Systemic conditions and treatments as risks for implant therapy.
OBJECTIVE
To evaluate whether systemic diseases with/without systemic medication increase the risk of implant failure and therefore diminish success and survival rates of dental implants.


METHODS
A MEDLINE search was undertaken to find human studies reporting implant survival in subjects treated with osseointegrated dental implants who were diagnosed with at least one of 12 systemic diseases.


RESULTS
For most conditions, no studies comparing patients with and without the condition in a controlled setting were found. For most systemic diseases there are only case reports or case series demonstrating that implant placement, integration, and function are possible in affected patients. For diabetes, heterogeneity of the material and the method of reporting data precluded a formal meta-analysis. No unequivocal tendency for subjects with diabetes to have higher failure rates emerged. The data from papers reporting on osteoporotic patients were also heterogeneous. The evidence for an association between osteoporosis and implant failure was low. Nevertheless, some reports now tend to focus on the medication used in osteoporotic patients, with oral bisphosphonates considered a potential risk factor for osteonecrosis of the jaws, rather than osteoporosis as a risk factor for implant success and survival on its own.


CONCLUSIONS
The level of evidence indicative of absolute and relative contraindications for implant therapy due to systemic diseases is low. Studies comparing patients with and without the condition in a controlled setting are sparse. Especially for patients with manifest osteoporosis under an oral regime of bisphosphonates, prospective controlled studies are urgently needed.
Bornstein
Michael M
MM
Department of Oral Surgery and Stomatology, School of Dental Medicine, Univerity of Bern, Freiburgstrasse 7, CH-3010 Bern, Switzerland. Michael.bornstein@zmk.unibe.ch
Cionca
Norbert
N
Mombelli
Andrea
A
D000163:Acquired Immunodeficiency Syndrome; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D002318:Cardiovascular Diseases; D002908:Chronic Disease; D003240:Connective Tissue Diseases; D000075202:Contraindications; D016371:Cranial Irradiation / Q000009:adverse effects; D003424:Crohn Disease; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D019232:Dental Restoration Failure; D003920:Diabetes Mellitus; D004164:Diphosphonates / Q000009:adverse effects; D006801:Humans; D016377:Organ Transplantation; D010024:Osteoporosis / Q000517:prevention & control; D010300:Parkinson Disease; D012307:Risk Factors; D012859:Sjogren's Syndrome
D050071:Bone Density Conservation Agents; D015921:Dental Implants; D004164:Diphosphonates