Risks and countermeasures of dental implant treatment in osteoporosis patients

doi:10.12337/zgkqzzxzz.2024.08.003

Abstract

Abstract: Osteoporosis (OP) is a systemic skeletal disease with the main characteristic of reduction of bone density and low bone mass. With the increasing age of the population, the incidence of OP increases year by year. Replacement of missing teeth with dental implants is one of the most common treatment options with a high success rate. However, in patients with OP, deterioration of bone tissue may lead to an increased risk of implant failure. Although OP is not a contraindication for implant therapy, clinicians should still pay great attention to associated risk factors. This article discusses the alveolar bone modeling and remodeling, the success rates of dental implants, the influence of anti-osteoporosis drugs, and the strategy of dental implant treatment in OP patients for clinical reference.

Key words: Osteoporosis, Dental implant, Osseointegration, Marginal bone loss

Liu Zhonghao, Dong Kai. Risks and countermeasures of dental implant treatment in osteoporosis patients[J]. Chinese Journal of Oral Implantology, 2024, 29(4): 303-310.

References

[1] 中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南(2022)[J].中国全科医学, 2023, 26(14):1671-1691. DOI: 10.12114/j.issn.1007-9572. 2023.0121.
[2] 中华医学会骨质疏松和骨矿盐疾病分会. 中国骨质疏松症流行病学调查及"健康骨骼"专项行动结果发布[J]. 中华骨质疏松和骨矿盐疾病杂志, 2019,12(4):317-318.
[3] Wagner F, Schuder K, Hof M, et al.Does osteoporosis influence the marginal peri-implant bone level in female patients? A cross-sectional study in a matched collective[J]. Clin Implant Dent Relat Res, 2017,19(4):616-623. DOI: 10.1111/cid.12493.
[4] Lemos C, de Oliveira AS, Faé DS, et al. Do dental implants placed in patients with osteoporosis have higher risks of failure and marginal bone loss compared to those in healthy patients? A systematic review with meta-analysis[J]. Clin Oral Investig, 2023,27(6):2483-2493. DOI: 10.1007/s00784-023-05005-2.
[5] Arioka M, Zhang X, Li Z, et al.Osteoporotic changes in the periodontium impair alveolar bone healing[J]. J Dent Res, 2019,98(4):450-458. DOI: 10.1177/0022034518818456.
[6] Chambrone L.Current status of the influence of osteoporosis on periodontology and implant dentistry[J]. Curr Opin Endocrinol Diabetes Obes, 2016,23(6):435-439. DOI: 10.1097/MED.0000000000000272.
[7] Singhal S, Chand P, Singh BP, et al.The effect of osteoporosis on residual ridge resorption and masticatory performance in denture wearers[J]. Gerodontol, 2012,29(2):e1059-e1066. DOI: 10.1111/j.1741-2358.2011.00610.x.
[8] Lu B, Zhang X, Liu B.A systematic review and meta-analysis on influencing factors of failure of oral implant restoration treatment[J]. Ann Palliat Med, 2021,10(12):12664-12677. DOI: 10.21037/apm-21-3449.
[9] Lotz EM, Cohen DJ, Schwartz Z, et al.Titanium implant surface properties enhance osseointegration in ovariectomy induced osteoporotic rats without pharmacologic intervention[J]. Clin Oral Implants Res, 2020,31(4):374-387. DOI: 10.1111/clr.13575.
[10] Overmann AL, Aparicio C, Richards JT, et al.Orthopaedic osseointegration: implantology and future directions[J]. J Orthop Res, 2020,38(7):1445-1454. DOI: 10.1002/jor.24576.
