Dental Implants In Patients With Osteoporosis – Is It Achievable?

noviembre 27, 2017

Dental Implants In Patients With Osteoporosis – Is It Achievable?

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Dental implant therapy for partially or totally edentulous patients is a proven and highly effective treatment for the restoration of proper chewing functions. Yet in some cases implants can fail as a result of certain biological risk factors. One of those is thought to be osteoporosis.

Osteoporosis is a common skeletal disease found in humans and according to the International Osteoporosis Foundation (IOF), it affects somewhere between 200 and 300 million people worldwide. It's a progressive disease in which bone density and bone quality are often greatly reduced. Because the disease leads to a deterioration in bone microstructure and increased bone fragility, it plays a significant part in implantology. Yet surprisingly, there remains a degree of uncertainty surrounding the link between implant survival rates and the conditions surrounding osteoporosis.

While much progress has been made towards improving the osseointegration process by using implants with treated surfaces and with enlarged diameters and lengths, the understanding that osteoporotic conditions have a direct impact on implant-based rehabilitation is questionable at best.

For example, some clinical studies indicated a higher probability of implant failure in those with osteoporosis (P<0.05), while others have shown that early implant loss is no higher in those with osteoporosis. In fact one previous systematic review complete with meta-analysis, indicated that there is no direct correlation between osteoporosis and implant loss whatsoever.

As a result any literature regarding indication protocols for osteoporosis patients is decidedly deficient. For this reason, one of the largest systematic reviews of clinical articles on the subject of osteoporosis and its effect on implant-based restorations was recently undertaken.

Setting the criteria

The review, carried out in accordance with the Cochrane Handbook for Systematic Reviews of Interventions was performed using the Patient Intervention Comparison, Outcome (PICO) framework. Only eligible studies published up to September 2016 were allowed. Titles and summaries were evaluated and reviews performed on 582 articles. Out of those, 30 eligible studies were eventually identified. 15 were then selected for qualitative analysis and 13 for quantitative analysis - the remaining 2 failed to meet the required inclusion criteria.

In the combined studies a total of 8,859 patients and 29,978 implants were included with an average patient age of 63.05 years. Those patients were closely monitored for a median time scale of 6 years. The primary outcome of the analysis was to measure the osseointegrated survival rates in patients with osteoporosis. The secondary outcome was to look at the peri-implant bone loss rate for osseointegrated implants and compare that to patients showing no osteoporotic effects.

This is what was found

Out of the 28 remaining studies, there were 10 which gave detailed data on implants in patients both with and without osteoporosis. In total 702 implants were placed in patients with osteoporosis, culminating in 33 failures (4.70% failure rate) while 4,114 implants were placed in non-osteoporotic patients, with 147 failures (3.57% failure rate).

In addition it was also possible to compare the rate of peri-implant bone loss in patients with osteoporosis to those in control groups in a further 3 studies. Out of 129 patients analysed, 80 suffered from osteoporosis. In this analysis, bone loss was found to be 0.18mm more in osteoporotic patients vs the control group.

Finally, in another 5 studies detailing implant loss in patients with osteoporosis vs non-osteoporotic patients, the implant survival rate in osteoporotic patients was calculated using a survival curve analysis. This resulted is an overall survival rate figure of 96.46%.  

The results

In all but 3 of the studies, osteoporotic conditions were not clinically proven to result in higher failure rates than those placed in control groups. Moreover, in the remaining 3 studies where osteoporosis did show greater marginal bone loss than those placed in control group subjects, those figures still fell well within acceptable clinical parameters.

The key takeaway

History suggests that dentists have in the past treated osteoporotic patients with an understandable degree of caution. However clinical research is rapidly working towards establishing efficient evidence-based protocols for the treatment of patients with osteoporosis. These include higher torque insertions, the use of simulated osteoporotic bone tissue, and treated surface implants. Once clinical protocols are established, all evidence so far points to the fact that osteoporotic patients will fare no worse than normal patients, provided they follow guidelines as laid down by their implant dentist. For implantologists and osteoporosis sufferers alike, it seems the future is bright and that has to be good news.

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Dentofacial Aesthetics and The Link Between Malocclusions, Quality of Life, and Self-Esteem
Dentofacial Aesthetics and The Link Between Malocclusions, Quality of Life, and Self-Esteem

diciembre 12, 2017

If you ask any group of people about the factors that make up a pleasing facial appearance, they'll probably give you a million different answers. However, in spite of the many minor incidentals, there appears to be an overriding set of principles that most people do agree on.

Craniodentofacial characteristics, dental esthetics–related quality of life, and self-esteem. Anja Gavric, Dubravka Mirceta, Mario Jakobovic, Andrej Pavlic, Magda Trinajstic Zrinski, Stjepan Spalj. American Journal of Orthodontics and Dentofacial Orthopedics, Volume 147, Issue 6, June 2015, Pages 711-718.

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Part 3 -  Osseointegration – The Trials, Tribulations And Successes
Part 3 - Osseointegration – The Trials, Tribulations And Successes

octubre 17, 2017

During the early 1970's while Brånemark was deep into his research into osseointegration, other Europeans followed suit. They included André Schröeder at Switzerland's Berne University who was working on a similar implant for clinical application in conjunction with the renowned Straumann Institute.

Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws.Adell R, Eriksson B, Lekholm U, Brånemark Pl, Jemt T. Int J Oral Maxillofac Implants 1990 Winter;5(4):347-59. PMID: 2094653

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Part 2 – Osseointegration - The Testing Years ES/EN
Part 2 – Osseointegration - The Testing Years ES/EN

septiembre 25, 2017

1982 was a huge turning point for Brånemark and it was a point that he had been working towards for the past 17 years. This included 15 years of clinical follow-up trials. Yet despite the hugely positive results, he was reluctant to present his findings to the public at the Toronto conference, because he felt quite simply, that the world still wasn't ready for dental implants.

A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Adell R, Lekholm U, Rockler B, Brånemark PI. Int J Oral Surg. 1981 Dec;10(6):387-416. PMID: 6809663

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