Implants in the Medically Compromised Patient

Abstract

Dental clinicians are confronted with an increasing number of medically compromised patients who require implant surgery for their oral rehabilitation. However, there are few guidelines on dental implant therapy in this patient category, so that numerous issues regarding pre-and post-operative management remain unclear to the dental clinician. Therefore, the aim of the present review is to offer a critical evaluation of the literature and to provide the clinician with scientifically based data for implant therapy in the medically compromised patient. This review presents the current knowledge regarding the influence of the most common systemic and local diseases on the outcome of dental implant therapy, e.g., abnormalities in bone metabolism, diabetes mellitus, xerostomia, and ectodermal dysplasias. Specific pathophysiologic aspects of the above-mentioned diseases as well as their potential implications for implant success are critically appraised. In line with these implications, guidelines for pre-and post-operative management that may assist in the successful implant-supported rehabilitation of this patient category are proposed.

Dental considerations for the patient with diabetes

“…Osteoporosis present in type 1 DM requires great care when performing surgery, in order to prevent iatrogenic fractures (4). Due to the delayed healing response in diabetic patients (8,25), implant therapy is still controversial and at the moment, there is a lack of definitive guidelines. In any case, these individuals could be candidates for the placement of dental implants if they have good control of their metabolism.…”

“…In any case, these individuals could be candidates for the placement of dental implants if they have good control of their metabolism. There is general agreement in advocating the use of prophylactic antibiotics in diabetic patients (25).…”

“…If the patient has renal complications, a dose adjustment of the drugs should be performed, using the creatinin clearance (1). It is recommended to associate antibiotic treatment when mechanical periodontal treatment is performed, and also administer an antibiotic prophylaxis (7,25). Osteoporosis present in type 1 DM requires great care when performing surgery, in order to prevent iatrogenic fractures (4).…”

Extraction Defect: Assessment, Classification and Management

“…The most common include smoking, poorly controlled diabetes, impaired liver function, drug or alcohol abuse, long-term corticosteroid use, and extreme age. 8,9 Diminished regenerative outcomes may be expected with medically compromised patients and surgical procedures modified to accommodate for these deficiencies. These modifications may include planning a more conservative implant treatment sequence, using autogenous bone over other biomaterials when needed, placing interpositional connective tissue grafts in order to pre-empt recession, and increasing the healing times.…”

Examination and Diagnosis

“…Generally, there is no evidence that diabetes is a contraindication to dental implant therapy, but as HbA1c may represent an independent factor correlated with postoperative complications and due to the known effects of hyperglycemic states on healing, medical advice and strict glycemic control before and after dental therapy are recommended [ 61 ]. Antimicrobial cover using penicillin, amoxicillin, clindamycin, or metronidazole should be provided during the implant surgery [ 62 ]. These patients should also quit smoking, optimize oral hygiene measures, and use antiseptic mouth rinses to prevent the occurrence of periodontal and peri-implant infections [ 1 ].…”