[11] Monje A, Ravidà A, Wang HL, et al.Relationship between primary/mechanical and secondary/biological implant stability[J]. Int J Oral Maxillofac Implants, 2019,34:S7-S23. DOI: 10.11607/jomi.19suppl.g1.
[12] Merheb J, Temmerman A, Rasmusson L, et al.Influence of skeletal and local bone density on dental implant stability in patients with osteoporosis[J]. Clin Implant Dent Relat Res, 2016,18(2):253-260. DOI: 10.1111/cid.12290.
[13] 宿玉成. 口腔种植学: 第2版 [M]. 北京:人民卫生出版社, 2014.
[14] Fini M, Giavaresi G, Torricelli P, et al.Osteoporosis and biomaterial osteointegration[J]. Biomed Pharmacother, 2004,58(9):487-493. DOI: 10.1016/j.biopha.2004.08.016.
[15] Zhou Y, Hu Z, Ge M, et al.Intraosseous injection of calcium phosphate polymer-induced liquid precursor increases bone density and improves early implant osseointegration in ovariectomized rats[J]. Int J Nanomedicine, 2021,16:6217-6229. DOI: 10.2147/IJN.S321882.
[16] 葛畅, 孟维艳. 骨质疏松症患者种植修复的研究进展[J].中华老年口腔医学杂志,2023,21(3):173-177. DOI: 10.19749/j.cn.cjgd.1672-2973.2023.03.010.
[17] Temmerman A, Rasmusson L, Kübler A, et al. A prospective, controlled, multicenter study to evaluate the clinical outcome of implant treatment in women withosteoporosis/osteopenia: 5-year results[J]. J Dent Res, 2019,98(1):84-90. DOI: 10.1177/0022034518798804.
[18] Liapaki A, Chen Y, Hadad H, et al.Evaluation of oral implant survival rate in postmenopausal women with osteopenia/osteoporosis. A retrospective pilot study[J]. J Stomatol Oral Maxillofac Surg, 2022,123(6):e777-e781. DOI: 10.1016/j.jormas.2022.06.023.
[19] Albrektsson T, Zarb G, Worthington P, et al.The long-term efficacy of currently used dental implants: a review and proposed criteria of success[J]. Int J Oral Maxillofac Implants, 1986,1(1):11-25.
[20] Lemos C, Verri FR, Noritomi PY, et al. Effect of bone quality and bone loss level around internal and external connection implants: a finite element analysis study[J]. J Prosthet Dent, 2021,125(1):137.e1-137.e10. DOI: 10.1016/j.prosdent.2020.06.029.
[21] Davies JE.Understanding peri-implant endosseous healing[J]. J Dent Educ, 2003,67(8):932-949.
[22] Simons WF, De Smit M, Duyck J, et al.The proportion of cancellous bone as predictive factor for early marginal bone loss around implants in the posterior part of the mandible[J]. Clin Oral Implants Res, 2015,26(9):1051-1059. DOI: 10.1111/clr.12398.
[23] Tabrizi R, Mousavi F, Ghasemi S, et al.Does osteoporosis increase marginal bone loss around dental implants in the posterior of the maxilla?[J]. Int J Oral Maxillofac Surg, 2021,50(7):964-968. DOI: 10.1016/j.ijom.2020.12.001.
[24] 中国药学会医院药学专业委员会. 骨质疏松症治疗药物合理应用专家共识(2023)[J].中国医院药学杂志, 2024,44(9):985-1006. DOI: 10.13286/j.1001-5213. 2024.09.01.
[25] Soares AP, do Espírito Santo RF, Line SR, et al. Bisphosphonates: pharmacokinetics, bioavailability, mechanisms of action, clinical applications in children, and effects on tooth development[J]. Environ Toxicol Pharmacol, 2016,42:212-217. DOI: 10.1016/j.etap.2016.01.015.
[26] Tsolaki IN, Madianos PN, Vrotsos JA.Outcomes of dental implants in osteoporotic patients. A literature review[J]. J Prosthodont, 2009,18(4):309-323. DOI: 10.1111/j.1532-849X.2008.00433.x.
