Dental Implants in The Medically Compromised Patie

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Chapter 5
Dental Implants in the Medically Compromised Patient

Population
Ayşe Sümeyye Akay and Volkan Arısan
Additional information is available at the end of the chapter
http://dx.doi.org/10.5772/intechopen.70182
Abstract
As a result of the increase of the life expectancy, elder people live with diverse diseases
or conditions like systemic disorders, immune-related disorders, and psychiatric issues.
Consecutively, practicing clinicians are faced with serving dental implant treatments in
such a population comprised of medical and demographic characteristics. Most com-
monly, implant therapy is performed among patients above middle ages; therefore,
clinicians often encounter medically compromised patients. The patients are usually
with adverse conditions like bleeding disorders, bone diseases, cardiovascular disease
(CVD), and/or immunologic conditions like cancer therapy, steroid or immunosuppres-
sive or antiresorptive medication, alcoholism, smoking, and many others. Nevertheless,
only few conditions could be stated for contraindication to dental implant therapy.
Besides the broad range of the mentioned dental implant comorbidities smoking seems
less prevalent compared to the general population. Dental implants in smoking patients
are certainly affected in relation to the failure rate, marginal bone loss, and some other
risks of postoperative complications. Hence, smoking or other similar conditions could
be accounted as a chronic systemic disorder just like diabetes mellitus or drug usage.
Briefly, it seems that establishing the medical and demographic conditions prior to
implant therapy along with controlling the systemic diseases or disorders may be more
important than the presence of compromise.
Keywords: systemic diseases, dental implant success, contraindication
1. Introduction
Dental implant (DI) is broadly considered to be the ideal treatment of the tooth loss, which is
mostly required in the aged population [1, 2]. The prevalent age-range for implant therapy has
been reported above 40 years [2] or between 51 and 60 years [1], thus the patients who required
© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
60 Clinical Trials in Vulnerable Populations
dental implant therapy are usually associated with systemic comorbidities. For both patients’
and clinicians’ benefit, systemic comorbidities of the patient should be well-diagnosed before
DI therapy. Besides, treatment plan and patient selection should be carried out with reference
to the clinical evidence. Patients should be ensured to inform thoroughly about the risks and
precautions.
2. Systemic disorders and compromised conditions

2.1. Elderly population
Aging has an effect on biological activity via altering the inflammatory, regenerative, and
remodeling phases of healing process. First, it makes inflammatory phase prolonged by pro-
moting the release of inflammatory mediators. Second, it decreases new tissue formation in the
regenerative phase by reducing angiogenesis and the number of mesenchymal stem cells,
which are the progenitors of new bone formation. Last, it causes an imbalance in bone
remodeling by changing cell activity, level of matrix metalloproteases, apoptosis, and collagen
turnover [3]. Therefore, it may not be wrong to consider that aging causes a delay on osseoin-
tegration of dental implants.
In the literature, there are eligible studies that have been conducted for long-term time periods
and the survival rate (SR) of dental implants is about 90% (Table 1). Furthermore, in a recent
meta-analysis, SR has been reported to be 91.2% for up to 10 years [4]. On the other hand,
considering the peri-implant pathology and bone level changes, studies have unsatisfactory
results. According to the aforementioned meta-analysis [4], there is only one prospective
clinical study that reports peri-implant marginal bone loss (MBL) after 10 years as 1.5 mm [5].
Additionally, another reviewer states that peri-implant mucositis and peri-implantitis are
observed more commonly in totally edentulous patients, which are mainly ≥65 years old [3].
2.2. Tobacco smoking

Tobacco consumption is one of the main considerable patient-related systemic conditions for
the patients who require DI. Though smoking is not a contraindication for DI therapy, there
have been a lot of studies that report negative effects on DI outcomes.
According to the clinical studies (Table 2), there is a tendency to consider that implant failure is
correlated with smoking habits. Most of the studies confirm the association between smoking
and increased failure rate of implants in both short- and long-term periods. Besides, tobacco
smoking has been proved to increase the failure rate of DI from 2.5- to 3-fold [9, 12]. However,
there is only one study that has showed a higher survival rate of DI in smoker patients [13].
People who consume 10–20 cigarettes daily are often counted as heavy smokers in clinical
studies. And despite a small number of studies that reveal the effect of the number of cigarettes
on failure, it has been demonstrated that consuming the 6–15 cig/day doubled the risk of
implant failure [9].
Dental Implants in the Medically Compromised Patient Population 61
Author, year, study Follow- No. of patients No. of SR of implant Peri-implant Conclusion
design up implants pathology
Moy et al., 2–20 541 subjects are ND 82% (for aged – Patients who are aged
2005, Retrospective years aged >60 years (4680 >60 years) >60 years have higher
cohort [6] (1140 total) total) risk for implant failure
(RR = 2.24)
Manor et al., 2009, 6 years 194 (2 equal 294 – Assigned as minor/ Old age may be a risk
Retrospective groups for moderate/major factor for late failures
cohort [7] evaluating MBL and risk is also more
early and late likely for men and
failures) posterior of jaws
Lee et al., 2010, 2.7 35 subjects are 118 – MBL: 0.27 mm Old age is not a risk
Prospective [8] years >70 aged factor for peri-implant
(mean) geriatric MCP MBL (p = 0.484)
with controlled
systemic
disease
Busenlechner et al., 8 years 2632 subjects ND 95.3% for the – Old age over 70 years
2014, Retrospective are >50 years age >70 years is not associated with
[9] (61% out of long-term implant
4316 total) success
Becker et al., 2015, 7 years 31 aged 84 94.6% for 13 MBL: 0.1 mm DI is successful in
Prospective [10] subjects patients with (difference of 0–7 aged population, and
40 implants years’ follow-up) MBL changes are
PD: 2.6 mm comparable with the
younger populations
Neves et al., 2016, 7.3 528 subjects are ND 92.7% for the 33.8% of patients >40 age is a risk factor
Retrospective [2] years aged >40 years (3998 age <40, 85.3% and 12.7% of of implant loss (risk is
(mean) (721 total MCP total) for age >40, implants have higher for more than
subjects with and 86.5% is pathology two times than <40
the age range of overall SR age), but is not a risk
20–87) (patient for peri-implant
based) pathology
Prasad et al., 2016, 5.7 Approximately ND 96.4% – Age over 65 years is
Retrospective years of the half of 1091 (1918 (implant shown to have an
cohort [11] mean total subjects is total) based), 94.6% increased risk of
aged >60 years (patient implant failure
based)
Hoeksema et al., 10 (1) 52 subjects (1) 104 (1) 97.1% MBL: 0.1 mm (1st Mandibular two-
2016, Prospective years with age range (2) 106 (2) 93.4% year), 0.7 mm (5th implant OD is equally
comparative [5] of 35–50 years year), 1.5 mm (10th successful in older
(2) 53 subjects year) patients compared
with age range PD: 3 mm for both with the younger
of 60–80 years groups at 10th year patients without
significant differences
of the parameters
Srinivasan et al., 1–10 206 subjects are 480 97.7% (1st MBL: 0.1–0.3 mm Age alone should not
2016, Sys. Rev., years aged ≥65 years year), 96.2% (1st year), 0.7 mm be a limiting factor for
meta-analysis [4] (5th year), (5th year), 1.5 mm DI therapy Reported
(includes 11 91.2% (10th (10th year) complications are
prospective year) found inadequate for
studies) a meta-analysis
Author, year, study Follow- No. of patients No. of SR of implant Peri-implant Conclusion
design up implants pathology
Mean/total of 1–20 4765 patients >1082 SR is 90% for 0.1 mm in the 1st, Implant therapy is a
values/subjects and years above middle long-term 1.7 mm in the 5th, successful treatment
considerations ages period and 1.5 mm in the in the medically
10th year follow- compromised patient
ups (out of 3 in
available 8 studies)
MCP, medically compromised patients; DI, dental implant; SR, survival rate; MBL, marginal bone loss; BoP, bleeding on
probing; RR, risk ratio; ND, no data available; OD, overdenture.
Table 1. Studies that indicate dental implant outcomes in the elderly population.
Regarding the MBL, smoking seems to have a destroying effect by increasing the annual rate of
MBL by 0.164 mm/year [14], and MBL is about 1.4 mm after 3 years with a statistically
significant difference from people who do not smoke tobacco [15, 16].
As a result, tobacco smoking alone is not contraindicated for DI, and DI survival is about 90%
for a long time period. On the other hand, smokers are under a higher risk of implant failure
compared to the nonsmokers. Thus, clinicians should take into account other concomitant
systemic factors which could increase the risk of failures.
2.3. Alcohol consumption
There is no evidence to suggest that alcoholism is a contraindication for DIs. SR of DI is similar

to healthy population with a reasonable alcohol consumption. Nevertheless, alcoholism is
claimed to increase the risk of complications for DI because it may cause many systemic
disorders like liver disease, bleeding disorders and osteoporosis (OP), and it may impair
immune response and some nutritional elements like folate and B vitamins, and it is often
associated with tobacco smoking [28].
It is reported that consumption of >10 g of alcohol increases the MBL and decreases DI survival
in humans [15]. Despite there are few studies available (Table 3) concerning the DI outcomes
in patients who consumed high level of alcohol, further clinical studies with well-defined
subjects are required for clarifying the relation.
2.4. Cardiovascular diseases
Cardiovascular disease (CVD) compromises the blood flow which may restrict oxygen or
nutrients in the osseous tissue, thus is hypothesized to have higher risk of osseointegration
failure [29–31]. Clinical studies and reviews demonstrate no evidence of contraindication
related to DI success in patients with CVD (Table 4), and this disease is registered as a relative
complication due to the risk of infective endocarditis. Antibiotic prophylaxis is necessary prior
to the surgery [31] according to the guidelines of the American Heart Association’s last
publish [32, 33].
Author, year, study design Follow-up No. of patients No. of implants SR of implant Peri-implant Conclusion
pathology
Ekfeldt et al., 2001, 8 years 54 total (half part is smoker, ND 31 DI loss in 7 6% of implants Except from instability associated
Retrospective controlled and 9 of them defined as heavy smokers had infection with bad bone quality, implant
study [17] (half of subjects lost heavy smokers who (at least half of during healing in losses mostly occur in patients with
at least half of their implants) consumed ≥10 cig/day) their implants) smokers heavy smoking habits or bruxism.
It is more prominent in post-
loading period (22 implants had
lost after loading in 7 patients of
heavy smokers)
Moy et al., 2005, 2–20 years 173 smoker ND 79.77% for – There is a correlation between
Retrospective [6] smokers smoking and increased failure rate
(RR = 1.56)
Galindo-Moreno et al., 2005, 3 years 63 smoker ND (514 total) – MBL is 1.36 mm MBL is significantly related to
Prospective [15] in smokers tobacco smoking
Alsaadi et al., 2007, Up to the ND (2004 total) 6946 total (343 92.95% for heavy – Smoking of >20 cig/day is shown
Dental Implants in the Medically Compromised Patient Population

