Vitamin D

Deficiency & Early

Implant Failure
Richard J. Miron, Michael A. Pikos, Mark Bishara,
What Every Clinician Should Know DDS, MSc, PhD DDS DDS

INTRODUCTION VITAMIN D DEFICIENCY

Dental implants are generally Vitamin D deficiency is a worldwide It is also important for other physiological functions,
considered a safe and highly public health problem that spans such as muscle strength, neuromuscular coordination,
predictable surgical procedure across all age groups from children to hormone release, and immune cell function.2 More
performed by many clinicians with adults. Naturally, as we age, our ability recently, vitamin D deficiency has also been linked
with up to a 300% increase in dental implant failure,
the aim of replacing missing teeth. to absorb vitamin D is also decreased.
and associations with other dental-related
Yet, to this day, a number of implants The major source of vitamin D is
complications are increasing.3-12 Optimizing vitamin
placed in adequate bone volume are directly from sunlight exposure along
D levels prior to surgery, therefore, becomes
lost each year within a 2- to 8-week with the very few foods that naturally
fundamental for maximizing wound healing, and this
period following implant placement contain sufficient doses. Unfortunately, article aims to discuss the relevant research on the
for unexplained reasons. direct sunlight has tremendously topic and its association with dental implant-related
decreased in modern society with the failures and bone grafting complications.
As society continues to consume increased number of desk-related jobs.
lower-quality foods and rely more Epidemiological studies have now Supplemental Recovery
heavily on fast foods, a large shown that roughly 70% of society is
percentage of today’s population is deficient.1 Program: The Science Behind
increasingly demonstrating generic Dental Healing
vitamin deficiency upon testing, Vitamin D deficiency is most known for
Owing to the impact of vitamin D deficiency-related
owing to this lack of nutritional its association in osteoporotic and
complications and failures in dentistry, clinicians are
intake. menopausal women. Few realize,
advised to use vitamin D supplements when
however, its drastic and substantial role
deficiency is observed. Typically, 5,000 IU/day is
These deficiencies are even more in various other diseases. These include recommended by the AACE; however, an 8- to 12-week
pronounced in the aging population, depression, dementia, Alzheimer’s supplementation period is needed to reach adequate
where a greater percentage of dental disease, asthma, cancer, cardiovascular levels.
implants are placed. Unfortunately, disease, and diabetes, among others.
one of the most prominent Vitamin D is essential for
deficiencies known to mankind is gastrointestinal calcium absorption,
that of vitamin D, a water-soluble mineralization of osteoid tissue, and
vitamin critical for proper immune maintenance of serum-ionized calcium
function as well as bone homeostasis. levels.

Figure 2. DentaMedica’s 6-week recovery

program aimed at optimizing vitamin D and
antioxidant levels prior to implant placement.
Vitamin D Deficiency & Early Implant
Failure: What Every Clinician Should
OPTIMIZING VITAMIN D LEVELS
Know
Serum 25-hydroxy vitamin D (25-OH) is the reliable marker of
vitamin D status, and a level below 20 ng/ml defines deficiency.
Optimal levels above 30 ng/ml are required to maximize the
bone health and non-skeletal benefits of vitamin D (Table 1). For
individuals undergoing any type of dental-related procedures,
levels between 40 and 60 ng/ml are generally recommended
since it is known that levels may decrease substantially
following a period of stress (simply, a dental surgical
intervention). Unfortunately, foods do not contain sufficient
levels.