[27] Dental management of patients receiving oral bisphosphonate therapy: expert panel recommendations[J]. J Am Dent Assoc, 2006,137(8):1144-1150. DOI: 10.14219/jada.archive.2006.0355.
[28] Gelazius R, Poskevicius L, Sakavicius D, et al.Dental implant placement in patients on bisphosphonate therapy: a systematic review[J]. J Oral Maxillofac Res, 2018,9(3):e2. DOI: 10.5037/jomr.2018.9302.
[29] Kwon TG, Lee CO, Park JW, et al.Osteonecrosis associated with dental implants in patients undergoing bisphosphonate treatment[J]. Clin Oral Implants Res, 2014,25(5):632-640. DOI: 10.1111/clr.12088.
[30] Vohra F, Al-Rifaiy MQ, Almas K, et al.Efficacy of systemic bisphosphonate delivery on osseointegration of implants under osteoporotic conditions: lessons from animal studies[J]. Arch Oral Biol, 2014,59(9):912-920. DOI: 10.1016/j.archoralbio.2014.05.016.
[31] Chen B, Li Y, Yang X, et al.Zoledronic acid enhances bone-implant osseointegration more than alendronate and strontium ranelate in ovariectomized rats[J]. Osteoporos Int, 2013,24(7):2115-2121. DOI: 10.1007/s00198-013-2288-7.
[32] Cheng YC, Ewers R, Morgan K, et al.Antiresorptive therapy and dental implant survival: an up to 20-year retrospective cohort study in women[J]. Clin Oral Investig, 2022,26(11):6569-6582. DOI: 10.1007/s00784-022-04609-4.
[33] Ervolino da Silva AC, de Souza Batista FR, Hassumi JS, et al. Improvement of peri-implant repair in estrogen-deficient rats fed a cafeteria diet and treated with risedronate sodium[J]. Biology (Basel), 2022,11(4):578. DOI: 10.3390/biology11040578.
[34] Stavropoulos A, Bertl K, Pietschmann P, et al.The effect of antiresorptive drugs on implant therapy: systematic review and meta-analysis[J]. Clin Oral Implants Res, 2018,29(Suppl 18):S54-S92. DOI: 10.1111/clr.13282.
[35] Al-Nawas B, Lambert F, Andersen S, et al.Group 3 ITI consensus report: materials and antiresorptive drug-associated outcomes in implant dentistry[J]. Clin Oral Implants Res, 2023,34(Suppl 26):S169-S176. DOI: 10.1111/clr.14135.
[36] 中华医学会骨质疏松和骨矿盐疾病分会. 地舒单抗在骨质疏松症临床合理用药的中国专家建议[J].中华骨质疏松和骨矿盐疾病杂志,2020,13(6):499-508. DOI: 10.3969/j.issn.1674-2591.2020.06.002.
[37] Park S, Heo HA, Min JS, et al.Effect of raloxifene on bone formation around implants in the osteoporotic rat maxilla: histomorphometric and microcomputed tomographic analysis[J]. Int J Oral Maxillofac Implants, 2020,35(2):249-456. DOI: 10.11607/jomi.7811.
[38] Park S, Heo HA, Kim KW, et al.Expression of osteogenic markers after administration of selective estrogen receptor modulators during implant placement in the osteoporotic rat maxilla[J]. J Oral Sci, 2022,64(1):53-58. DOI: 10.2334/josnusd.21-0316.
[39] de Souza Santos AM, Dos Santos Pereira R, Montemezzi P, et al. The interplay of raloxifene and sonochemical bio-oss in early maxillary sinus bone regeneration: a histological and immunohistochemical analysis in rabbits[J]. Medicina (Kaunas), 2023,59(9):1521. DOI: 10.3390/medicina59091521.
[40] Apostu D, Lucaciu O, Lucaciu GD, et al.Systemic drugs that influence titanium implant osseointegration[J]. Drug Metab Rev, 2017,49(1):92-104. DOI: 10.1080/03602532.2016.1277737.
