Impact of renin-angiotensin system inhibitors and beta-blockers on dental implant stability

Abstract

Background Current experimental research suggests antihypertensive medication reduces the failure risk of dental implants due to enhanced bone remodeling. However, evidence from clinical studies evaluating the impact of antihypertensive medication on implant stability is lacking. Methods We retrospectively analyzed 377 implants in 196 patients (46 implants inserted in antihypertensive drug users (AH) and 331 implants in non-users (NAH)) for implant stability measured by radiofrequency analysis, and we determined the implant stability quotient (ISQ). AH subgroups were stratified by the use of beta-blockers, renin-angiotensin system (RAS) inhibitors, and both of the aforementioned. The impact of antihypertensive medication on ISQ values at implant insertion (primary stability) and implant exposure (secondary stability) was analyzed by a linear regression model with a regression coefficient and its 95% confidence interval (95% CI), adjusted for potential confounders. Results Time between implant insertion and implant exposure was 117.1 ± 56.6 days. ISQ values at insertion were 71.8 ± 8.7 for NAH and 74.1 ± 5.6 for AH, respectively. ISQ at exposure was 73.7 ± 8.1 for NAH and 75.7 ± 5.9 for AH. Regression analysis revealed that none of the AH subgroups were significantly related to ISQ at implant insertion. However, renin-angiotensin system inhibitors (RAS) were significantly associated with higher ISQ values at exposure (reg. coeff. 3.59, 95% CI 0.46–6.71 (p=0.025)). Conclusions Outcome of the present study indicates enhanced bone remodeling and osseointegration following dental implant insertion in patients taking RAS inhibitors than in non-users. Future randomized prospective studies must confirm these indicative results.

Clinical Performance of CAD/CAM All-Ceramic Tooth-Supported Fixed Dental Prostheses: A Systematic Review and Meta-Analysis

“…Thus, the provided data did not allow for direct comparisons between metal-ceramics and all-ceramics restorations, as this would require an appropriate control group to calculate and compare the necessary effect sizes in a meta-analysis. Notably, patient diseases and medications can affect biological parameters such as periodontal bone quantity, and should be considered in future studies to account for these confounding factors [58][59][60][61]. Another limitation was the small number of studies focusing on long-term survival rates, which should be addressed in future studies.…”

Emerging factors affecting peri‐implant bone metabolism

“…An increased survival rate was found among the patients using antihypertensive medication (0.6% of failed implants in the AHTN group vs. 4.1% in the control population) 353 . Other retrospective study reported higher ISQ in patients taking antihypertensive medication (75.7 ± 5.9) compared with healthy patients (73.7 ± 8.1) 354 . But this higher implant stability was only statistically significant in patients taking renin‐angiotensin system inhibitors, while patients taking beta blockers showed a tendency to higher ISQ but without reaching statistical significance.…”

“…353 Other retrospective study reported higher ISQ in patients taking antihypertensive medication (75.7 ± 5.9) compared with healthy patients (73.7 ± 8.1). 354 But this higher implant stability was only statistically significant in patients taking renin-angiotensin system inhibitors, while patients taking beta blockers showed a tendency to higher ISQ but without reaching statistical significance. Another study analyzed the association of hypertension, antihypertensive drugs, and the absence of osseointegration of dental implants.…”

Hipertensión arterial asociada a osteoporosis en pacientes mujeres del hospital del Seguro Social, Trujillo

“…El aumento crónico de estos péptidos, sobre todo de la angiotensina II, la cual se ha demostrado que tiene un rol importante en el metabolismo óseo, por medio del siguiente sistema: el factor estimulante de colonias de macrófagos (M-CSF), la osteoprotegerina (OPG), el receptor activador del factor nuclear kappa B (RANK) y su ligando RANKL. Este sistema activa los osteoclastos por medio de los osteoblastos y provoca la resorción ósea y la disminución de la densidad ósea (22,23) .…”