Dental endosseous implants in the medically compromised patient¹

Abstract

The literature contains numerous observations on the significance of systemic disorders as contraindications to dental endosseous implant treatment, but the justification for these statements is often apparently allegorical. Although implants are increasingly used in healthy patients, their appropriateness in medically compromised patients is less equivocal. Perhaps surprisingly, the evidence of their efficacy in these groups of patients is quite sparse. Indeed, there are few if any randomized controlled trials (RCTs) in this field. Furthermore, any health risks from the placement of implants are unclear. We review the current evidence for the risks associated with endosseous implants in a range of systemic disorders. There is clearly a need for prospective systematic trials. The degree of disease-control may be far more important that the nature of the disorder itself, and individualized assessment, including the medical condition, quality of life and life expectancy is indicated. The benefits of implants to many of these patients may outweigh any risks. However, proper informed consent is mandatory.

Dental implants in patients with oral mucosal alterations: An update

“…The literature contains many references to contraindications of implant treatment in patients with systemic diseases, though in some instances such contraindications appear to be only theoretical (1). Systemic diseases can affect the oral tissues, increasing the susceptibility to other pathologies or interfering with the healing processes.…”

Outcome of Implants in Kidney Transplant Patient Undergoing Immunosuppressive Therapy: Case Report

“…In fact the number of immunocompromised patients is increasing as a consequence of successful organ transplantation (10,11). Also in preparation for transplantation procedures, the patients must have all potential sources of inflammation removed, so in the course of dental treatment, most often to heal the oral cavity, they have numerous teeth extracted, thus leading to vast denture losses, and after successful transplantation they need to rehabilitate their masticatory system (12).…”

Patient assessment and diagnosis in implant treatment

“…Today, these conditions indicate implant treatment under medical supervision and particular precautions should be considered, such as antibiotic prophylaxis, calcium-substitution, or substitution of coagulation factors. 8,9 Erosive disorders (e.g., epidermolysis bullosa, lichen planus) and hyposalivation with the symptoms of xerostomia (e.g., in patients with Sjö gren-Syndrome or rheumatoid arthritis), are not a contraindication for implant treatment. 9 On the contrary, since patients with hyposalivation are at a higher risk of developing caries lesions due to the decreased salivary buffer capacity and reduced remineralization of enamel and dentine, implants may be favourable over teeth with questionable prognoses.…”