title: Systemic drugs that influence titanium implant osseointegration.
abstract: Titanium implants are widely used on an increasing number of patients in orthopedic and dental medicine. Despite the good survival rates of these implants, failures that lead to important socio-economic consequences still exist. Recently, research aimed at improving implant fixation, a process called osseointegration, has focused on a new, innovative field: systemic delivery of drugs. Following implant fixation, patients receive systemic drugs that could either impair or enhance osseointegration; these drugs include anabolic and anti-catabolic bone-acting agents in addition to new treatments. Anabolic bone-acting agents include parathyroid hormone (PTH) peptides, simvastatin, prostaglandin EP4 receptor antagonist, vitamin D and strontium ranelate; anti-catabolic bone-acting agents include compounds like calcitonin, biphosphonates, RANK/RANKL/OPG system and selective estrogen receptor modulators (SERM). Examples of the new therapies include DKK1- and anti-sclerostin antibodies. All classes of treatments have proven to possess positive impacts such as an increase in bone mineral density and on osseointegration. In order to prevent complications from occurring after surgery, some post-operative systemic drugs are administered; these can show an impairment in the osseointegration process. These include nonsteroidal anti-inflammatory drugs, proton pump inhibitors and selective serotonin reuptake inhibitors. The effects of aspirin, acetaminophen, opioids, adjuvants, anticoagulants and antibiotics in implant fixations are not fully understood, but studies are being carried out to investigate potential ramifications. It is currently accepted that systemic pharmacological agents can either enhance or impair implant osseointegration; therefore, proper drug selection is essential. This review aims to discuss the varying effects of three different classes of treatments on improving this process.
authors.affiliation: a Department of Orthopaedics and Traumatology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.
authors.forename: Dragos
authors.initials: D
authors.lastname: Apostu
authors.affiliation: b Department of Oral Rehabilitation , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.
authors.forename: Ondine
authors.initials: O
authors.lastname: Lucaciu
authors.affiliation: c Department of Orthopaedics and Traumatology , Rehabilitation Clinic Cluj , Cluj-Napoca , Romania.
authors.forename: Gheorghe Dan Osvald
authors.initials: GD
authors.lastname: Lucaciu
authors.affiliation: d Department of Maxillofacial Surgery and Oral Implantology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Crisan
authors.affiliation: e Department of Oral and Maxillofacial Surgery , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.
authors.forename: Liana
authors.initials: L
authors.lastname: Crisan
authors.affiliation: d Department of Maxillofacial Surgery and Oral Implantology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Baciut
authors.affiliation: e Department of Oral and Maxillofacial Surgery , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.
authors.forename: Florin
authors.initials: F
authors.lastname: Onisor
authors.affiliation: e Department of Oral and Maxillofacial Surgery , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.
authors.forename: Grigore
authors.initials: G
authors.lastname: Baciut
authors.affiliation: b Department of Oral Rehabilitation , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.
authors.forename: Radu Septimiu
authors.initials: RS
authors.lastname: Câmpian
authors.affiliation: d Department of Maxillofacial Surgery and Oral Implantology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.
authors.forename: Simion
authors.initials: S
authors.lastname: Bran
mesh_terms: D045930:Anabolic Agents / Q000494:pharmacology; D000700:Analgesics / Q000009:adverse effects; D000818:Animals; D050071:Bone Density Conservation Agents / Q000494:pharmacology; D006801:Humans; D008954:Models, Biological; D016348:Osseointegration / Q000187:drug effects*; D019736:Prostheses and Implants; D014025:Titanium
chemical_list: D045930:Anabolic Agents; D000700:Analgesics; D050071:Bone Density Conservation Agents; D014025:Titanium
keywords: Drug-supported osseointegration; drug-enhanced osteoblast activity; drugs that down-regulate osteoclast activity; drugs that influence titanium implant osseointegration; titanium implant