Retrospective [18] abutment heavy smoker smokers significantly higher early implant
connection who consumed failure when compared to no
>20 cig/day) smoking groups
Holahan et al., 2008, 5 years 24 smoker 83 in smokers 88% for smokers – Implants placed in smokers are 2.6
Retrospective chart review [19] times more likely to fail than
implants placed in nonsmokers
Sverzut et al., 2008, <1 year 76 smoker (out of 650 total) 197 in smokers 97.19% for – Tobacco use alone cannot be
Retrospective [20] (1628 total) smokers, 96.68% considered as a factor for risk
for nonsmokers related to early implant failures
Alsaadi et al., 2008, 2 years 22 (>20 cig/day) 93 implants in 93.94% – Smoking does not seem
Retrospective [21] patients who predominant player for late
consumed >20 implant loss
cig/day
Alsaadi et al., 2008, <1 year 90 smoker 95 in smokers 94.44% – Tendency for more early implant
Prospective [22] failures is noticed in smokers
Lee et al., 2011, 5 years ND (95 total) ND (249 total) ND ND Implant failures are correlated with
Retrospective [23] smoking
Cakarer et al., 2014, 5 years ND 246 in smokers – Smoking is not affected the DI
Retrospective [24] survival
63
64
Clinical Trials in Vulnerable Populations
Author, year, study design Follow-up No. of patients No. of implants SR of implant Peri-implant Conclusion
pathology
97.5% (6 failed
out of 246
implant)
Busenlechner et al., 2014, 8 years 1726 smoker ND (13147 total) 76.5% for – Smoking increases the failure rate
Retrospective [9] smokers (overall by 3-fold 6–15 cig/day doubles the
SR is 97%) risk of implant failure
Tran et al., 2016, Retrospective 10 years 215 smoker (2729 total) – – Smoking increases the failure rate
chart review [12] by 2.6-fold
Krennmair et al., 2016, 3 years 9 smoker (out of 44 total) ND – 1.45* mm in Smoking is risk factors for MBL
Prospective cohort [16] smokers (OR: 8.9)
Neves et al., 2016, 7.3 years 476 smoker ND 85.1% (patient 36.6% pathology Smoking is not associated with
Retrospective [2] of mean based) rate (patient higher risk of implant failure and
based) peri-implant pathology (>4 mm
pocket depth with BoP or MBL)
Pedro et al., 2017, Analytical, 2–4 years ND (18 total) ND (57 total) – ND Smoking has an influence on both
observational, longitudinal mesial and distal bone loss (p =
study [25] 0.037)
Niedermaier et al., 2017, 7 years 141 smoker (out of 380 total) ND (2081 total) 98.6% for – Smokers have a significantly higher
Retrospective cohort [13] smokers, 96.1% DI survival rate than nonsmokers
for nonsmokers
Clementini et al., 2014, >1 year 478 smoker and 1207 ND ND Smoking Smoking has a harmful effect on
Systematic review and meta- nonsmoker increases the peri-implant bone loss. However,
analysis [14] annual rate of the level of evidence for oral
MBL by 0.164 implant therapy in patients with
mm/year systemic conditions is very low
Mean/total of values/subjects 1–20 years 3520 patients with smoking 1057 implants in SR is about 90% Apprx. 1.4 mm Smoking has a negative impact on
habits (13 out of 17 available smokers (6 out for smokers MBL after 3 years the success and survival of dental
studies) of 17 available implants
studies)
Statistically significant difference with healthy groups.DI, dental implant; SR, survival rate; MBL, marginal bone loss; BoP, bleeding on probing; OR, odds ratio; RR, risk
ratio; ND, no data available.
Table 2. Studies that indicate dental implant outcomes in patients with smoking habits.
Author, year, Follow- No. of patients No. of SR of Peri- Conclusion

study design up implants implant implant
pathology
Galindo-Moreno 3 years 23 alcohol users ND – MBL: 1.66 MBL is significantly related to

et al., 2005, mm a daily consumption of >10 g
Prospective [15] of alcohol
Gander et al., 20 33 (29 patients with 136 total 92.7% (at 1st – In head and neck oncology
2014, months SCC, 24 underwent year), 87.5% patients alcohol (p = 0.001) is
Retrospective [26] mandibular (after 20th associated with higher
reconstruction) month) implant failure rate
Scully et al., 2007, ND ND ND Similar to – May not be a risk for DI
Review [27] healthy
population
Diz et al., 2013, ND ND ND Similar to – May be at increased risk of
Review [28] healthy complications for DI
population
MBL, marginal bone loss; ND, no data available; SR, survival rate; SCC, squamous cell carcinoma; DI, dental implant.
Table 3. Studies that indicate dental implant outcomes in patients with alcohol abuse.
DI surgery is suggested as a legitimate procedure for the patients at high risk for IE (such as
aortic or mitral valve replacement or cyanotic congenital malformation) which under prophy-
lactic antibiotic regime of 2 g amoxicillin orally at 1 hour preoperatively [34]. There is also
evidence suggesting that this regimen significantly reduces failures of DIs though it is still
unknown whether postoperative antibiotics are more beneficial, and which antibiotic is the
most effective [33]. Reviewers stated the importance of concomitant bleeding or cardiac ische-
mia which could develop during DI insertion, therefore, procuring medical advice is
recommended prior to the implant surgery [28]. As a matter of fact, recent myocardial infarc-
tion, stroke, and cardiovascular surgery are well-known contraindications for performing DI
surgery [35].
According to the current literature, CVD does not hinder the osseointegration of DI [36, 37]
and is not associated with higher risk of implant failure (Table 4). SR is about 89% up to 20
years (Table 4). However, the number of the studies that reports peri-implant health condition
is insufficient. Unlike the other studies available, one study revealed that CVD has risk factors
for peri-implant bone loss with the mean value of 1.38 mm after 3 years [16]. Further studies
are needed in this respect.
2.5. Diabetes
As being the most prevalent endocrine disease, diabetes mellitus is a metabolic disorder that is
generally diagnosed by the characteristic symptoms of polydipsia, polyuria, and polyphagia in
correlation with exceeded blood glucose levels more than 200 mg/dL. It causes hyperglycemia
due to a defect of insulin secretion [39], that insulin has an effect on the regeneration of bone
matrix. In a diabetic patient, hyperglycemia reduces clot quality, number of osteoclasts, and
collagen production, which are the keys of bone regeneration [30].
66
Author, year, study Follow-up No. of patients No. of SR of implant Peri-implant Conclusion
design implants pathology
Moy et al., 2005, 2–20 years 1140 total (202 with ND (4680 total) 85% for – There is no correlation between hypertension,
Retrospective cohort [6] hypertension, 106 hypertension, coronary artery disease, pulmonary disease and
with CVD, 75 with 85% for CVD increased failure rate of DI
pulmonary disease)
Alsaadi et al., 2007, Up to the ND (2004 total) ND (6946 total) ND – Cardiac disease is not associated with increased
Retrospective [18] abutment incidence of the early failures
connection
Alsaadi et al., 2008, 2 years 19 subjects with CVD 76 in subjects 90.79% – Cardiac problem does not seem a predominant
Retrospective [21] with CVD player for late implant loss
Neves et al., 2016, 7.3 years 222 subjects with ND 89.2% (patient 32% (patient based) Cardiac disease is not associated with higher risk
Retrospective [2] of mean CVD based) of implant failure and peri-implant pathology
(>4 mm pocket depth with BoP or MBL)
Nobre et al., 2016, 5 years 70 total (CVD 352 CVD: 86.7%; MBL at 1st and 5th Implant rehabilitations represent a valid
Retrospective [38] after subjects: 38 patients; non-CVD: year is 0.95–1.52 mm in treatment for diabetic patients with or without
loading non-CVD subjects: 32 93.8% CVD; 0.78–1.54 mm in coexisting CVD, with a good risk/benefit ratio
patients) non-CVD group (nonsignificant differences between the groups)
Krennmair et al., 2016, 3 years 19 subjects with CVD ND – 1.38 mm in CVD* CVD is risk factors for bone loss. (OR: 5.1)
Prospective cohort [16] (out of 44 total)
Pedro et al., 2017, 2–4 years ND (18 total) ND (57 total) – ND Heart diseases are not a contraindication for DI
Analytical, bone loss
observational,
longitudinal [25]
Niedermaier et al., 7 years 95 subjects with CVD ND (2081 total) 97.8% – DI survival in patients with cardiovascular
2017, Retrospective (380 total) problems does not differ from the healthy
cohort [13] control subjects
Mean/total of values/ 2–20 years 1533 patients with 428 (in 2 out of Approx. 89% 0.95 mm at 1st year CVD may not pose a risk for dental implants
subjects CVD (in 6 out of 8 8 available SR 1.38 mm at 3rd year
available studies) studies) 1.52 mm at 5th year
Statistically significant difference with healthy groups.CVD, cardiovascular disease; RD, rheumatic disorders; OR, odds ratio; MBL, marginal bone loss; ND, no data
available; SR, survival rate.
Table 4. Studies that indicate dental implant outcomes in patients with cardiovascular diseases.
A decreased bone density is observed around the titanium implants in animal subjects, and
implant survival is slightly reduced in poor metabolic control [28] with an average rate of 89%
(Table 5). Yet no clinical evidence exists to establish an association of glycemic control with
implant failure because of the insufficient identification and reporting of glycemic control in
most of the published studies [40].
Though diabetes is not a contraindication for DI therapy, evaluating the HbA1c level of the
patient and chlorhexidine mouth wash and antibiotic prophylaxis are recommended in order
to reduce the relative risk of infection associated with diabetes [28, 30].
2.6. Bleeding disorders

There is no evidence to suggest that bleeding disorders (BDs) are contraindication for place-
ment of DIs [28] or a contraindication for implant survival/success [31]. Since the risk of
thromboembolism of interrupting or changing the antiplatelet therapy is higher than the risk
of hemorrhage caused by dental implant surgery, invasive dental procedures including dental
implant surgery are suggested to perform normally [42].
Considering the oral anticoagulant therapy (OAT), DI is not contraindicated in patients
under an OAT [28, 31]. Minor DI surgery (that does not involve autogenous bone grafts,
extensive flaps, or osteotomy preparations extending outside the bony envelope) is asserted
to be safe regarding the risk of hemorrhage in patients who have an INR value of 2–4, and
local hemostatic agents are suggested enough for these patients [43, 44]. On the other hand, it
should be noted that some medications that are commonly used in dental practice (like
metronidazole, erythromycin, and clarithromycin) may increase the anticoagulant effect of
warfarin [31].
There are some additional precautions for the patients with inherited BDs such as taking
medical advice previously, the replacement of deficient coagulation factor to reach a minimum
level of 50% before surgery, slow injection of local anesthesia with vasoconstrictor, the use of
antifibrinolytic agents (oral tranexamic acid and/or 5% tranexamic mouthwash) up to 7 days
postsurgically, and the use of topical antiseptics (chlorhexidine or povidone iodine) in order to
reduce the risk of local infection. Sinus lifting and bone graft procedures are recommended to
be avoided, and consulting for the use of nonsteroidal anti-inflammatory drugs is advised as
they may increase the risk of a dangerous hemorrhage [31].
Studies that analyze the bleeding risk and DI success after invasive DI surgeries are lacking
(Tables 6 and 7). Studies are also required for evaluating whether anticoagulants have an effect
on DI therapy negatively or which is the optimum drug or regimen.
2.7. Thyroid disorders

