Medical Contraindications to Implant Therapy: Part I: Absolute Contraindications

Abstract

In order to ensure implant success, it is essential to select patients who do not possess local or systemic contraindications to therapy. Hence, it is the purpose of this paper to review the medical diseases that reportedly preclude conventional dental implant treatment. Absolute contraindications to implant rehabilitation include recent myocardial infarction and cerebrovascular accident, valvular prosthesis surgery, immunosuppression, bleeding issues, active treatment of malignancy, drug abuse, psychiatric illness, as well as intravenous bisphosphonate use. Any of these conditions bar elective oral surgery, and require judicious monitoring by the physician as well as the dental provider. Noncompliance to the suggested protocol may, in the worst possible case, result in patient mortality.

Examination and Diagnosis

“…Most studies that involve implant placement in irradiated bone reflect this. Additionally, active use of cytotoxic anticancer drugs, which induce rapid granulocytopenia, followed by thrombocytopenia, may contraindicate implant rehabilitation [ 22 ]. There are, though, a very limited number of investigations on chemotherapeutic effects on implant survival.…”

“…There are different studies, mainly retrospective ones, that deal with the impact of medical/systemic factors and/ or medications on the outcome osseointegrated implants, but the extrapolation of their results should be cautious, since it is not possible to collect much information from such studies if not much insight into the occurrence and nature of systemic disease is given [ 18,19 ]. Several authors have also identified diseases for which dental implants are not recommended, or are at least questionable, but it often remains unclear what type of evidence these statements are based on [20][21][22][23]. Therefore, it still remains a debated question whether some systemic factors/medications compromise the achievement of an intimate bone to implant interface and what their role is during the healing time [ 18,19 ].…”

“…All but the autograft fall subject to endocarditis, as well as regurgitation, stenosis, and degeneration. Because the patient on such regimens cannot mount an appropriate response to wounding from surgery, implantation is prohibited [ 22 ]. The total dose of ionizing radiation for cancer treatment ranges from 50 to 80 Gy.…”

“…• Group 1 (very high risk Other reported relative contraindications include adolescence, ageing, osteoporosis, smoking, diabetes, positive interleukin-1 genotype, HIV positivity, cardiovascular disease, hypothyroidism, and Crohn's disease [ 22 ].…”

“…The patient may pursue elective dental care only if at least 6 months have passed since the ischemic incident and they obtain medical clearance. Additionally, the health-care professional must be aware of any anticoagulant or thrombolytic therapy administered and understand that the desire for oral implants does not necessarily justify interruption of a therapeutic INR [ 22 ].…”