Consensus

Medication-Related Dental Implant Failure

The main goal of this systematic review was to assess the association of implant failure rate as the primary outcome with intake of oral or parenteral medications that may affect bone metabolism.

General Statement: Limited evidence on the effect of long-and short-term medication intake on dental implant therapy outcomes indicates that there may be an association between implant failure rate and the intake of certain medications that influence bone metabolism.

Consensus Statements

Consensus Statement 1: The association between nonsteroidal anti-inflammatory drug (NSAID) intake and implant failure rate is unclear

Nonsteroidal anti-inflammatory drugs (NSAIDs): The association between nonsteroidal anti-inflammatory drug (NSAID) intake and implant failure rate is unclear. This statement is based on the analysis of five studies (i.e., three RCTs, including a total of 191 patients, and two retrospective cohort studies, including a total of 81 patients) that revealed marked heterogeneity of the pharmacological regimen in the selected studies and a majority of studies reporting no implant failures in either the test or control groups, or both groups. i.e., Ibuprofen, Flurbiprofen, Celecoxib, Acetylsalicylic, Rofecoxib, Nabumetone, Naproxen, Etodolac and others.

Consensus Statement 2: The association between the long-term intake of certain AHTNs and implant failure rate is unclear

Antihypertensive medication (AHTNs): The association between the long-term intake of certain AHTNs and implant failure rate is unclear. This statement is based on very limited available evidence of one retrospective study including 728 patients. Noteworthy, AHTNs exhibited a lower implant failure rate compared to the control population not taking AHTNs in this study. i.e., Beta-blockers, Thiazide diuretics, Angiotensin-converting enzyme inhibitors, Angiotensin II receptor blockers and others.

Consensus Statement 3: The intake of certain SSRIs is associated with a statistically significant increased implant failure rate

Selective serotonin reuptake inhibitors (SSRIs): The intake of certain SSRIs is associated with a statistically significant increased implant failure rate. This statement is based on the quantitative analysis of two retrospective cohort studies including a total of 790 patients, which suggested that implant failure rate was higher in subjects taking SSRIs as compared to a control population (Odd ratio: 2.92; average difference: 7.48%, C.I. [95%] = 6.96–8.00 with a p < 0.01, between 36 and 90 months of follow-up). i.e., Citalopram, Dapoxetine, Escitalopram, Fluoxetine, Fluvoxamine, Indalpine, Paroxetine, Sertraline, Venlafaxine and Zimeline and others.

Consensus Statement 4: The intake of PPIs is associated with a statistically significant increased implant failure rate

Proton pump inhibitors (PPIs): The intake of PPIs is associated with a statistically significant increased implant failure rate. This statement is based on the quantitative analysis of two retrospective cohort studies including a total of 1,798 patients, which suggested that implant failure rate was higher in subjects taking PPIs as compared to a control population (Odds ratio: 2.02; average difference: 4.29%, C.I. [95%] = 3.81–4.77 with a p < 0.01, between 16 and 94 months of follow-up). i.e., Omeprazole, Lansoprazole, Pantoprazole, Dexlansoprazole, Esomeprazole, Rabeprazole and others.

Consensus Statement 5: The intake of BPs related to the treatment of osteoporosis was not associated with an increased implant failure rate

Bisphosphonates (BPs) related to osteoporosis: The intake of BPs related to the treatment of osteoporosis was not associated with an increased implant failure rate. This statement is based on the quantitative analysis of six cohort studies (i.e., five retrospective on oral BPs and one prospective using intravenous BPs including a total of 1,239 patients), which suggested that implant failure rate was higher in subjects taking BPs as compared to a control population (average difference: −0.13%, C.I. [95%] = −0.3 to 0.05, between 12 and 66 months of follow-up). Caution should be taken when interpreting these data due to the inherent risks associated with the occurrence of medication-induced osteonecrosis in patients taking BPs. The effect of BP on implant outcomes in patients undergoing treatment of neoplastic diseases therapy was not evaluated, because implant therapy is usually contraindicated in this population. i.e., Risedronate, Ibandronate, Alendronate, Zoledronic acid and others.

Clinical Recommendations

What are the implications of the increasing intake of medication by the general population in daily practice?

Clinicians and patients considering implant therapy should be aware of possible medication-related implant failures. Hence, a comprehensive assessment and understanding of the patient’s medical background and current medications, as well as a personalized informed consent, should be considered integral components of all phases of contemporary implant therapy (initial and supportive therapy).

What considerations should be taken in daily clinical practice pertaining medication intake-related implant failure?

Clinicians should consider the association between increased implant failure rate and the intake of proton pump inhibitors (PPIs) or selective serotonin reuptake inhibitors (SSRIs) in their routine risk assessment as part of comprehensive implant therapy. Clinicians should proceed with caution when implant therapy is considered in patients taking bisphosphonates (BPs) related to osteoporosis. Standard implant therapy is contraindicated in patients receiving high-dose bisphosphonates (BPs) for the treatment of neoplastic diseases.

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