Thyroid hormones of triiodothyronine (T3) and thyroxine (T4) have been demonstrated to
have influence on cortical bone healing than cancellous bone around titanium implants [47].
Thus, thyroid hormones-related disorders could be regarded as the considerable issues for
evaluating the success of dental implants.
Author, year, Follow-up No. of No. of SR of Peri- Conclusion

study design patients implants implant implant
pathology
Moy et al., 2005, 2–20 years 48 diabetic ND 68.75% in – There is a correlation between
Retrospective diabetic diabetes and increased failure
cohort [6] patients rate (RR = 2.75)
Alsaadi et al., Up to the ND ND ND – Controlled diabetes type 2 is not
2007, abutment associated with increased
Retrospective [18] connection incidence of the early failures
Alsaadi et al., 2 years 9 33 100% – Diabetes type 2 does not seem
2008, predominant player for late
Retrospective [21] implant loss
Busenlechner 8 years 185 (4.3% out ND 95.1% for – Diabetes is not associated with
et al., 2014, of 4316 total) diabetes long-term implant survival (p =
Retrospective [9] (overall 0.928)
97%)
Neves et al., 2016, 7.3 years 56 diabetic ND 92.9% 26.8% Diabetes is not associated with
Retrospective [2] (mean) (patient patient higher risk of implant failure and
based SR) based peri-implant pathology (>4 mm
PD with BoP/MBL)
Niedermaier 7 years 9 ND 91.9% – DI survival in diabetic patients
et al., 2017, does not differ from the healthy
Retrospective control subjects
cohort [13]
Shi et al., 2016 ND 252 587 ND – There is no difference between
Meta-analysis the failure rates of the patients
[41] (abstract with uncontrolled and well-
available) controlled diabetes
Diz et al., 2013, ND ND ND Slightly – Evaluating the HbA1c level for
Review [28] reduced in patient selection, avoiding
bad hypoglycemia, using
metabolic chlorhexidine and antibiotic
control prophylaxis are recommended
for diabetic patients
Oates et al., 2013, Unrestricted – – Implant – Clinical evidence is lacking for
Review [40] failure rates the association of glycemic
ranging control with implant failure,
from 0 to because the identification and
9.1% reporting of glycemic control are
insufficient or lacking in most of
the published studies
Mean/total of 2–20 years 559 diabetic 620 (in 2 Approx. Diabetes may interfere with the
values/subjects patients (in 6 out of 7) 89% SR SC and SR pf implants
out of 7
available
studies)
DI, dental implant; BoP, bleeding on probing; MBL, marginal bone loss; ND, no data available; SR, survival rate; RR, risk
ratio; PD, pocket depth.
Table 5. Studies that indicate dental implant outcomes in patients with diabetes.
Author, year, Objective of the study No of Conclusion related to surgical risks of DI

study design patients
Clemm, 2016, Postoperative bleeding risk of patients 564 1. No thromboembolic complication occurred
Clinical continuing their anticoagulation therapy patients 2. The postoperative bleeding risk after
comparative (antiaggregant, vit-K inhibitors, vitamin- implant surgery and/or bone grafting pro-
study [45] K inhibitor withdrawal bridged with cedures is very low in patients continuing
heparin, direct oral anticoagulants) and the anticoagulant therapy
undergoing implant surgery and 3. The invasiveness of the surgical procedure
advanced bone grafting procedures had no statistically significant effect on
bleeding frequencies
4. Patients taking vit-K inhibitors had a sig-
nificantly higher risk of a postoperative
bleeding compared to patients without any
anticoagulant
5. Most of the postoperative bleedings are
easily controllable via local hemostatic
measures
Table 6. Hemorrhagic risks in patients undergoing advanced implant surgery and bone grafting procedures.
Author, year, study Follow-up No. of No. of SR of Peri- Conclusion

design patients implants implant implant
pathology
Markovic et al., 2016, 1 year 20 80 100% for – There is no difference between

Randomized both healing of the hydrophilic and
study [46] groups hydrophobic TiZr implant surface.
OAT influences the bone healing
by resulting in lower ISQ at 3rd
month in comparison with baseline
values, although without
compromising implant stability
OAT, oral anticoagulation therapy; ISQ, implant stability quotient; SR, survival rate.
Table 7. Studies that indicate dental implant outcome in patients with bleeding disorders or under an anticoagulant
therapy.
Concerning the peri-implant pathology, thyroid disorders are reported to have the lowest
potential risk compared to the other systemic disorders, in a recent clinical study [2] (Table 8).
Due to the limited number of clinical studies that report DI outcomes in patients with thyroid
disorders, it is hard to deduce a suggestion. Therefore, there is a certain need for further
studies about the thyroid disorders.
2.8. Hepatitis
Concerning the dental implantology, hepatitis is one other disease which has not been studied
widely yet. These infectious diseases impair immune system, increase oxidative stresses
induced by the viral proteins, and cause virus-associated organ damage including liver fibro-
sis, steatosis, or hepatocellular carcinoma [48].
Author, year, Follow-up No. of No. of SR of implant Peri- Conclusion

study design patients implants implant
pathology
Alsaadi et al., 2008, 2 years 25 Hypo- 111 Hypo- 93.69% Hypo- – Hypo- or hyperthyroidism
Retrospective [21] 6 Hyper- 22 Hyper- 86.36% Hyper- does not seem a predominant
player for late implant loss
Neves et al., 2016, 7.3 years 37 ND 86.5% (patient 18.9% Thyroid disorders are
Retrospective [2] of mean based SR) (patient associated with neither higher
based) risk of implant failure nor peri-
implant pathology (>4 mm PD
with BoP or MBL)
Mean/total of Up to 7 68 133 (in Further studies are required
values/subjects years one study
available)
BoP, bleeding on probing; MBL, marginal bone loss; ND, no data available; SR, survival rate; PD, pocket depth.
Table 8. Studies that indicate dental implant outcomes in patients with thyroid disorders.
Being one of the most spread and dangerous human pathogens, hepatitis C is shown to affect
the oral conditions by increasing decays, gingival bleeding, and pocket depth due to the
evident change in salivary flow [49].
Though hepatitis was indicated only as a possible risk factor previously [50], a present report is
registered that hepatitis is the only risk factor for peri-implant pathology among the other
systemic compromising factors such as cardiac diseases, thyroid disorders, diabetes, rheuma-
tologic disorders, HIV infection, and smoking [2] (Table 9).
2.9. Bone diseases
Being the most frequent bone disorder, osteoporosis (OP) affects both bone mass and density.
The effect is also more prominent in cancellous bone and in women [30].
Clinical studies have demonstrated that a SR of DIs in the patients with the diagnosis of OP is
about 94% (Table 10). Despite a small number of studies that report peri-implant conditions,
one study has presented a high rate of peri-implantitis in patients with OP (76.1%), but this
rate does not differ from the healthy population or the patients with osteopenia [51]. Regard-
ing the peri-implant MBL, one recent study has reported a mean value of 0.11 mm at first
Author, year, Follow- No. of No. of SR of Peri- Conclusion

study design up patients implants implant implant
pathology
Neves et al., 2016, 7.3 years 12 with ND 83.3% 66.7% Hepatitis is not associated with higher risk of
Retrospective [2] of mean hepatitis (patient (patient implant failure but it is a risk factor for peri-
based) based) implant pathology (OR = 3.74) (>4 mm PD
with BoP or MBL)
OR, odds ratio; BoP, bleeding on probing; MBL, marginal bone loss; ND, no data available; PD, pocket depth.
Table 9. Studies that indicate dental implant outcomes in patients with hepatitis.
Author, year, Follow-up No. of patients No. of SR of Peri-implant Conclusion

study design implants implant pathology
Alsaadi et al., Up to the ND ND ND – OP is found significantly

2007, abutment associated with early
Retrospective [18] connection implant failures (OR:
2.88)
Alsaadi et al., 2 years 19 subjects with 68 86.76% – OP does not seem
2008, OP predominant player for
Retrospective [21] late implant loss
Holahan et al., 5 years 41 with OP ND ND – OP or OPN is not a
2008, (21.4% of 192 contraindication to DI.
Retrospective total), 57 with No association between
chart review [19] OPN (29.7% of BMD T-score and DI
total) survival is found
Busenlechner 8 years 151 subjects with ND 94.4% for – OP is not associated with
et al., 2014, OP (3.5% out of OP- long-term implant
Retrospective [9] 4316 total) subjects survival (p = 0.661)
(overall
rate is
97%)
Dvorak et al., 6 years 47 subjects with ND 81% for Peri-implantitis There is no relation
2011, Cross- OP, 16 with OPN, OPN, rates: 75% in the between (neither OPN
sectional 140 are healthy 87% for OPN, 76.1% in nor OP) bone status and
study [51] controls OP, 87% OP group, 76.5% peri-implantitis or
for the in the control implant loss
control
Siebert et al., 1 year 24 women (the 120 100% ND The mean MBL is similar
2015, half was under iv. for both groups.
Comparative 5 mg zoledronic Immediate implant
prospective [54] acid once-yearly, osseointegration can be
others without successful in patients
OP) who received iv.
zoledronic acid
Chow et al., 2016, 5 year 79 subjects with 158 98.7% MBL 0.65 mm OP is not a
Prospective [53] OP BOP 49.6% contraindication for DI,
PI 47.4% and reduced skeletal
BMD is not associated
with increased MBL.
BOP is found
significantly correlated
with MBL
Niedermaier 7 years 7 subjects ND 94.1% – OP under the medication

et al., 2017, with BF seems to be a
Retrospective [13] risk factor for success of
DI
Temmerman 1 year 20 subjects with 63 in OP- 98.4% is MBL: 0.11 0.49 DI in patients suffering
et al., 2017, OP, 28 control patients, for OP mm for OP from OP/OPN is a
Prospective subjects 85 in group, group; 0.05 0.52 reliable treatment
nonrandomized control 100.0% is mm for control compared to healthy
controlled for group (implant patients. Long-term
multicenter [52] control based) follow-up is necessary
group
Author, year, Follow-up No. of patients No. of SR of Peri-implant Conclusion

study design implants implant pathology
Mean/total of 1–8 years 388 (in 8 out of 9 409 (in 4 94% SR Mean MBLs are Bone disease does not
values/subjects available studies) out of 9 in 0.11 mm at 1st seem to be associated
available patients year and 0.65 mm with the peri-implantitis
studies) with OP at 5th year or failure of DIs
follow-ups
OP, osteoporosis; OPN, osteopenia; OR, odds ratio; ND, no data available; BMD, bone mineral density; MBL, marginal
bone loss; DI, dental implant; SR, survival rate.
Table 10. Studies that indicate dental implant outcomes in patients with bone diseases.
year [52], and one other has reported a mean of 0.65 mm at fifth year [53]. Additionally, bone
status does not seem to be a predisposition for DI failures.
2.10. Rheumatologic disorders

