Authored by Dr Dominique Laatz MSc. MSc. (Oral Surgeon and Implantologist at the German Dental & Dermatology Clinic)
Introduction:
Dental implants have become the best standard in tooth replacement for adult patients. Compared to other restorative options, they exhibit the highest success rates in long-term studies and give patients the highest confidence, when it comes to solid food.
Since implant restorations are bone-supported and dental implants are placed in direct bone contact, bone quality and quantity are major factors to consider beforehand.
Naturally, potential implant patients suffering from Osteoporosis – a condition affecting the bone density negatively – will automatically ask themselves or their doctors, whether this could affect their prospects for having dental implants or not.
Osteoporosis and Implants:
To properly answer this medical question, a thorough look at the current scientific literature is a must, to understand the scientific evidence for all different scenarios. Most authors agree, that outcomes (for example long-time survival rates) of dental implants in patients with Osteoporosis are not worse than in patients who don’t suffer from this condition. Hence, Osteoporosis is not, in medical terms would be considered a so-called contraindication for having dental implants.
The Exception:
But, especially one particular contraindication, which results from the treatment of severe and otherwise non-responsive forms of post-menopausal Osteoporosis needs to be mentioned. In some cases, this phenomenon is treated by so-called Bisphosphonates – a medication, that seeks to achieve to stop a disadvantageous, osteoporosis-typical bone remodeling, by tuning down the process of bone remodeling altogether.
Unfortunately, as a result of this intended process, bony wounds often show a delayed and incomplete healing process, with a significant number of bony complications – namely the formation of osteonecrosis bone sequesters. This unwanted side effect is mainly triggered by tooth extractions, but also – to a lesser extent – by dental implant placement.
Not every Bisphosphonate-Therapy is tantamount to a permanent, absolute contraindication for dental implants, though. Especially, if Bisphosphonates were given in cases of Osteoporosis as opposed to treating or prevent bone metastastazations and if they have been administered orally as opposed to intravenous injections, most authors and specialists, do not see it as an absolute and permanent contraindication.
Another factor to consider is the duration of the Bisphophonat-Treatment, with shorter treatment periods being considered more favourable than extended ones.
Summary:
Patients with Osteoporosis should know, that implants are widely considered unproblematic in most cases among experts and the overwhelming part of current scientific data from controlled clinical trials and meta-analyses to the specific topic.
The data largely suggests, no statistically significant differences in the outcome of dental implants, when patients with Osteoporosis were compared to a non-osteoporosis control group.
However, in cases where Osteoporosis was treated with Bisphosphonates, extreme caution is required. Bisphosphonate-induced bony sequesters after tooth extractions and – though less frequently – dental implants are serious unwanted events, which should therefore be avoided.
The patient should inform the respective dental practitioner or implantologist beforehand, to give the opportunity for a proper risk assessment & management and to explore possible alternative treatment options.
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