Kate Scheer discusses how prescription meds can affect the success of dental implants.
A recent study from the Complutense University of Madrid found some commonly prescribed drugs in the UK adversely affect the success of dental implants. Indeed, they found that people who were taking antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), had a more than 4.5-fold increased risk of their implants failing.
They suggest that SSRIs may affect bone metabolism, interfering with the osseointegration process, so key to the implant integrating with the bone.
SSRIs are not the only medications to have been contraindicated for implant success. Corticosteroids are frequently used to treat a variety of systemic illnesses. Their frequent use causes a patient’s immune system to be suppressed, which increases their risk of contracting bacterial, viral, and fungal infections. Patients who use exogenous steroids run the risk of developing osteopenia and osteoporosis, and conventional therapies for these infections might be difficult to administer. This should be kept in mind by the clinician when looking at the maxilla and mandible. Patients on systemic corticosteroid therapy are more likely to experience decreased bone density, increased epithelial fragility, and immunological suppression, all of which affect the dental implant’s ability to osseointegrate.
Bisphosphonates are a well-known class of medications that act as bone resorption inhibitors by preventing osteoclast activity. The osteoclast-mediated bone resorption caused by tumours, which causes hypercalcemia and osteolytic metastases, has been inhibited by a class of intravenous bisphosphonates that contain nitrogen and include pamidronate and zoledronate. It was discovered by oral and maxillofacial surgeons that the use of these two intravenous bisphosphonate medications was associated with cases of avascular necrosis (osteonecrosis) of the mandible and/or maxilla.
The most frequent and avoidable cause of dental implant failure is infection. Peri-implantitis is a plaque-associated disease that occurs in the tissues surrounding dental implants and is characterised by inflammation in the peri-implant mucosa and consequent gradual bone loss. Bacteria and food particles that build around dental implants cause peri-implantitis.
Other factors in implant failure include age and smoking, with age comes reduced bone density, which can mean longer healing times and less reliable outcomes. Smoking slows down the blood flow, which has an impact on the osseointegration process. Patients with bruxism are also at greater risk of implant failure than individuals without parafunction (41 per cent vs 12 per cent). This is caused by the implant’s uncontrolled functional loading, which causes micromotions over the critical limit and prevents osseointegration by encasing the implant in fibrous tissue.
Little wonder then that the search is on for the ultimate smart dental implant. And researchers at the University of Pennsylvania may be getting close. They have recently developed a dental implant that resists bacterial growth and generates electricity through its piezoelectric qualities. The implant features two new technologies: a nanoparticle-infused biofilm that resists bacterial growth. The other is an embedded light source that provides phototherapy. The light draws power from motion like brushing teeth or chewing and is said to promote periodontal health of the surrounding tissue. It is yet to be commercialised, however, and needs further development and research.
Of course, successful implant osseointegration depends on the quality and quantity of interfacial bone and the skill of the clinician. The Piezomed from W&H provides dental professionals with the benefits of innovative piezosurgery. By using the high-quality system, clinicians can remove only the targeted bone with precision, leaving the surrounding soft tissue and bone undamaged. The Piezomed module integrates seamlessly with the Implantmed Plus, and features a compact design ideal for any space. The unit is incredibly versatile, improving procedures and results for patients as it is gentle on soft tissue, ensuring reduced patient discomfort and quicker healing. The measurement of osseointegration is crucial to loading and monitoring the dental implants to ensure success. Utilising the Osstell Beacon from W&H allows you to measure and evaluate the stability of the implant, ensuring full osseointegration. It allows you to reduce treatment times and avoid rejection in high-risk patients.
With the correct measurement tools and knowledge of any contraindicated medications patients may be taking, dental clinicians will be in a better place to produce more positive dental implant outcomes for patients.
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References available on request.