Rheumatologic disorders encompass a large number of diseases and syndromes such as
rheumatoid arthritis, osteoarthritis, and osteoporosis, which are the most common rheumato-
logic diseases (RDs) [2]. Different RDs could affect DI success in different ways [28]. For
instance, rheumatoid arthritis (RA) has not stated a predominant player for late implant loss
in one study [21]. However, together with the connective tissue disease, RA increases bone
resorption when compared to the connective tissue disease alone [55].
Today, there are only a few number of clinical studies with limited amount of participants that
evaluate the success of DIs in patients with RD. Although RD was shown as risk factor for peri-
implant MBL in a recent prospective study [16], no relationship was found with the implant
failure risk or peri-implant pathology in another study [2]. Therefore it can be concluded that
any relation of RD in DI success is unclear, and there is a certain need for further studies with
sufficient number of participants (Table 11).
2.11. Bisphosphonate therapy
Bisphosphonates (BFs) suppress the osteoclast function and therefore are used for the treat-
ment of disorders causing abnormal bone resorption such as OP, malignancies (multiple
myeloma, bone metastases of breast, or prostate cancer), or nonmalignant bone diseases (the
most prevalent of osteoporosis and Paget disease) [30, 37].
According to the recent meta-analyses, the consumption of oral BF in patients with OP

could only be assumed to be a relative contraindication for DI. Further, there is no evi-
dence that any BFs have a negative impact upon implant survival. In this context, patients
should be informed about the related risks and DI could be placed under optimum oral
care conditions. On the contrary, in patients who are under BF treatment intravenously
together with RT doses of above 50 Gy, DI placement was reported to be a contraindica-
tion [30, 56].
Author, year, Follow- No. of No. of SR of Peri- Conclusion

study design up patients implants implant implant
pathology
Alsaadi et al., 2008, 2 years 6 patients 28 100% – RA does not seem predominant player for
Retrospective [21] with RD late implant loss
Krennmair et al., 3 years 6 patients ND – 1.61 mm RD is risk factors for bone loss (OR: 50.1)
2016, with RD in RD
Prospective [16] (44 total)
Neves et al., 2016, 7.3 36 – 80.6% 25% RDs are associated neither with higher risk
Retrospective [2] years patients (patient (patient of implant failure nor peri-implant
(mean) with RD based) based) pathology (>4 mm pocket depth with BoP
or MBL). However, it is associated with a
higher number of implant failures
RD, rheumatologic disease; RA, rheumatoid arthritis; BoP, bleeding on probing; MBL, marginal bone loss; DI, dental
implant; SR, survival rate; ND, no data available; OR, odds ratio.
Table 11. Studies that indicate dental implant outcomes in patients with rheumatologic disorders.
In conclusion, BFs do not seem to have an adverse effect on DI survival under optimum oral care
conditions, and OBFs are not associated with occurrence of osteonecrosis of jaws (ONJ) (Table 12).
2.12. Head and neck cancer

Squamous cell carcinoma, adenocarcinoma, and ameloblastoma are the most common malignan-
cies that are encountered in the head and neck regions. These patients with malignancies fre-
quently go under challenging adjuvant therapeutic procedures such as radiotherapy (RT) or
chemotherapy (CT) in addition to the tumor surgery. Due to the aggressive nature of the cancer
and challenging cancer therapies, it is difficult to manage the DI surgery and prosthetic procedures.
Furthermore, studies that evaluate the DI success in cancer patients are limited because most
of the studies had a control group of patients who are under another cancer treatment (instead
of a healthy control group) or have no control subjects to compare the success of dental
implants. Therefore, the results are sufficient to achieve a conclusion regarding DI success
(Tables 13 and 14). According to these clinical studies, CT does not seem to be associated with
the higher DI failure when compared with the surgical treatment only. RT seems to be
impairing the osseointegration process. Regardless of the cancer-treatment procedure,
smoking and alcohol consumption in patients diagnosed with head and neck cancer yield
higher implant failures. Additionally, there are no studies about implant therapy in patients
with malignant diseases that are treated with BFs [64], and no study determined peri-implant
conditions of DI in such patient population.
For improving the DI success in cancer patients, implant surgery is recommended to be

performed at least 21 days prior to the initiation or following after 9 months of radiotherapy
under a strict surgical asepsis and antimicrobial prophylaxis. Premature loading of the
implants should be avoided [28, 31].
Author, year, Follow- No. of No. of SR of implant Peri-implant Conclusion

study design up patients implants pathology
Jeffcoat, 2006, 3 years 50 (the half is 210 100% for OBF, – OBF usage is not associated
Longitudinal under OBF, and 99.2% for with occurrence of ONJ
single-blind the other half control group compared to placebo
controlled [57] is not used
BF)
Martin et al., >1 year 589 aged ND 26 implants loss – Implant failure occurred as
2010, Cohort [58] women in 16 patients early as 4 weeks and as late
as 11 years after placement
Famili et al., 2011, 1 year 211 women 347 98.7% – OBF therapy is not
Retrospective [59] significantly affects implant
success
Al-Sabbagh et al., 6 years 39 51 86.4% – It is suggested that there is a
2015, possible association between
Retrospective [60] implant failure and not using
of BF in elder patients (OR:
9.22)
Mozzati et al., 10 235 middle- 1267 98.7% (implant – The risk for developing
2015, Clinical years aged women based) 93.2% BRONJ associated to DI
chart review [61] under OBPs (patient based) surgery remains low for
for OP patients receiving oral BPs.
The use of procedures that
could enhance healing such
as platelet concentrates is
recommended
Siebert et al., 1 year 24 women 120 100% ND (MBL is Immediate implant
2015, (half under similar) osseointegration can be
Comparative iv. BF, others successful in a patient with
prospective [54] without OP) OP using once-yearly
infusion of 5 mg iv.
zoledronic acid
Suvarna et al., 3 years 112 (58 140 92% – No significant risk of implant
2016, patients on failure is seen in patients on
Retrospective [62] OBF therapy) OBP therapy compared with
healthy patients
Tallarico et al., 3 years 32 98 98% 1.35 0.21 No prosthesis failed during

2016, the entire follow-up, and no
Prospective [63] major complications were
recorded. OBF therapy is not
significantly affecting DI
success in case of accurate
treatment selection,
minimally invasive surgical
approach and constant
follow-up
Ata-Ali et al., 1–7 1288 patients 4562 Ranged between – There is not enough evidence
2016, Systematic years (386 cases (1090 DI 66.7 and 100% in that BFs have a negative
review and meta- and 902 in cases, BF users, 95.5 impact upon implant SR
analysis [56] controls) Further, prospective studies

3472 in and 100% in involving larger sample sizes

controls) nonusers and longer durations of
follow-up are required to
confirm these results
Mean/total of 1–10 1238 2233 (in 7 SR is about 97% 1.35 mm at BFs do not seem to have an
values/subjects years out of 8 in patients who 3rd year adverse effect on DI survival
available are under BFs follow-up (in under an optimum oral care
studies) therapy one study conditions, and OBFs are not
available) associated with occurrence of
ONJ
BF, bisphosphonate; OBF, oral bisphosphonate; OP, osteoporosis; BRONJ, BP-related osteonecrosis of the jaws; ONJ,
osteonecrosis of the jaws; MBL, marginal bone loss; DI, dental implant; SR, survival rate; ND, no data available.
Table 12. Studies that indicate dental implant outcomes in patients who underwent bisphosphonate treatment.
Author, year, Follow- No. of patients No. of SR of Peri- Conclusion

study design up implants implant implant
pathology
Kovacs, 2001, 10 30 (received 106 in CT 98.1% on – CT is not detrimental to the

Retrospective [65] years (3 postsurgical adjuvant group, implant survival and success of DIs
years of CT) and 17 (received 54 in basis in the mandible
mean) only oncological surgery
surgery) group
Cao and ? 27 total number of 131 total 65% on – Implants and prostheses in
Weischer, 2003 nonirradiated and patient basis irradiated patients have
[66] (abstract irradiated patients significantly lower survival
available) rates than in nonirradiated
patients
Korfage et al., 5 years 50 (18 patients were 195 (72 in 98.6% for – Implant loss is higher in
2011, treated with surgery surgery-, non-RT patients with head and
Prospective [67] only, 32 patients with and 123 in treated, neck cancer who received
RT in addition to the surgery + 89.4% for RT posttumor surgery
surgery) RT) RT-treated
group
Gander et al., 20 33 (29 patients with 136 total 92.5% (at 1st – Only smoking (p = 0.016)
2014, months SCC, 24 underwent year), 87.5% and alcohol abuse (p =
Retrospective [26] mandibular (after 20th 0.001) are associated with
reconstruction) month) higher implant failure rates
SCC, squamous cell carcinoma; CT, chemotherapy; RT, radiotherapy; DI, dental implant; SR, survival rate; ND, no data
available.
Table 13. Studies that indicate dental implant outcomes in head and neck oncology patients.
76
Author, year, Follow- No. of patients No. of implants SR of implant Peri- Conclusion
study design up implant
pathology
Moy et al., 2005, 2–20 22 patients received RT ND 68.18% in irradiated – There is a correlation between head and
Retrospective years patients neck radiation and increased failure rate (RR
cohort [6] = 2.73)
Alsaadi et al., 2 years 2 patients received RT 15 in irradiated patients 80% – RT is affected significantly the late implant
2008, loss (OR: 3.32)
Retrospective [21]
Carr, 2012, 2 years ND (412 total) ND (1512 total) ND ND Late implant failure is influenced by the
Retrospective local factor of “implant location” and the
case series [69] systemic factor of “radiotherapy”
Mancha, 2012, 5 years 30 RT-group, 20 control (non-RT 225 in RT group, 130 in 92.6% for irradiated – Irradiated patients have significantly higher
Retrospective [70] treated oral cancer group) control group (48.3% for ORN- implant loss than nonirradiated patients (p =
developed patients) 0.063)
Korfage et al., 14 164 patients with oral cancer 318 in RT-group, 206 in 91.5% for irradiated, – Implant loss is higher in irradiated patients
2014, years (also 91 of them are smoker, 65 nonirradiated group 99.5% for (p < 0.001) but no significant difference is
Retrospective [71] are nonsmoker) nonirradiated shown for bone loss assessed on panoramic
radiographs Smoking is also not found
associated with the occurrence of ORN
Rana et al., 2016, 5 years 46 patients with oral cancer 162 67% (52 implant had RT dose of <50 Gy units also showed
Retrospective [72] lost) significantly increased amount of implant
survival rate
Nooh, 2013, 1–14 944 patients with oral cancer 3775 88.9% (for 3357 – In preimplantation RT, SR of DI is
Systematic years implants) significantly higher for the mandible (93.3%)
Review [68] than for the maxilla (78.9%) or for grafted
bone (87.5%) While RT dose above 55 Gy
significantly decreased implant survival
Mean/total of 1–20 284 patients with oral cancer (in 720 implants in Approx. 83.07% SR RT, especially a dose above 50 Gy, negatively
values/subjects years 5 out of 6 available studies), 54 irradiated patients (in 4 in irradiated patients affects DI success
irradiated patients (in 3/6) out of 6 available
studies)
ORN, osteoradionecrosis; RT, radiotherapy; DI, dental implant; OR, odds ratio; RR, risk ratio; SR, survival rate; ND, no data available.
Table 14. Studies that indicate dental implant outcomes in patients who underwent radiation therapy.
2.12.1. Radiotherapy and hyperbaric oxygen therapy

RT reduces the cellular and vascular processes of healing, therefore it is assumed to impair the
osseointegration and increase the risk of DI-related complications [31]. RT doses higher than 50
Gy are known to hinder osseointegration of DIs [30]. On the other hand, DI placement
becomes contraindicated in patients who have received additional therapy of BFs intrave-
nously or hormonal therapy, corticosteroids or immunosuppressive medication [30].
According to the data retrieved from the recent studies, it can be concluded that implant loss
is clearly higher in irradiated patients (Table 14). The failures are more prominent in mandible
or in grafted bone [68].
In the past, adjuvant hyperbaric oxygen therapy (HBO) treatment was shown to lead lower DI
failure rates in cancer patients who underwent RT than those nonirradiated and irradiated
patients [73]. Whereas, according to the recent clinical studies and reviews (Table 15), it seems
that HBO has no positive effect on implant survival in irradiated patients. Therefore, this issue
remains controversial.

