Dental implants in individuals living with HIV-1: Results from a prospective study in patients undergoing highly active antiretroviral therapy.

OBJECTIVE: To assess survival and success rates of dental implants and the occurrence of peri-implant diseases (mucositis/peri-implantitis) in HIV-1-infected individuals. MATERIAL AND METHODS: In this prospective study, 13 HIV-1-infected individuals undergoing highly active antiretroviral therapy (with undetectable plasma HIV RNA levels, and CD4+ T cells > 350/mm3 ) were followed after implant placement, as well as 13 non-HIV-1-infected matched controls. Patients enrolled in this study were followed up to 120 months (mean = 40.6 months; standard deviation = 22.2; range 18 -120 months). Twenty-five implants were placed in pristine healed sites for each group and bone augmentation procedures, when needed, were done only for contour augmentation. Patients were enrolled in a strict periodontal/peri-implant supportive therapy protocol with three recalls per year. The two groups were compared regarding subject-level characteristics (age, gender, smoking, diabetes) and implant-level characteristics (marginal bone level, peri-implant health status). RESULTS: All the implants healed uneventfully and reached 100% survival rates (after at least 18 months) in both groups. There were no significant differences between groups for peri-implant diseases (mucositis/peri-implantitis) and for all subject-level co-variables (p > .05). Only the variables dental implant prosthesis type (DIPT) (p = .021, d = .86) and follow up (p = .011, d = .77) showed statistically significant differences between groups. CONCLUSION: The findings suggest that well-controlled HIV-1-infected individuals are eligible to undergo implant therapy, achieving survival and success rates comparable to non-HIV-1-infected controls.

Dental implants and bone augmentation in HIV-infected patients under HAART: Case report and review of the literature.

The present study reviewed the literature regarding dental implants in HIV-infected patients and reports the long-term follow-up of three clinical cases of patients under HAART that received bone augmentation and dental implants. The first case presents a young patient with a large defect in the mandible, as a consequence of a longitudinal fracture, that was treated with guided bone regeneration (GBR) previously to implant placement. The second case reported is middle-aged man with a fractured upper lateral incisor treated with immediate placement and simultaneous GBR to repair the dehiscence due to the buccal bone resorption. The third case shows an elderly patient that underwent sinus lifting with the simultaneous placement of two implants. All cases were treated after patients were medically controlled and followed for at least 10 years. Controlled HIV-infected patients undergoing HAART may be candidates to implant rehabilitation, as long as their plasmatic HIV viral load and CD4+ T lymphocytes count are within the parameters that indicate immune stability. Long-term stability of soft and hard tissues can be obtained maintaining function and esthetics. However, stronger evidence, based on prospective, controlled clinical trials is needed to provide the dental and medical teams with conclusive data.