Examples are cod liver oil (400 to 1,000 IU/teaspoon); fresh-

caught salmon (600 to 1,000 IU/3.5 oz vitamin D3); tuna (236
IU/3.5 oz vitamin D3); egg yolk (20 IU/yolk vitamin D3 or D2); and
fortified milk, cheese, or yogurt (100 IU/3 oz, usually vitamin D3).
These are low levels considering deficiency should be treated
with 4,000 to 6,000 IU/day for a 6- to 8-week period to restore
levels to sufficient values. According to AACE and ACE
guidelines, it is recommended that supplementation maintain THE ROLE OF ANTIOXIDANTS
levels above 30 ng/ml.13 The Endocrine Society in the United
States recommends achieving a concentration of more than 30 IN WOUND HEALING
ng/ml (> 75 nmol/L) of serum 25-OH,considering the optimal
range is 40 to 60 ng/ml (100 to 150 nmol/L).  In addition to bone-related deficiencies, several additional factors can
impair wound healing, such as infection found in periodontal disease,
The Endocrine Society also advocates an intake of 1,500 to poor diet, aging, diabetes, alcohol overuse, smoking, stress, and
2,000 IU/day (37.5 to 50 μg) in adults, and that obese patients impaired nutritional status.14-16 In recent years, reactive oxygen
(BMI > 30 kg/m2) should take 3 times more than the normal species (ROS) have gained attention because of their central role to
adult daily vitamin dose.13 Unfortunately, epidemiological the progression of many inflammatory diseases.
studies across the United States have routinely shown that
deficiencies of vitamin D are typically found in approximately 17 Excessive production of ROS or impaired ROS detoxification causes
70% of the population, and this deficiency is only expected to oxidative damage, which has been shown to be a main cause of non-
increase as the population works more indoors. The following healing chronic wounds and tissue degeneration.18,19To combat
research articles focus on the link between these deficiencies oxidative stress, all cells in the body require an intrinsic store of
and the associated risk for early dental implant failure. molecules known as “antioxidants,” which prevent tissue
damage.20 When this balance is shifted, however, high levels and
RELATED DENTAL COMPLICATIONS ASSOCIATED WITH activity of ROS cause DNA damage, protein damage, and lipid
VITAMIN D DEFICIENCY peroxidation. This leads to impairments in wound healing and many
Vitamin D plays an important role in supporting the immune long-term chronic degenerative diseases and whole-body tissue
system and the integration of various biomaterials. It is also inflammation, which are linked to common diseases such as
relevant for decreasing general oxidative stress and dementia and various cancers.
minimizing additional inflammation caused by surgery. As
Unfortunately, a large percentage
expressed previously, vitamin D is also involved in biomaterial
of the population today suffers
integration and other metabolic processes, such as bone
from vitamin and mineral
remodeling. Therefore, some complications have been related
deficiencies directly linked to
to vitamin D deficiency in the dental field.
antioxidant levels (Table 3). As a
result, it is clear that prior to any
In 2009, a first animal study investigated the role of vitamin D
major surgery, vitamin recovery
in dental implant osseointegration.9 Utilizing a rat model,
programs are indispensable to
implants were placed in both normal control and vitamin D-
help restore the patient’s levels
deficient animals and subjected to implant push-out tests, as
prior to surgery to prevent failure
well as histological analysis. The push-out tests revealed an
and/or delayed wound healing.
approximate 66% decrease in value in the vitamin D-deficient
Furthermore, restoring patient
group and also revealed significantly lower bone-to-implant
antioxidant levels remains a
contact as early as 14 days post-implant placement. It was
relatively easy and inexpensive radical scavenger and in the
concluded from this study that the effect of vitamin D
task. Vitamin C is, perhaps, one of synthesis of collagen hydroxylation
deficiency was unexpectedly profound. It was further
the most well-known antioxidants in humans.21
addressed that future clinical research would benefit patient
and has a primary function as a
care, owing to these observations.
It also contributes to immune defense by supporting
various cellular functions of both the innate and
adaptive immune systems. Vitamin C deficiency results
in impaired immunity and higher susceptibility to
infections.22 Vitamin C is found in many natural fruits
and vegetables, yet the population remains relatively
deficient, owing to the poor nutritional status
encountered in many patients.

VISIT DENTAMEDICA.US TO READ THE FULL ARTICLE