Schoen et al., 1 year 26 (the half ND 85.2% in HBO MBLs: 0.6 0.6 Adjuvant hyperbaric oxygen
2007, RCT [74] is HBO group, 93.9% mm in HBO-, 0.7 therapy does not influence
treated, in non-HBO 0.7 mm in non- implant survival or peri-
others is group HBO group implant MBL in radiated
control) mandibular jaw bone. There is
no statistically significant
difference for postoperative
complications and patient
satisfaction
Esposito and – – – – – Despite the limited amount of
Worthington, clinical research available, it
2013, appears that HBO therapy in
Systematic irradiated patients requiring
review [75] dental implants may not offer
any appreciable clinical
benefits. There is a definite
need for more RCTs to
ascertain the effectiveness of
HBO in irradiated patients
requiring dental implants
Chambrone – – 1689 in The mean SR – The risk of implant failure
et al., 2013, irradiated of 15 studies increases significantly in
Systematic jaws ranged from irradiated patients (RR: 2.74)
review [76] 46.3 to 98.0% and in maxillary sites (RR:
5.96). HBO therapy does not
reduce the risk of implant
failure
HBO, hyperbaric oxygen; RR, risk ratio; RCT, randomized controlled trial; MBL, marginal bone loss.
Table 15. The effect of hyperbaric oxygen (HBO) on reducing the risk of DI failure in irradiated patients.
2.13. Immunosuppressive conditions
Immunosuppressive disabilities encompass several disorders and conditions including RDs,

autoimmune skin diseases (scleroderma, pemphigus, burning mouth syndrome etc.), organ
transplantation, and immunosuppressive drug usage [2, 77, 78].
Since a good immune response is necessary for wound healing, immunocompromised condi-
tions have been commonly assumed as a contraindication for DI placement [31]. In animal
studies, it is showed that immunosuppressive drugs reduce osteoblast’s proliferation and
impair implant osseointegration [79, 80]. Furthermore, immunocompromised condition may
present additional risks for blood borne infections [28]. Therefore, installation of DIs in
patients under long-term immunosuppressive treatment should be elucidated with additional
measures [81].
2.13.1. Organ transplantation

Bone healing is negatively affected by immunosuppressive medications. There are reports of
case series and clinical studies that show successful treatments of DIs in patients who
underwent organ transplants (Table 16). Reviewers stated that DIs could be a valid treatment
providing that the appropriate surgical procedures and hygienic conditions are ensured
[28, 78]. Modification of the immunosuppressive medication could lead a significantly lower
toxicity [78].
As a conclusion, it is apparent that DI is not contraindicated for the patients who had organ
transplants. However, it is suggested that the patients’ medical condition should be investi-
gated with the relevant physician before DI surgery, and the surgery should also be conducted
under prophylactic medication in order to reduce the risk of blood-borne infections [28, 31].
2.13.2. HIV-positive patients

Acquired immune deficiency syndrome (AIDS) is a condition that is caused by the infection of
the human immunodeficiency virus (HIV). HIV-infected individuals may have compromised
oral health because of having HIV-associated gingivitis and periodontitis etc. [85] that yield an
additional impairment of the general health.
Recently, HIV-infection is regarded as a chronic disease rather than a terminal disease owing to
the therapeutic regimen of highly active antiretroviral therapy (HAART) that includes combi-
nations of diverse antiretroviral medications. This regimen, however, is associated with many
adverse effects including bone disorders, osteopenia, osteonecrosis, and osteoporosis [86, 87].
Hence, there is a need for identifying the predictability of dental implant therapy in patients
with HIV-infection.
According to the clinical studies available (Table 17), clinical outcomes regarding the peri-
implant pathology are conflicting. There may be a tendency for peri-implant infections due to
the immunocompromised condition. However, HIV infection does not seem to increase the
failure in the short or long term. So DI could be regarded as an eligible treatment for improv-
ing quality of life in the HIV-positive patients.
Author, year, Follow- No. of patients No. of SR of Peri-implant Conclusion

study design up implants implant pathology
Gu and Yu, 3 years 13 45 100% MBL is 1.30 mm DI treatment can be

2011, Case offered to liver transplant
series [82] patients who are stable
under long-term
immunosuppression.
Stable liver function and
general condition should
be affirmed though overall
examination and
consultation
Gu et al., 2011, 5 years 1 11 – – A stable osseointegration
Case report [83] with moderate vertical
(only abstract bone loss is achieved
available)
Montebugnoli 3 20 (10 have 32 (20 in – MBL is 0.21 mm for The bone response around
et al., 2012, months organ transplanted, transplanted, 0.32 submerged DI in
Prospective [84] transplant, the 12 in control mm is for control immunocompromised
other 10 are in group) group organ transplant patients
control group) does not differ from that
observed in control
patients
Montebugnoli 1 year 13 organ 29 in – For transplanted and It seems that bone and
et al., 2015, transplanted transplanted, control subjects, periodontal response and
Prospective [81] (11 hearts, two 28 in healthy MBLs are 0.17 and microbiological status
livers, and 13 control 0.20 mm, PDs are around submerged DI in
control subjects 0.06 and 0.11 mm immunocompromised
subjects) organ-transplanted
patients do not differ 1
year after loading from
those observed in healthy
control patients
Mean/total of 1–5 37 patients had 105 implants 100% 0.19 mm for 1st year SR outcome is scarce. MBL
values/subjects years organ- 1.30 mm at 3rd year seems acceptable More
transplant studies needed
MBL, marginal bone loss; DI, dental implant; SR, survival rate; PD, pocket depth.
Table 16. Studies that indicate dental implant outcomes in patients who received organ transplant.
2.14. Psychiatric disorders
Patients with neurologic disorders or other disabilities such as cerebral palsy, mental retarda-
tion, epilepsy, Down syndrome, Rett’s syndrome, Asperger syndrome, Prader-Willi syndrome,
fragile X chromosome, dystrophia myotonica, autism, and schizophrenia cause many prob-
lems during implant treatment and prosthetic maintenance [93]. Epilepsy impairs the oral
condition of patients due to nausea-induced vomiting, mechanical trauma caused by seizures,
and antiepileptic drugs-associated oral complications such as gingival overgrowth, xerostomia,
and yeast infections [94, 95]. Likewise, most widely used antidepressant drugs, selective seroto-
nin reuptake inhibitors (SSRIs), affect not only the nervous system but also peripheral tissues
80
Author, year, study Follow-up No. of patients No. of SR of implant Peri-implant pathology Conclusion
design implants
Stevenson et al., 6 months 20 HIV+, and 9 HIV 40 in HIV+, 18 100% for both – No difference in short-term clinical outcome is
2007, edentulous adults in HIV groups found between the HIV+ and the HIV subjects
Prospective [88] subjects
Oliveira et al., 2011, 1 year 40 (11 PI-based 60 (20 in each 100% for all 0.49 mm in PI-HAART The placement of DI in HIV+ patients is a
Pilot study [89] HAART, 14 NNRTI- groups) groups group, 0.47 mm in reasonable treatment, regardless of CD4+ cell
based HAART NNRTI-HAART and 0.55 count, viral load levels, and type of antiretroviral
without PI, 15 mm in control therapy. Longer follow-ups are necessary to
control group of who ascertain the success
had HIV )
Neves et al., 2016, 7.3 years 5 HIV+ ND 60% (patient 60% (patient-based peri- AIDS is not risk factor for neither higher implant
Retrospective [2] of mean based) implant pathology rate) failure nor peri-implant pathology (>4 mm pocket
depth with BoP or MBL). However, these rates are
high when compared mean failure rates of
population
Gherlone et al., 1 year 66 HIV+ 190 92.1% on MBL is 1.19 mm, peri- Despite higher incidence of peri-implant infections
2016, Prospective implant basis implantitis prevalence is in the first 6 months (a), DI is a suitable treatment
[90, 91] (a, b) 5.2% on implant basis (a, with a slightly worse results (a, b) regardless of
b) CD4+ cell count (b). HIV+ heavy smokers (>10 cig/
day) demonstrated increased risk of early failure,
peri-implantitis, pus, and pain (b)
Gay-Escoda et al., 6.5 years 9 HIV+ 57 98.3% Success rate: 68.4%. Though there is a high prevalence of peri-implant
2016, Retrospective of mean Patient- and implant- diseases, DI in HIV+ patients seem to provide
case series [92] based rates of peri- satisfactory clinical results
implant mucositis:
22.2%–10.5%, peri-
implantitis: 44.4%–45.6%
Mean/total of Up to 7.3 125 HIV+ patients 347 (in 4 out of Approx. 90% 0.83 mm MBL in 1st year. SR is acceptable. Mean MBL outcomes are scarce
values/subjects years 5 studies) SR 50% of peri-implant and conflicting. Peri-implant pathology incidences
pathology rate for mean seem higher as compared to the healthy
follow-up of 7 years population
HAART, highly active anti-retroviral therapy; PI, protease inhibitor; NNRTI, nonnucleoside reverse transcriptase inhibitor; MBL, marginal bone loss; BoP, bleeding on
probing; SR, survival rate; resp, respectively.
Table 17. Studies that indicate dental implant outcomes in HIV-infected patients.
Author, year, Follow- No. of patients No. of SR of Peri-implant pathology Conclusion

