The Truth Behind What Really Influences Early Dental Implant Failure ES/EN

Julio / July 18, 2017

The Truth Behind What Really Influences Early Dental Implant Failure ES/EN

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In 2014 a study finally came to an end. It wasn't however any ordinary study. Instead it was a 34 year analysis on the influences that affect early dental implant failure in patients. In addition it just so happened to be one of the largest observational studies of its kind anywhere in the world.
Between 1980 and 2014 the team from the Centre of Dental Specialist Care in Malmo, Sweden observed 2670 patients who between them received a total of 10,096 dental implants.

 

Factors Influencing Early Dental Implant Failures. B.R. Chrcanovic, J. Kisch, T. Albrektsson, and A. Wennerberg.

The aim of the analysis?

To assess the influence of both systemic and local factors on the frequency of implant failures up to the second stage of surgery.

 

The reasoning?

Previously, much had been documented about local and systemic factors affecting the long term outcome of dental implants - e.g those that occurred after occlusal loading (Chrcanovic et al 2014). However up until this point, the causes and effects of early implant failure – e.g those that occurred before abutment connection surgery, were less clear.

For many years it was thought that the factors that influenced implant failure between the two distinct stages were different. While microbial environments, para-functional habits such as bruxism and nail biting, and a lack of proper oral care by the patient are known to heavily impact implant success in the post prosthetic stages; the idea that osseointegration failure in the earlier stages was driven by differing systemic and/or local factors was less well known. This is why the Malmo study was set up.

 

So what were the findings?

Overall, 642 of the 10,096 dental implants (6.43%) that were placed in the Centre between 1980 and 2014, failed. Out of the 642 implant failures, 176 implants spanning 139 patients were lost during the early pre-abutment stages.
Analysis was then conducted on the 176 failed implants to try to find any connecting link. When more than one statistical outcome was analysed, it was discovered that 2 distinct variables were found to have a significant effect on implant failure. These were
  • The taking of anti-depressant drugs; and
  • Smoking
While the impact that smoking has on new bone growth is well documented, there's growing biochemical and clinical evidence to support the fact that the taking of anti-depressant medications may also impair bone metabolism. This is supported by experiments carried out on bone cells in 2001 (Westbroek et al/Bliziotes et al) and again in 2004 (Battaglino et al).
To echo this, 'In vivo' testing in 2008 found that Selective Serotonin Reuptake Inhibitors (SSRI's) did indeed show a negative impact on both new cell growth and density of bone. As did tests of the drug Fluoxetine as carried out by Warden et al and Yadav et al in the same year.
Moreover, from a clinical perspective, there is also growing evidence to support a correlation between anti-depressants and decreased bone mineral density. A study by Williams et al in 2013 for example, found that decreased bone density was present in many men and women suffering from mood disorders. While as recently as 2016, a pilot study carried out by the Department of Restorative Dentistry in Buffalo found that 33% of patients who experienced implant failure up to the abutment stage had been taking some form of anti-depressant drugs. Similar results were also reflected in the larger Malmo Study.

 

The key takeaway

Anti-depressant drug use is on the rise and in Spain for example, the number of people who take them regularly is up by 20%. In Germany it's up by 46%, and in the US, 1 in 10 people have been prescribed anti-depressants within the last year. For dental implant surgeons this means that four of the known side effects of anti-depressants are problematic for dental implants.
As well as possible osteoporosis, bruxism, dry mouth, and a condition known as akathisia can all impact on the bone healing process. So for the dental surgeon, it's important to have a deep understanding of what medications a patient is taking so that they can make an informed decision on the right course of treatment for the patient.

 

References

Battaglino R, Fu J, Späte U, Ersoy U, Joe M, Sedaghat L, Stashenko P. 2004. Serotonin regulates osteoclast differentiation through its transporter. J Bone Miner Res. 19(9):1420–1431.

Bliziotes MM, Eshleman AJ, Zhang XW, Wiren KM. 2001. Neurotransmitter action in osteoblasts: expression of a functional system for serotonin receptor activation and reuptake. Bone. 29(5):477–486.

Chrcanovic BR, Albrektsson T, Wennerberg A. 2014. Reasons for failures of oral implants. J Oral Rehabil. 41(6):443–476

Warden SJ, Robling AG, Sanders MS, Bliziotes MM, Turner CH. 2005. Inhibition of the serotonin (5-hydroxytryptamine) transporter reduces bone accrual during growth. Endocrinology. 146(2):685–693.

Westbroek I, van der Plas A, de Rooij KE, Klein-Nulend J, Nijweide PJ. 2001. Expression of serotonin receptors in bone. J Biol Chem. 276(31):28961– 28968

Yadav VK, Ryu JH, Suda N, Tanaka KF, Gingrich JA, Schutz G, Glorieux FH, Chiang CY, Zajac JD, Insogna KL, et al. 2008. Lrp5 controls bone formation by inhibiting serotonin synthesis in the duodenum. Cell. 135(5):825– 837



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

Octubre / October 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 / September 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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Part 1 - Osseointegration – From Accidental Finding To The First Dental Implant- The Early Years! ES/EN
Part 1 - Osseointegration – From Accidental Finding To The First Dental Implant- The Early Years! ES/EN

Septiembre / September 01, 2017

Anyone who knows anything about dental implants is aware of the story of Per-Ingvar Brånemark and how he accidentally discovered the process he later named as osseointegration. You're probably also aware that despite him being named as one of the most influential people in the dental profession, he wasn't actually a dentist.

Osseointegration and its experimental background., Brånemark PI., J Prosthet Dent. 1983 Sep;50(3):399-410. PMID: 6352924

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