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Insufficient evidence to support relationship between systemic conditions and implant failure Critical Summary Prepared by: Sarah Gray DDS, MS 

OVERVIEW

  • Systematic Review Conclusion:

    The evidence does not identify any definitive relationship between various systemic diseases and their therapies and the success of dental implants.

  • Critical Summary Assessment:

    Only studies with a high risk of bias were available for this review, which provided insufficient evidence linking various systemic conditions with implant outcome.

  • Evidence Quality Rating:

    Limited

A Critical Summary of:

Systemic conditions and treatments as risks for implant therapy

Bornstein MM, Cionca N, Mombelli A. International Journal of Oral & Maxillofacial Implants. 2009;24 Suppl():12-27

  • Clinical Questions:

    What effects do various systemic diseases and their treatments therapies have on the success of dental implants?

  • Review Methods:

    The authors searched Medline through March 2008 using keywords for 13 systemic diseases and therapies identified in a previous study (Mombelli, 2006). Inclusion criteria were human subjects with specific diagnoses, success or failure of osseointegrated dental implants, and a minimum of five subjects in a case series (this does not apply to case reports). Two independent reviewers screened titles and abstracts, and a third resolved disagreements. Additional studies were obtained through reference citations and by personal communications. Methodological quality was determined using the Oxford Centre for Evidence-based Medicine. Outcomes assessed included implant success in patients with varying systemic conditions and treatments.

  • Main Results:

    The initial search yielded an unspecified number of articles, most of which were case reports and case series. The only available matched-control retrospective study indicated no increased risk of failure for patients with diabetes. In a large cohort study, patients with type 2 diabetes treated with implants by one clinician had a significant higher failure rate than patients without diabetes. A weak association was found in two case-control studies of implant failure and density of peripheral bone associated with osteoporosis. A systematic review of implants placed before and after radiotherapy reported failure rates between 0 percent and 12.6 percent for a follow-up period of up to 12 years. There was inadequate data to estimate the risk of implant failure for patients with all other specified conditions and diseases.

  • Conclusion:

    There is insufficient evidence to predict the outcome of implant therapy for patients with scleroderma, Sjogren's syndrome, neuropsychiatric disorders/Parkinson's disease, lichen planus, HIV infection, ectodermal dysplasia, immunosuppression after organ transplants, cardiovascular disease, Crohn’s disease, diabetes, osteoporosis, or patients on oral bisphosphonates or postradiotherapy.

  • Source of funding:

    Not specified

Commentary:

  • Importance and Context:

    This review evaluated 13 systemic diseases and therapies, many of which are relatively common. . As implant therapy becomes more prevalent, practitioners need parameters for predicting the success of treatment using implants in patients with common systemic diseases. A better understanding of the implications of certain medical conditions on implant therapy can minimize the risk of failure.

  • Strengths and Weaknesses of the Systematic Review:

    The authors used only one database to search for, select and analyze evidence. Inclusion criteria were limited to human implant patients with specified medical conditions. Case reports with fewer than five subjects were included and studies were not adequately evaluated for bias or heterogeneity. A complete list of the articles subjected to full review was not provided, although quality assessment of some articles was conducted. The review methodology was limited and an assessment of the validity of the findings of the included studies was not conducted. Severe and acute medical conditions, traditionally thought to be contraindications for implant therapy, were excluded from the study. One MSc thesis identified through a personal communication was included in the review.

  • Strengths and Weaknesses of the Evidence:

    The evidence evaluated had a high risk of bias. The review consisted mostly of case series and case reports, some of which had studied few patients. Because the quantity and quality of evidence was inadequate, conclusions could not be made about both the long-term success of implants in patients with various systemic conditions or about certain therapeutic regimens. Many studies lacked controls, and for some conditions (neuropsychiatric disorders, Crohn's disease, Sjogren's syndrome, heart/renal transplants), no or very limited literature was available. Outcomes were contradictory within diseases (diabetes), reporting and quality of data were inconsistent, and there was significant heterogeneity among studies.

  • Implications for Dental Practice:

    Evidence for predicting the success or failure of dental implants in patients with various systemic diseases and therapies is limited and generally low in quality. Until more conclusive evidence is available, the decision to place implants in patients with these conditions should be based upon sound clinical judgment and a thorough analysis of other factors including bone quantity and quality, and patient expectations.

  • Critical Summary Publication Date: 9/9/2010

These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association ©

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