study design up implants implant
Cune et al., 2009, 16 61 patients 134 97.6% 72% of implants were Although adequate
Retrospective [95] years with epilepsy, considered having plaque control is not
additional inadequate level of feasible in those
motor and/or hygiene PD is 2 mm patients, MBLs
intellectual remained stable and
impairments implant loss is rare
Ekfeldt et al., 10 22 patients 70 85.8% Peri-mucositis: 14 DI is a valid option in
2013, years with different implants in 10 patients patients with ND,
Prospective [93] neurologic (PD ≥ 4 mm). Peri- although maintenance
disabilities implantitis: 4 implants often requires the
in 3 patients (bone loss ≥ management of more
3 threads) complications
compared with healthy
patients
Wu et al., 2014, 3–67 490 total 916 (94 in 88.4% – SSRI is associated with
Retrospective months number of users, 822 for increased failure risk of
cohort [98] SSRI-users and in users, osseointegrated
nonusers nonusers) 95.4% implants, which might
for suggest a careful
nonusers surgical treatment
planning for SSRI users
ND, neurologic disabilities; SSRI, selective serotonin reuptake inhibitor; PD, probing depth; MBL, marginal bone loss; SR,
survival rate.
Table 18. Studies that indicate dental implant outcomes in patients with psychiatric disorders.
including bones because of having serotonin receptors [96]. Therefore, SSRI blocks on bone cells
have been reported to affect bone formation negatively [97].
Since bone metabolism and oral conditions have an influence on the osseointegration of DI,
neuropsychiatric disabilities and the drugs used are considerable issues for DI treatment.
Clinical research related to the effect of psychiatric disorders on DI success is limited. It seems
that this kind of disorders do not cause higher failures or peri-implant pathology (Table 18).
On the other hand, SSRIs might increase DI failure rate as presented in a cohort study with a
large number of subjects. Further studies are required to ascertain the association between
antidepressant drugs and DI failure.
3. Conclusion
Implant survival in the elderly population, osteoporosis (OP) and HIV infection seem to be
similar with the healthy population. CVDs or diabetes may present a small risk. RT seems to
have the worst effect on DI success with an average SR of 83%. Some of the other compromised
conditions such as alcoholism, bleeding disorders, thyroid disorders, hepatitis, RDs, organ
transplantation, and HBO therapy should be investigated with additional clinical data to
reveal objective conclusions regarding DIs.
Results with regard to peri-implantitis or peri-implant conditions are insufficient and even
conflicting for majority of the compromising systemic aspects. Future studies should be
designed for indicating peri-implant tissue health and maintenance in compromised patients.
It must be taken into account that follow-up of the patients in a professional oral maintenance
regimen after implant placement reduces the implant failure rate by 80% [12]. Thus, it can be
stated that controlling the systemic diseases before the implant therapy and proper establish-
ment of the medical conditions are more important than the presence of a compromise alone.
Acknowledgements
This study was supported by Istanbul University Research Fund.
Author details
Ayşe Sümeyye Akay and Volkan Arısan*
*Address all correspondence to: [email protected]

Department of Oral Implantology, Faculty of Dentistry, Istanbul University, Çapa, Istanbul,
Turkey
References
[1] Austin S, Bailey D, Chandu A, Dastaran M, Judge R. Analysis of commonly reported

medical conditions amongst patients receiving dental implant therapy in private practice.
Australian Dental Journal. 2015;60(3):343-352. DOI: 10.1111/adj.12237
[2] Neves J, de Araújo Nobre M, Oliveira P, Martins Dos Santos J, Malo P. Risk Factors for Implant
Failure and Peri-Implant Pathology in Systemic Compromised Patients. J Prosthodont. 2016
Jun 27. DOI: 10.1111/jopr.12508. [Epub ahead of print]
[3] Bartold PM, Ivanovski S, Darby I. Implants for the aged patient: Biological, clinical and
sociological considerations. Periodontology 2000. 2016;72(1):120-134. DOI: 10.1111/prd.
12133
[4] Srinivasan M, Meyer S, Mombelli A, Müller F. Dental implants in the elderly population:
a systematic review and meta-analysis. Clin Oral Implants Res. 2017;28(8):920-930. DOI:
10.1111/clr.12898
[5] Hoeksema AR, Visser A, Raghoebar GM, Vissink A, Meijer HJ. Influence of age on
clinical performance of mandibular two-implant overdentures: A 10-year prospective
comparative study. Clinical Implant Dentistry and Related Research. 2016;18(4):745-751.

DOI: 10.1111/cid.12351
[6] Moy PK, Medina D, Shetty V, Aghaloo TL. Dental implant failure rates and associated risk
factors. The International Journal of Oral & Maxillofacial Implants. 2005;20(4):569-577
[7] Manor Y, Oubaid S, Mardinger O, Chaushu G, Nissan J. Characteristics of early versus
late implant failure: A retrospective study. Journal of Oral and Maxillofacial Surgery.
2009;67(12):2649-2652. DOI: 10.1016/j.joms.2009.07.050
[8] Lee HJ, Kim YK, Park JY, Kim SG, Kim MJ, Yun PY. Short-term clinical retrospective
study of implants in geriatric patients older than 70 years. Oral Surgery, Oral Medicine,
Oral Pathology, Oral Radiology, and Endodontics. 2010;110(4):442-446. DOI: 10.1016/j.
tripleo.2010.02.019
[9] Busenlechner D, Fürhauser R, Haas R, Watzek G, Mailath G, Pommer B. Long-term
implant success at the Academy for Oral Implantology: 8-year follow-up and risk factor
analysis. Journal of Periodontal & Implant Science. 2014;44(3):102-108. DOI: 10.5051/
jpis.2014.44.3.102
[10] Becker W, Hujoel P, Becker BE, Wohrle P. Dental implants in an aged population:
Evaluation of periodontal health, bone loss, implant survival, and quality of life. Clini-
cal Implant Dentistry and Related Research. June 2016;18(3):473-479. DOI: 10.1111/
cid.12340
[11] Prasad S, Hambrook C, Reigle E, Sherman K, Bansal N, Hefti A. Implant Treatment in the
Predoctoral Clinic: A Retrospective Database Study of 1091 Patients. J Prosthodont. 2016
Nov 22. DOI: 10.1111/jopr.12570
[12] Tran DT, Gay IC, Diaz-Rodriguez J, Parthasarathy K, Weltman R, Friedman L. Survival of
dental implants placed in grafted and nongrafted bone: A retrospective study in a uni-
versity setting. The International Journal of Oral & Maxillofacial Implants. 2016;31(2):310-
317. DOI: 10.11607/jomi.4681
[13] Niedermaier R, Stelzle F, Riemann M, Bolz W, Schuh P, Wachtel H. Implant-supported
immediately loaded fixed full-arch dentures: Evaluation of implant survival rates in a
case cohort of up to 7 years. Clinical Implant Dentistry and Related Research. 2017;19
(1):4-19. DOI: 10.1111/cid.12421
[14] Clementini M, Rossetti PH, Penarrocha D, Micarelli C, Bonachela WC, Canullo L. Sys-
temic risk factors for peri-implant bone loss: A systematic review and meta-analysis.
International Journal of Oral and Maxillofacial Surgery. 2014;43(3):323-334. DOI: 10.1016/
j.ijom.2013.11.012
[15] Galindo-Moreno P, Fauri M, Avila-Ortiz G, Fernández-Barbero JE, Cabrera-León A, Sá-
nchez-Fernández E. Influence of alcohol and tobacco habits on peri-implant marginal
bone loss: A prospective study. Clinical Oral Implants Research. 2005;16(5):579-586.
DOI: 10.1111/j.1600-0501.2005.01148.x
[16] Krennmair S, Weinländer M, Forstner T, Krennmair G, Stimmelmayr M. Factors affecting

peri-implant bone resorption in four Implant supported mandibular full-arch restora-
tions: A 3-year prospective study. Journal of Clinical Periodontology. 2016;43(1):92-101.
DOI: 10.1111/jcpe.12469
[17] Ekfeldt A, Christiansson U, Eriksson T, Lindén U, Lundqvist S, Rundcrantz T, Johansson
LA, Nilner K, Billström C. A retrospective analysis of factors associated with multiple
implant failures in maxillae. Clinical Oral Implants Research. 2001;12(5):462-467
[18] Alsaadi G, Quirynen M, Komárek A, van Steenberghe D. Impact of local and systemic
factors on the incidence of oral implant failures, up to abutment connection. Journal of
Clinical Periodontology. 2007;34(7):610-617. DOI: 10.1111/j.1600-051X.2007.01077.x
[19] Holahan CM, Koka S, Kennel KA, Weaver AL, Assad DA, Regennitter FJ, Kademani D.
Effect of osteoporotic status on the survival of titanium dental implants. The International
Journal of Oral & Maxillofacial Implants. 2008;23(5):905-910
[20] Sverzut AT, Stabile GA, de Moraes M, Mazzonetto R, Moreira RW. The influence of
tobacco on early dental implant failure. Journal of Oral and Maxillofacial Surgery. 2008;
66(5):1004-1009. DOI: 10.1016/j.joms.2008.01.032
[21] Alsaadi G, Quirynen M, Komárek A, van Steenberghe D. Impact of local and systemic
factors on the incidence of late oral implant loss. Clinical Oral Implants Research.
2008;19:670-676. DOI: 10.1111/j.1600-0501.2008.01534.x
[22] Alsaadi G, Quirynen M, Michiles K, Teughels W, Komárek A, van Steenberghe D. Impact

of local and systemic factors on the incidence of failures up to abutment connection with
modified surface oral implants. Journal of Clinical Periodontology. 2008;35(1):51-57. DOI:
10.1111/j.1600-051X.2007.01165.x
[23] Lee JY, Park HJ, Kim JE, Choi YG, Kim YS, Huh JB, Shin SW. A 5-year retrospective
clinical study of the Dentium implants. The Journal of Advanced Prosthodontics. Decem-
ber 2011;3(4):229-235. DOI: 10.4047/jap.2011.3.4.229
[24] Cakarer S, Selvi F, Can T, Kirli I, Palancioglu A, Keskin B, Yaltirik M, Keskin C. Investi-
gation of the risk factors associated with the survival rate of dental implants. Journal of
Implant Dentistry. 2014;23(3):328-333. DOI: 10.1097/ID.0000000000000079
[25] Pedro RE, De Carli JP, Linden MS, Lima IF, Paranhos LR, Costa MD, Bós ÂJ. Influence
of age on factors associated with peri-implant bone loss after prosthetic rehabilitation
over osseointegrated implants. The Journal of Contemporary Dental Practice. 2017;18
(1):3-10
[26] Gander T, Studer S, Studer G, Grätz KW, Bredell M. Medium-term outcome of Astra Tech
implants in head and neck oncology patients. International Journal of Oral and Maxillo-
facial Surgery. 2014;43(11):1381-1385. DOI: 10.1016/j.ijom.2014.05.005
[27] Scully C, Hobkirk J, Dios PD. Dental endosseous implants in the medically compromised
patient. Journal of Oral Rehabilitation. 2007;34(8):590-599. DOI: 10.1111/j.1365-2842.2007.
01755.x
[28] Diz P, Scully C, Sanz M. Dental implants in the medically compromised patient. Journal
of Dentistry. 2013;41(3):195-206. DOI: 10.1016/j.jdent.2012.12.008
[29] Elsubeihi ES, Zarb GA. Implant prosthodontics in medically challenged patients: The Uni-
versity of Toronto experience. Journal of the Canadian Dental Association. 2002;68(2):103-108
[30] Gómez-de Diego R, Mang-de la Rosa Mdel R, Romero-Pérez MJ, Cutando-Soriano A,
López-Valverde-Centeno A. Indications and contraindications of dental implants in med-
ically compromised patients: Update. Medicina Oral, Patología Oral y Cirugía Bucal
Journal. 2014;19(5):e483-e489
[31] Donos N, Calciolari E. Dental implants in patients affected by systemic diseases. British
Dental Journal. 2014;217(8):425-430. DOI: 10.1038/sj.bdj.2014.911
[32] Farbod F, Kanaan H, Farbod J. Infective endocarditis and antibiotic prophylaxis prior to
dental/oral procedures: Latest revision to the guidelines by the American Heart Associa-
tion published April 2007. International Journal of Oral and Maxillofacial Surgery.
2009;38(6):626-631. DOI: 10.1016/j.ijom.2009.03.717
[33] Esposito M, Worthington HV, Loli V, Coulthard P, Grusovin MG. Interventions for
replacing missing teeth: Antibiotics at dental implant placement to prevent complica-
tions. Cochrane Database of Systematic Reviews. 2010;(7):CD004152. DOI: 10.1002/
14651858.CD004152.pub3. https://www.ncbi.nlm.nih.gov/pubmed/20614437
[34] Findler M, Chackartchi T, Regev E. Dental implants in patients at high risk for infective
endocarditis: A preliminary study. International Journal of Oral and Maxillofacial Sur-
gery. 2014;43(10):1282-1285. DOI: 10.1016/j.ijom.2014.04.015
[35] Hwang D, Wang HL. Medical contraindications to implant therapy: Part I: Absolute contra-
indications. Implant Dentistry. 2006;15(4):353-360. DOI: 10.1097/01.id.0000247855.75691.03
[36] Hwang D, Wang HL. Medical contraindications to implant therapy: Part II: Relative con-
traindications. Implant Dentistry. 2007;16(1):13-23. DOI: 10.1097/ID.0b013e31803276c8
[37] Bornstein MM, Cionca N, Mombelli A. Systemic conditions and treatments as risks for
implant therapy. The International Journal of Oral & Maxillofacial Implants. 2009;24
(Suppl):12-27
[38] Nobre Mde A, Maló P, Gonçalves Y, Sabas A, Salvado F. Outcome of dental implants in
diabetic patients with and without cardiovascular disease: A 5-year post-loading retro-
spective study. European Journal of Oral Implantology. 2016;9(1):87-95
[39] Michaeli E, Weinberg I, Nahlieli O. Dental implants in the diabetic patient: Systemic and
rehabilitative considerations. Quintessence International. 2009;40(8):639-645
[40] Oates TW, Huynh-Ba G, Vargas A, Alexander P, Feine J. A critical review of diabetes,
glycemic control, and dental implant therapy. Clinical Oral Implants Research. 2013;24
(2):117-127. DOI: 10.1111/j.1600-0501.2011.02374.x
[41] Shi Q, Xu J, Huo N, Cai C, Liu H. Does a higher glycemic level lead to a higher rate of
dental implant failure?: A meta-analysis. Journal of the American Dental Association.
2016;147(11):875-881. DOI: 10.1016/j.adaj.2016.06.011
[42] Napeñas JJ, Hong CH, Brennan MT, Furney SL, Fox PC, Lockhart PB. The frequency of
bleeding complications after invasive dental treatment in patients receiving single and dual
antiplatelet therapy. Journal of the American Dental Association. 2009;140(6):690-695
[43] Madrid C, Sanz M. What impact do systemically administrated bisphosphonates have on

