, Marcantonio E. The Influence of Cyclosporin A on Mechanical Retention of Dental Implants Previously Integrated to the Bone: A Study in Rabbits. J Periodontol 2006; 77:2059-62. [PMID: 17209791 DOI: 10.1902/jop.2006.050290] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Immunosuppressive agents may induce severe changes on bone metabolism and may impair the osseointegration process during the implant healing. No data are available concerning the influence of cyclosporin A on dental implants previously integrated to the bone. The aim of this study was to evaluate the influence of cyclosporin A administration on the mechanical retention of bone previously integrated to dental implants. METHODS Eighteen female New Zealand rabbits were submitted to an implant surgery. Each animal received one commercial dental implant of 10 x 3.75 mm. After 12 weeks of an undisturbed healing period, six animals were randomly sacrificed and the removal torque test was performed (group A). In addition, six animals were submitted to a daily injection of cyclosporin A in a dosage of 10 mg/kg (group C), and six animals received saline solution as a control (group B). After 12 weeks of cyclosporin A administration, groups B and C were sacrificed and submitted to a removal torque test in which higher values can be interpreted as higher mechanical bone retention to the implant surface or higher osseointegration. RESULTS The removal torque results were 30.5 (+/-9.8) Ncm for group A, 50.17 (+/-17.5) Ncm for group B, and 26 (+/-7.8) Ncm for group C. The statistical analysis showed significant differences between groups A and B (P <0.05) and groups B and C (P <0.01). CONCLUSION Cyclosporin A administration may impair the mechanical retention of dental implants previously integrated to the bone.
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Affiliation(s)
- Celso E Sakakura
- Department of Periodontology, Educational Foundation of Barretos, Barretos, São Paulo, Brazil
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Heckmann SM, Heckmann JG, Linke JJ, Hohenberger W, Mombelli A. Implant Therapy Following Liver Transplantation: Clinical and Microbiological Results After 10 Years. J Periodontol 2004; 75:909-13. [PMID: 15295960 DOI: 10.1902/jop.2004.75.6.909] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The number of immunocompromised patients is increasing as a consequence of successful organ transplantation. Placing dental implants in these patients has been questioned because of their increased risk for infections. The 10-year follow-up data of a 71-year-old liver transplant recipient with long-term immunosuppressive therapy is reported. Six months after liver transplantation, two interforaminal implants were inserted in the edentulous mandible, and an overdenture using non-rigid telescopic attachments was fabricated 3 months later. METHODS Oral clinical parameters included the modified plaque index, sulcus fluid flow rate, modified bleeding index, probing depth, distance implant mucosa, attachment level, width of the keratinized mucosa and mobility values. The distance implant bone (DIB) was determined on digital panoramic radiographs. The levels of eight periodontal marker organisms were established using DNA probe technology. Additionally, swabs of the edentulous oral mucosa were taken for microbiological culture and antimicrobial resistance testing. RESULTS The peri-implant parameters were within normal ranges indicating a stable osseointegration with moderate vertical bone loss. Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Campylobacter rectus, and Treponema denticola were not detected. Low levels of Porphyromonas gingivalis, Fusobacterium nucleatum, and Eikenella corrodens were found. Prevotella intermedia was the only bacterium with a level higher than 10(4). The mucosal swabs indicated the presence of an abundant normal oral flora, including Escherichia coli and Candida albicans. The antibiogram revealed multiple resistance to antibiotics. CONCLUSION This case report suggests that immunocompromised patients can be successfully rehabilitated with dental implants.
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Duarte PM, Nogueira Filho GR, Sallum EA, Sallum AW, Nociti Júnior FH. Short-term immunosuppressive therapy does not affect the density of the pre-existing bone around titanium implants placed in rabbits. ACTA ACUST UNITED AC 2003; 17:362-6. [PMID: 15107920 DOI: 10.1590/s1517-74912003000400012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The aim of this study was to evaluate the influence of the administration and withdrawal of cyclosporin A/nifedipine on the bone density in a lateral area adjacent to implants placed in rabbits. Two screw-type titanium implants were placed bilaterally in twenty-eight New Zealand rabbits. The animals were assigned to one of the following groups and received daily subcutaneous injections for 14 days: Groups A and C: vehicle (dimethyl sulfoxide); Groups B and D: CsA (10 mg/kg) plus nifedipine (50 mg/kg). The animals in Groups A and B were sacrificed 14 days postoperatively and, in Groups C and D, 42 days postoperatively. After sacrifice, the tibiae were removed and undecalcified sections were obtained. Bone density was obtained in a 500 mm-wide zone lateral to the implant surface. Intergroup analysis showed no significant difference (p > 0.05) in the degree of bone density between control and test groups either on day 14 or on day 42. Thus, it appears that a short-term immunosuppressive therapy may not present a negative influence on the density of the pre-existing bone around titanium implants placed in rabbits.
