Use of Systemic Steroids, Hormone Replacement Therapy, or Oral Contraceptives Is Associated with Decreased Implant Survival in Women.

BACKGROUND: Systemic steroids, such as prednisone, hormonal replacement therapies, or oral contraceptives, are commonly prescribed to women who might also be receiving dental implant therapy. However, the effect of these medications on dental implant survival is unknown. METHODS: The medical and dental records of individuals with dental implants (N = 1480 implants) who visited a postgraduate periodontics clinic between 2000 and 2017 were initially considered. Those younger than 21 years old, pregnant, or male were excluded according to the study's exclusion criteria. The presence of systemic diseases and conditions was assessed. Implant failure rates among female patients using systemic steroids, hormone replacement therapy, or oral contraceptives were compared with failure rates among patients not taking those medications. RESULTS: The implant failure rate for the 65 implants in patients taking steroid medications was 7.69%; the failure rate for the 712 implants in patients not taking steroids was 1.54% (p < 0.001). After adjusting for smoking and the presence of diabetes, that relationship persisted, with an 8.47% implant failure rate for the 59 implants in patients taking steroids (vs. 1.54% failure for the 585 implants in patients not taking steroids; p < 0.001). Regression analyses demonstrated that the odds of implant failure versus success were 5.31 times greater in patients taking systemic steroids, hormone replacement therapy, or oral contraceptives (p < 0.05). No statistically significant differences in patient plaque control were found between the experimental and control groups. CONCLUSIONS: Among women, the use of systemic steroids is associated with a five-fold increase in the rate of dental implant failure, regardless of the presence of smoking or diabetes.

The Effect of Hypothyroidism on Bone Loss at Dental Implants.

Hypothyroidism (HT) is an endocrine disorder characterized by abnormally reduced thyroid gland activity and is most commonly of autoimmune etiology. HT is associated with alterations in bone metabolism, and HT patients typically experience decreased bone resorption. The objective of this study was to use dental implants as standardized reference markers to compare the extent of alveolar bone loss in implant patients with and without HT. We examined medical and dental history records and radiographic data from 635 patients receiving 1480 implants during 2000-2017. The rate of bone loss was calculated from differences in radiographic bone levels over time, corrected for radiographic distortion. Peri-implant bone loss from patients with HT was significantly lower than for those without HT (t1252= -3.42; 95% confidence interval= 0.47-1.73; P < .001; M = 0.53 and 1.63 mm/yr, respectively). A similar relationship persisted after excluding smokers and diabetics and after additionally excluding those on systemic steroids, hormone replacement therapy, hormone medications, or autoimmune diseases other than HT. Our data suggest that patients with HT have a decreased rate of bone loss around dental implants and may not be at increased risk for dental implant failure. The decreased bone metabolic rate among patients with HT might contribute to those findings.

Effect of Proton Pump Inhibitors on Bone Loss at Dental Implants.

PURPOSE: Proton pump inhibitors (PPIs) are prescribed for the treatment of gastric reflux disease, but such medications might also influence bone metabolism. Therefore, the primary goal of this study was to determine if bone loss severity at dental implants could be associated with PPI use. MATERIALS AND METHODS: Dental, medical, and radiographic history records of patients receiving dental implants at the University at Buffalo, School of Dental Medicine from 2000 to 2017 were reviewed in this retrospective clinical study. Bone loss around each implant was evaluated radiographically by direct measurement of crestal bone loss and by counting the number of radiographically evident exposed threads. PPI use was confirmed by medical record examination. The effects of systemic factors were assessed. Confidence intervals (CI) and P values of mean differences between PPI and non-PPI groups were computed via IBM SPSS Statistics v.25. RESULTS: A total of 1,480 implants from 635 patients were used in this study. Greater crestal implant bone loss was associated with patients with a history of PPI medication use. Mean crestal bone loss of 1.60 mm was noted at implants from PPI patients, in contrast to 1.01 mm of crestal implant bone loss at implants from the non-PPI group (group difference = 0.59 mm, 58.40% increase, P = .024, CI [95%] = 0.08 to 1.09 mm). Following adjustment for systemic factors, those effects persisted, with crestal implant bone loss of 1.87 mm from PPI patients, in contrast to 1.04 mm from non-PPI patients (group difference = 0.83 mm, 79.80% increase, P = .028, CI [95%] = 0.09 to 1.56 mm). Similarly, 0.63 exposed threads per implant were found in the PPI group, in contrast to 0.38 supracrestal implant threads in the non-PPI patient group (mean difference = 0.25 exposed threads, 65.8% increase, P = .039, CI [95%] = 0.01 to 0.50 mm). After excluding systemic factors, a similar pattern was observed with 0.79 vs 0.36 threads exposed from subjects taking PPIs, compared with those not taking PPIs, respectively (mean difference = 0.43 exposed threads, 119.4% increase, P = .014, CI [95%] = 0.09 to 0.77 mm). CONCLUSION: The data suggest that PPI medications are related to more loss of crestal bone at implant sites. Patients receiving implant therapy might require more frequent periodontal maintenance.