oral implant therapy? A systematic review. Clinical Oral Implants Research. 2009;20
(Suppl 4):87-95. DOI: 10.1111/j.1600-0501.2009.01772.x
[44] Bacci C, Berengo M, Favero L, Zanon E. Safety of dental implant surgery in patients
undergoing anticoagulation therapy: A prospective case-control study. Clinical Oral
Implants Research. 2011;22(2):151-156. DOI: 10.1111/j.1600-0501.2010.01963.x
[45] Clemm R, Neukam FW, Rusche B, Bauersachs A, Musazada S, Schmitt CM. Management
of anticoagulated patients in implant therapy: A clinical comparative study. Clin Oral
Implants Res. 2016;27(10):1274-1282. DOI: 10.1111/clr.12732
[46] Marković A, Đinić A, Calvo Guirado JL, Tahmaseb A, Šćepanović M, Janjić B. Random-
ized clinical study of the peri-implant healing to hydrophilic and hydrophobic implant
surfaces in patients receiving anticoagulants. Clin Oral Implants Res. 2016 Aug 18. DOI:
10.1111/clr.12948
[47] Feitosa Dda S, Bezerra Bde B, Ambrosano GM, Nociti FH, Casati MZ, Sallum EA, de
Toledo S. Thyroid hormones may influence cortical bone healing around titanium
implants: A histometric study in rats. Journal of Periodontology. 2008;79(5):881-887.
DOI: 10.1902/jop.2008.070466
[48] Smirnova OA, Ivanov AV, Ivanova ON, Valuev-Éllison VT, Kochetkov SN. Cellular
defense systems against oxidative and ER stresses: Mechanisms of regulation and influ-
ence of hepatitis C virus. Molecular Biology (Mosk). 2011;45(1):127-141
[49] Coates EA, Brennan D, Logan RM, Goss AN, Scopacasa B, Spencer AJ, Gorkic E. Hepati-
tis C infection and associated oral health problems. Australian Dental Journal. 2000;45:
108-114
[50] Marrone A, Lasserre J, Bercy P, Brecx MC. Prevalence and risk factors for peri-implant
disease in Belgian adults. Clinical Oral Implants Research. 2013;24(8):934-940. DOI:
10.1111/j.1600-0501.2012.02476.x
[51] Dvorak G, Arnhart C, Heuberer S, Huber CD, Watzek G, Gruber R. Peri-implantitis and
late implant failures in postmenopausal women: A cross-sectional study. Journal of Clin-
ical Periodontology. 2011;38(10):950-955. DOI: 10.1111/j.1600-051X.2011.01772.x
[52] Temmerman A, Rasmusson L, Kübler A, Thor A, Quirynen M. An open, prospective,
non-randomized, controlled, multicentre study to evaluate the clinical outcome of
implant treatment in women over 60 years of age with osteoporosis/osteopenia: 1-year
results. Clinical Oral Implants Research. 2017;28(1):95-102. DOI: 10.1111/clr.12766
[53] Chow L, Chow TW, Chai J, Mattheos N. Bone stability around implants in elderly
patients with reduced bone mineral density - a prospective study on mandibular
overdentures. Clin Oral Implants Res. 2017;28(8):966-973. DOI: 10.1111/clr.12907
[54] Siebert T, Jurkovic R, Statelova D, Strecha J. Immediate implant placement in a patient with
osteoporosis undergoing bisphosphonate therapy: 1-year preliminary prospective study.
Journal of Oral Implantology. 2015;41(1):360-365. DOI: 10.1563/AAID-JOI-D-13-00063
[55] Krennmair G, Seemann R, Piehslinger E. Dental implants in patients with rheumatoid
arthritis: Clinical outcome and peri-implant findings. Journal of Clinical Periodontology.
2010;37(10):928-936. DOI: 10.1111/j.1600-051X.2010.01606.x
[56] Ata-Ali J, Ata-Ali F, Peñarrocha-Oltra D, Galindo-Moreno P. What is the impact of
bisphosphonate therapy upon dental implant survival? A systematic review and meta-
analysis. Clinical Oral Implants Research. 2016;27(2):e38-e46. DOI: 10.1111/clr.12526
[57] Jeffcoat MK. Safety of oral bisphosphonates: Controlled studies on alveolar bone. The
International Journal of Oral & Maxillofacial Implants. 2006;21(3):349-353
[58] Martin DC, O'Ryan FS, Indresano AT, Bogdanos P, Wang B, Hui RL, Lo JC. Characteris-
tics of implant failures in patients with a history of oral bisphosphonate therapy. Journal
of Oral and Maxillofacial Surgery. 2010;68(3):508-514. DOI: 10.1016/j.joms.2009.09.055
[59] Famili P, Quigley S, Mosher T. Survival of dental implants among post-menopausal
female dental school patients takingoral bisphosphonates: A retrospective study. Com-
pendium of Continuing Education in Dentistry. 2011;32(6):E106-E109
[60] Al-Sabbagh M, Thomas MV, Bhavsar I, De Leeuw R. Effect of bisphosphonate and age on
implant failure as determined by patient-reported outcomes. Journal of Oral
Implantology. 2015;41(6):e287-e291. DOI: 10.1563/aaid-joi-D-14-00195
[61] Mozzati M, Arata V, Giacomello M, Del Fabbro M, Gallesio G, Mortellaro C, Bergamasco

L. Failure risk estimates after dental implants placement associated with plasma rich in
growth factor-Endoret in osteoporotic women under bisphosphonate therapy. Journal of
Craniofacial Surgery. May 2015;26(3):749-755. DOI: 10.1097/SCS.0000000000001535
[62] Suvarna S, Dutt P, Misra A, Usmani N, Singh A, Suvarna C. Intricate assessment and
evaluation of dental implants in patients on bisphosphonate therapy: A retrospective
analysis. The Journal of Contemporary Dental Practice. May 1 2016;17(5):414-417
[63] Tallarico M, Canullo L, Xhanari E, Meloni SM. Dental implants treatment outcomes in
patient under active therapy with alendronate: 3-year follow-up results of a multicenter
prospective observational study. Clinical Oral Implants Research. August 2016;27(8):943-
949. DOI: 10.1111/clr.12662
[64] Walter C, Al-Nawas B, Wolff T, Schiegnitz E, Grötz KA. Dental implants in patients
treated with antiresorptive medication—A systematic literature review. International
Journal of Implant Dentistry. 2016;2(1):9. DOI: 10.1186/s40729-016-0041-7
[65] Kovács AF. Influence of chemotherapy on endosteal implant survival and success in oral
cancer patients. International Journal of Oral and Maxillofacial Surgery. 2001;30(2):144-147
[66] Cao Y, Weischer T. Comparison of maxillary implant-supported prosthesis in irradiated

and non-irradiated patients. Journal of Huazhong University of Science and Technology.
Medical Sciences. 2003;23(2):209-212
[67] Korfage A, Schoen PJ, Raghoebar GM, Bouma J, Burlage FR, Roodenburg JL, Vissink A,
Reintsema H. Five-year follow-up of oral functioning and quality of life in patients with
oral cancer with implant-retained mandibular overdentures. Head Neck. 2011;33(6):831-
839. DOI: 10.1002/hed.21544
[68] Nooh N. Dental implant survival in irradiated oral cancer patients: A systematic review
of the literature. The International Journal of Oral & Maxillofacial Implants. 2013;28
(5):1233-1242. DOI: 10.11607/jomi.3045
[69] Carr AB. Implant location and radiotherapy are the only factors linked to 2-year implant
failure. Journal of Evidence-Based Dental Practice. 2012;12(3 Suppl):217-219. DOI:
10.1016/S1532-3382(12)70042-8
[70] Mancha de la Plata M, Gías LN, Díez PM, Muñoz-Guerra M, González-García R, Lee GY,
Castrejón-Castrejón S, Rodríguez-Campo FJ. Osseointegrated implant rehabilitation of
irradiated oral cancer patients. Journal of Oral and Maxillofacial Surgery. 2012;70
(5):1052-1063. DOI: 10.1016/j.joms.2011.03.032
[71] Korfage A, Raghoebar GM, Slater JJ, Roodenburg JL, Witjes MJ, Vissink A, Reintsema H.
Overdentures on primary mandibular implants in patients with oral cancer: A follow-up
study over 14 years. British Journal of Oral and Maxillofacial Surgery. 2014;52(9):798-805.
DOI: 10.1016/j.bjoms.2014.05.013
[72] Rana MC, Solanki S, Pujari SC, Shaw E, Sharma S, Anand A, Singh HP. Assessment of the
survival of dental implants in irradiated jaws following treatment of oral cancer: A
retrospective study. Nigerian Journal of Surgery. 2016;22(2):81-85
[73] Granström G, Tjellström A, Brånemark PI. Osseointegrated implants in irradiated bone:

