title: Selective serotonin reuptake inhibitors and the risk of osseointegrated implant failure: a cohort study.
abstract: Selective serotonin reuptake inhibitors (SSRIs), the most widely used drugs for the treatment of depression, have been reported to reduce bone formation and increase the risk of bone fracture. Since osseointegration is influenced by bone metabolism, this study aimed to investigate the association between SSRIs and the risk of failures in osseointegrated implants. This retrospective cohort study was conducted on patients treated with dental implants from January 2007 to January 2013. A total of 916 dental implants in 490 patients (94 implants on 51 patients using SSRIs) were used to estimate the risk of failure associated with the use of SSRIs. Data analysis involved Cox proportional hazards, generalized estimating equation models, multilevel mixed effects parametric survival analysis, and Kaplan-Meier analysis. After 3 to 67 mo of follow-up, 38 dental implants failed and 784 succeeded in the nonusers group, while 10 failed and 84 succeeded in the SSRI-users group. The main limitation of this retrospective study was that drug compliance dose and treatment period could not be acquired from the files of the patients. The primary outcome was that compared with nonusers of SSRIs, SSRI usage was associated with an increased risk of dental implants failure (hazard ratio, 6.28; 95% confidence interval, 1.25-31.61; p = .03). The failure rates were 4.6% for SSRI nonusers and 10.6% for SSRI users. The secondary outcomes were that small implant diameters (≤4 mm; p = .02) and smoking habits (p = .01) also seemed to be associated with higher risk of implant failure. Our findings indicate that treatment with SSRIs is associated with an increased failure risk of osseointegrated implants, which might suggest a careful surgical treatment planning for SSRI users.
authors.affiliation: Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
authors.forename: X
authors.initials: X
authors.lastname: Wu
authors.affiliation: Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Al-Abedalla
authors.affiliation: Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Rastikerdar
authors.affiliation: Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Abi Nader
authors.affiliation: East Coast Oral Surgery, Moncton, New Brunswick, Canada.
authors.forename: N G
authors.initials: NG
authors.lastname: Daniel
authors.affiliation: Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Nicolau
authors.affiliation: Faculty of Dentistry, McGill University, Montreal, Quebec, Canada faleh.tamimimarino@mcgill.ca.
authors.forename: F
authors.initials: F
authors.lastname: Tamimi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015921:Dental Implants; D003764:Dental Materials / Q000737:chemistry; D017267:Dental Prosthesis Design; D019232:Dental Restoration Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016348:Osseointegration / Q000187:drug effects*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012907:Smoking; D014025:Titanium / Q000737:chemistry; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015921:Dental Implants; D003764:Dental Materials; D017367:Selective Serotonin Reuptake Inhibitors; D014025:Titanium
keywords: bone remodeling; dental implants; epidemiology; medical devices; osseointergration; risk factors