[41] Chen BL, Xie DH, Zheng ZM, et al.Comparison of the effects of alendronate sodium and calcitonin on bone-prosthesis osseointegration in osteoporotic rats[J]. Osteoporos Int, 2011,22(1):265-270. DOI: 10.1007/s00198-010-1186-5.
[42] Januário AL, Sallum EA, de Toledo S, et al. Effect of calcitonin on bone formation around titanium implant. A histometric study in rabbits[J]. Braz Dent J, 2001,12(3):158-162.
[43] Nociti FH Jr, Sallum AW, Sallum EA, et al.Effect of estrogen replacement and calcitonin therapies on bone around titanium implants placed in ovariectomized rats: a histometric study[J]. Int J Oral Maxillofac Implants, 2002,17(6):786-792.
[44] Chiba K, Okazaki N, Kurogi A, et al.Randomized controlled trial of daily teriparatide, weekly high-dose teriparatide, or bisphosphonate in patients with postmenopausal osteoporosis: the TERABIT study[J]. Bone, 2022,160:116416. DOI: 10.1016/j.bone.2022.116416.
[45] Gomes-Ferreira P, de Oliveira D, Frigério PB, et al. Teriparatide improves microarchitectural characteristics of peri-implant bone in orchiectomized rats[J]. Osteoporos Int, 2020,31(9):1807-1815. DOI: 10.1007/s00198-020-05431-y.
[46] Kim JY, Park JH, Jung HD, et al.Treatment of medication-related osteonecrosis of the jaw around the dental implant with a once-weekly teriparatide: a case report and literature review[J]. J Oral Implantol, 2019,45(5):403-407. DOI: 10.1563/aaid-joi-D-19-00040.
[47] Zidrou C, Kapetanou A, Rizou S.The effect of drugs on implant osseointegration - a narrative review[J]. Injury, 2023,54(8):110888. DOI: 10.1016/j.injury.2023.110888.
[48] Miller PD, Adachi JD, Albergaria BH, et al.Efficacy and safety of romosozumab among postmenopausal women with osteoporosis and mild-to-moderate chronic kidney disease[J]. J Bone Miner Res, 2022,37(8):1437-1445. DOI: 10.1002/jbmr.4563.
[49] Falco A, Berardini M, Trisi P.Correlation between implant geometry, implant surface, insertion torque, and primary stability: in vitro biomechanical analysis[J]. Int J Oral Maxillofac Implants, 2018,33(4):824-830. DOI: 10.11607/jomi.6285.
[50] Cinar D, Imirzalioglu P.The effect of three different crown heights and two different bone types on implants placed in the posterior maxilla: three-dimensional finite element analysis[J]. Int J Oral Maxillofac Implants, 2016,31(2):e1-e10. DOI: 10.11607/jomi.4048.
[51] Andrés-García R, Vives NG, Climent FH, et al.In vitro evaluation of the influence of the cortical bone on the primary stability of two implant systems[J]. Med Oral Patol Oral Cir Bucal, 2009,14(2):e93-e97.
[52] Hindi AR, Bede SY.The effect of osseodensification on implant stability and bone density: a prospective observational study[J]. J Clin Exp Dent, 2020,12(5):e474-e478. DOI: 10.4317/jced.56727.
[53] Alghamdi HS.Methods to improve osseointegration of dental implants in low quality (type-IV) bone: an overview[J]. J Funct Biomater, 2018,9(1):7. DOI: 10.3390/jfb9010007.
[54] Sun X, Yang S, Tong S, et al.Study on exosomes promoting the osteogenic differentiation of adscs in graphene porous titanium alloy scaffolds[J]. Front Bioeng Biotechnol, 2022,10:905511. DOI: 10.3389/fbioe.2022.905511.
[55] 张婷婷, 李潇, 刘莉. 骨质疏松状态下不同种植体表面涂层改性技术对种植体骨结合的影响[J].口腔颌面修复学杂志, 2023,24(5):395-400. DOI: 10.19748/j.cn.kqxf.1009-3761. 2023.5.014.