A case-controlled study using adjunctive hyperbaric oxygen therapy. Journal of Oral and
Maxillofacial Surgery. 1999;57(5):493-499
[74] Schoen PJ, Raghoebar GM, Bouma J, Reintsema H, Vissink A, Sterk W, Roodenburg JL.
Rehabilitation of oral function in head and neck cancer patients after radiotherapy with
implant-retained dentures: Effects of hyperbaric oxygen therapy. Oral Oncology. 2007;43
(4):379-388
[75] Esposito M, Worthington HV. Interventions for replacing missing teeth: Hyperbaric
oxygen therapy for irradiated patients who require dental implants. The Cochrane
Database of Systematic Reviews. 2013;(9):CD003603. DOI: 10.1002/14651858.CD003603.
pub3. https://www.ncbi.nlm.nih.gov/pubmed/24085641
[76] Chambrone L, Mandia Jr J, Shibli JA, Romito GA, Abrahao M. Dental implants installed in
irradiated jaws: A systematic review. Journal of Dental Research. 2013;92(12 Suppl):119S-
130S. DOI: 10.1177/0022034513504947
[77] Zigdon H, Gutmacher Z, Teich S, Levin L. Full-mouth rehabilitation using dental

implants in a patient with scleroderma. Quintessence International. 2011;42(9):781-785
[78] Radzewski R, Osmola K. The use of dental implants in organ transplant patients under-
going immunosuppressive therapy: An overview of publications. Implant Dentistry.
2016;25(4):541-546. DOI: 10.1097/ID.0000000000000417
[79] Zheng X, Mo A, Wang Y, Guo Y, Wu Y, Yuan Q. Effect of FK-506 (tacrolimus) therapy on

bone healing of titanium implants: A histometric and biomechanical study in mice.
European Journal of Oral Sciences. 2017;125(1):28-33. DOI: 10.1111/eos.12320
[80] Annussek T, Kleinheinz J, Thomas S, Joos U, Wermker K. Short time administration of

antirheumatic drugs—Methotrexate as a strong inhibitor of osteoblast's proliferation
in vitro. Head & Face Medicine. 2012;8:26. DOI: 10.1186/1746-160X-8-26
[81] Montebugnoli L, Venturi M, Cervellati F, Servidio D, Vocale C, Pagan F, Landini MP,

Magnani G, Sambri V. Peri-implant response and microflora in organ transplant patients
1 year after prosthetic loading: A prospective controlled study. Clinical Implant Dentistry
and Related Research. 2015;17(5):972-982. DOI: 10.1111/cid.12207
[82] Gu L, Yu YC. Clinical outcome of dental implants placed in liver transplant recipients
after 3 years: A case series. Transplantation Proceedings. 2011;43(7):2678-2682. DOI:
10.1016/j.transproceed.2011.06.037
[83] Gu L, Wang Q, Yu YC. Eleven dental implants placed in a liver transplantation patient: A
case report and 5-year clinical evaluation. Chinese Medical Journal (England). 2011;124
(3):472-475
[84] Montebugnoli L, Venturi M, Cervellati F. Bone response to submerged implants in organ
transplant patients: A prospective controlled study. The International Journal of Oral &
Maxillofacial Implants. 2012;27(6):1494-1500
[85] Ryder MI, Nittayananta W, Coogan M, Greenspan D, Greenspan JS. Periodontal disease in
HIV/AIDS. Periodontology 2000. 2012;60(1):78-97. DOI: 10.1111/j.1600-0757.2012.00445.x
[86] Annapoorna N, Rao GV, Reddy NS, Rambabu P, Rao KR. An increased risk of osteopo-
rosis during acquired immunodeficiency syndrome. International Journal of Medical
Sciences. 2004;1(3):152-164
[87] Hofman P, Nelson AM. The pathology induced by highly active antiretroviral therapy
against human immunodeficiency virus: An update. Current Medicinal Chemistry.
2006;13(26):3121-3132
[88] Stevenson GC, Riano PC, Moretti AJ, Nichols CM, Engelmeier RL, Flaitz CM. Short-term
success of osseointegrated dental implants in HIV-positive individuals: A prospective
study. The Journal of Contemporary Dental Practice. 2007;8(1):1-10
[89] Oliveira MA, Gallottini M, Pallos D, Maluf PS, Jablonka F, Ortega KL. The success of
endosseous implants in human immunodeficiency virus-positive patients receiving anti-
retroviral therapy: A pilot study. Journal of the American Dental Association. 2011;142
(9):1010-1016
[90] Gherlone EF, Capparé P, Tecco S, Polizzi E, Pantaleo G, Gastaldi G, Grusovin MG.
Implant prosthetic rehabilitation in controlled HIV-positive patients: A prospective lon-
gitudinal study with 1-year follow-up. Clinical Implant Dentistry and Related Research.
2016;18(4):725-734. DOI: 10.1111/cid.12353
[91] Gherlone EF, Capparé P, Tecco S, Polizzi E, Pantaleo G, Gastaldi G, Grusovin MG. A
prospective longitudinal study on implant prosthetic rehabilitation in controlled HIV-
positive patients with 1-year follow-up: The role of CD4+ level, smoking habits, and oral
hygiene. Clinical Implant Dentistry and Related Research. 2016;18(5):955-964. DOI:
10.1111/cid.12370
[92] Gay-Escoda C, Pérez-Álvarez D, Camps-Font O, Figueiredo R. Long-term outcomes of

oral rehabilitation with dental implants in HIV-positive patients: A retrospective case
series. Medicina Oral, Patología Oral y Cirugía Bucal. 2016;21(3):e385-e391
[93] Ekfeldt A, Zellmer M, Carlsson GE. Treatment with implant-supported fixed dental
prostheses in patients with congenital and acquired neurologic disabilities: A prospective
study. The International Journal of Prosthodontics. 2013;26(6):517-524. DOI: 10.11607/
ijp.3511
[94] Stoopler ET, Sollecito TP, Greenberg MS. Seizure disorders: Update of medical and dental
considerations. General Dentistry. 2003;51(4):361-366; quiz 367
[95] Cune MS, Strooker H, van der Reijden WA, de Putter C, Laine ML, Verhoeven JW. Dental
implants in persons with severe epilepsy and multiple disabilities: A long-term retrospec-
tive study. The International Journal of Oral & Maxillofacial Implants. May-June 2009;24
(3):534-540
[96] Tsapakis EM, Gamie Z, Tran GT, Adshead S, Lampard A, Mantalaris A, Tsiridis E. The
adverse skeletal effects of selective serotonin reuptake inhibitors. European Psychiatry.
2012;27(3):156-169. DOI: 10.1016/j.eurpsy.2010.10.006
[97] Yadav VK, Ryu JH, Suda N, Tanaka KF, Gingrich JA, Schütz G, Glorieux FH, Chiang CY,
Zajac JD, Insogna KL, Mann JJ, Hen R, Ducy P, Karsenty G. Lrp5 controls bone formation
by inhibiting serotonin synthesis in the duodenum. Cell. 2008;135(5):825-837. DOI:
10.1016/j.cell.2008.09.059
[98] Wu X, Al-Abedalla K, Rastikerdar E, Abi Nader S, Daniel NG, Nicolau B, Tamimi F. Selective
serotonin reuptake inhibitors and the risk of osseointegrated implant failure: A cohort study.
Journal of Dental Research. 2014;93(11):1054-1061. DOI: 10.1177/0022034514549378

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Dental Implants in the Medically Compromised Patient

Ayşe Sümeyye Akay and Volkan Arısan

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Keywords: systemic diseases, dental implant success, contraindication

2. Systemic disorders and compromised conditions

2.2. Tobacco smoking

2.3. Alcohol consumption

There is no evidence to suggest that alcoholism is a contraindication for DIs. SR of DI is similar

2.4. Cardiovascular diseases

Dental Implants in the Medically Compromised Patient Population

Author, year, Follow- No. of patients No. of SR of Peri- Conclusion

Galindo-Moreno 3 years 23 alcohol users ND – MBL: 1.66 MBL is significantly related to

2.6. Bleeding disorders

2.7. Thyroid disorders

Author, year, Follow-up No. of No. of SR of Peri- Conclusion

Author, year, Objective of the study No of Conclusion related to surgical risks of DI

Author, year, study Follow-up No. of No. of SR of Peri- Conclusion

Markovic et al., 2016, 1 year 20 80 100% for – There is no difference between

Author, year, Follow-up No. of No. of SR of implant Peri- Conclusion

2.9. Bone diseases

Author, year, Follow- No. of No. of SR of Peri- Conclusion

Author, year, Follow-up No. of patients No. of SR of Peri-implant Conclusion

Alsaadi et al., Up to the ND ND ND – OP is found significantly

Niedermaier 7 years 7 subjects ND 94.1% – OP under the medication

Author, year, Follow-up No. of patients No. of SR of Peri-implant Conclusion

2.10. Rheumatologic disorders

2.11. Bisphosphonate therapy

According to the recent meta-analyses, the consumption of oral BF in patients with OP

Author, year, Follow- No. of No. of SR of Peri- Conclusion

2.12. Head and neck cancer

For improving the DI success in cancer patients, implant surgery is recommended to be

Author, year, Follow- No. of No. of SR of implant Peri-implant Conclusion

Tallarico et al., 3 years 32 98 98% 1.35  0.21 No prosthesis failed during

Author, year, Follow- No. of No. of SR of implant Peri-implant Conclusion

3472 in and 100% in involving larger sample sizes

Author, year, Follow- No. of patients No. of SR of Peri- Conclusion

Kovacs, 2001, 10 30 (received 106 in CT 98.1% on – CT is not detrimental to the

2.12.1. Radiotherapy and hyperbaric oxygen therapy

Author, year, Follow- No. of No. of SR of implant Peri-implant Conclusion

2.13. Immunosuppressive conditions

Immunosuppressive disabilities encompass several disorders and conditions including RDs,

2.13.1. Organ transplantation

2.13.2. HIV-positive patients

Author, year, Follow- No. of patients No. of SR of Peri-implant Conclusion

Gu and Yu, 3 years 13 45 100% MBL is 1.30 mm DI treatment can be

2.14. Psychiatric disorders

Author, year, Follow- No. of patients No. of SR of Peri-implant pathology Conclusion

This study was supported by Istanbul University Research Fund.

Ayşe Sümeyye Akay and Volkan Arısan*

*Address all correspondence to: [email protected]

[1] Austin S, Bailey D, Chandu A, Dastaran M, Judge R. Analysis of commonly reported

comparative study. Clinical Implant Dentistry and Related Research. 2016;18(4):745-751.

[16] Krennmair S, Weinländer M, Forstner T, Krennmair G, Stimmelmayr M. Factors affecting

[22] Alsaadi G, Quirynen M, Michiles K, Teughels W, Komárek A, van Steenberghe D. Impact

Tallarico et al., 3 years 32 98 98% 1.35 0.21 No prosthesis failed during