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Affiliation(s)
- Poliana Mendes Duarte
- Department of Prosthodontics and Periodontics, School of Dentistry of Piracicaba, State University of Campinas
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Beikler T, Flemmig TF. Implants in the medically compromised patient. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 2003; 14:305-16. [PMID: 12907698 DOI: 10.1177/154411130301400407] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Dental clinicians are confronted with an increasing number of medically compromised patients who require implant surgery for their oral rehabilitation. However, there are few guidelines on dental implant therapy in this patient category, so that numerous issues regarding pre- and post-operative management remain unclear to the dental clinician. Therefore, the aim of the present review is to offer a critical evaluation of the literature and to provide the clinician with scientifically based data for implant therapy in the medically compromised patient. This review presents the current knowledge regarding the influence of the most common systemic and local diseases on the outcome of dental implant therapy, e.g., abnormalities in bone metabolism, diabetes mellitus, xerostomia, and ectodermal dysplasias. Specific pathophysiologic aspects of the above-mentioned diseases as well as their potential implications for implant success are critically appraised. In line with these implications, guidelines for pre- and post-operative management that may assist in the successful implant-supported rehabilitation of this patient category are proposed.
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Affiliation(s)
- Thomas Beikler
- Department of Periodontology, University of Münster, Waldeyerstr. 30, 48149 Münster, Germany.
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Sakakura CE, Margonar R, Holzhausen M, Nociti FH, Alba RC, Marcantonio E. Influence of cyclosporin A therapy on bone healing around titanium implants: a histometric and biomechanic study in rabbits. J Periodontol 2003; 74:976-81. [PMID: 12931759 DOI: 10.1902/jop.2003.74.7.976] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Immunosuppressive agents may induce severe changes on bone metabolism. The purpose of the present study was to evaluate the influence of the administration of cyclosporin A (CsA) on the bone tissue around titanium implants. METHODS Eighteen New Zealand rabbits were randomly divided into 2 groups of 9 each. The test group (CsA) received daily subcutaneous injection of CsA (10 mg/kg body weight) and the control group (CTL) received saline solution by the same administration route. Three days after therapy began, 2 implants (7.0 mm long and 3.75 mm in diameter) were inserted bilaterally at the region of the tibial methaphysis. After 4, 8, and 12 weeks the animals were sacrificed and biomechanical tests and histometrical procedures, consisting of the determination of the percentages of bone-implant contact and bone area within the limits of the implant threads, were performed. RESULTS Intergroup analysis showed that the removal torque and the percentage of bone contact with the implant surface for CsA group were significantly lower than those of the CTL group at 12 weeks (28.5 and 39.2 N cm, P = 0.01; 7.76% and 18.52%, P = 0.02, respectively). CONCLUSION The data from the present study suggest that long-term administration of cyclosporin A may negatively influence bone healing around dental implants.
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Affiliation(s)
- Celso E Sakakura
- Department of Periodontology, Dental School of Araraquara, State University of São Paulo, Araraquara, SP, Brazil
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Abstract
Bone is a tissue that constantly undergoes deposition, resorption of stromal matrix, and remodeling. These processes may be altered by a variety of chemical, mechanical, cellular, and pathological mechanisms. Understanding the physiology of bone healing and the mechanisms affecting this process is important not only when evaluating normal skeletal development but also when initiating fracture repair. Because the ultimate success of spinal fusions involves creation of an osseous union, we focus this review on the anatomy and physiology of bone under physiological conditions, normal bone healing and mechanisms that alter it, and available adjuvant therapies that may enhance healing potential in a clinical setting.
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Affiliation(s)
- Julie G Pilitsis
- Department of Neurosurgery, Wayne State University, Detroit, Michigan 48201, USA.
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