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Does Chronic Use of Corticosteroids Affect the Osseointegration

of Dental Implants? - A Literature Review

Authors: Yoonsuk Choi, Angela De Bartolo, DDS, and Analia Veitz-Keenan, DDS

Implants have widely been accepted as the for several medical conditions including placement showed a significant protective
most popular option for prosthetic resto- systemic lupus erythematosus, rheumatoid association with implant failure. In other
ration of edentulous spaces. A critical deter- arthritis, fibromyalgia, and localized sclero- words, the use of corticosteroids decreased
minant of the success of dental implants is derma. the risk of dental implant failure. The hazard
osseointegration. ratio (HR) was 0.72 in univariable associa-
The patient was taking 10 mg of Prednisone tion and 0.82 in multivariable association. A
Osseointegration (systemic corticosteroids), 100 mg of Gab- hazard ratio of 0.82 signifies that corticoste-
Osseointegration is the functional connec- apentin (GABA analog), and 10 mg of Oxy- roid use provides an 18% risk reduction in
tion between living bone and the surface of a codone (opioid analgesic). dental failure rate compared to patients who
load-bearing implant. Stability after place- are not taking corticosteroids. A p-value less
1
ment of the implant is required for long- The systemic conditions seemed under con- than <0.05 shows the association between
term implant success. Primary mechanical trol through daily medications and opioid corticosteroid use and implant failure rate
stability is achieved during placement of the analgesics, which are directed to take as and that an 18% risk reduction is statistical-
implant and is determined by how well the needed. The patient did not utilize any to- ly significant.
threads of the implant are able to biomechan- bacco products.
ically lock into the bone. Secondary stabil- When corticosteroid treatment was initiated
2 .
ity is achieved through osseointegration. So why explore the relationship between after the placement of implants, there was
Overall, implant placement is an objectively corticosteroids and successful osseointe- still no association with the failure of dental
predictable procedure with a high success gration of dental implants? As mentioned implants.
rate. The literature suggests a 95% success above, corticosteroid intake is known to
rate after 10 years of observation and fol- suppress osteoblastic activity, which affects In the study, The impact of glucocorticoste-
low-up. The osseointegration and, ultimate- the bone healing process. It also suppresses roids administered for systemic diseases on
3
ly the success of the implant, is dependent the immune response, which puts patients at the osseointegration and survival of dental
on certain risk factors such as bone quality, a higher risk of getting peri-implantitis. The implants placed without bone grafting-A
smoking, parafunctional habits, and medica- purpose of this review is to assess the associ- retrospective study in 31 patients, conduct-
tions including thiazide diuretics, β-block- ation between the chronic use of corticoste- ed by Petsinis et al., the total implant sur-
ers, anti-inflammatory drugs, proton pump roids and the placement of dental implants. vival rate was calculated as 99% (103/104).
inhibitors, and serotonin reuptake inhibitors. The study was able to exclude patients with
All of these factors have been shown to mod- Methodology other known risk factors that may contribute
ulate bone metabolism which may alter the For the purpose of this review, we searched to the failure of dental implants and exclude
osseointegration of dental implants. 4 PubMed and other electronic databases, in- confounding variables. The author conclud-
cluding TripDatabase and Google Scholar. ed that glucocorticosteroid intake for sys-
Corticosteroids temic diseases would not be a contraindi-
This article will focus on the effect of cor- The search aimed to find any articles relat- cation for dental implant placement without
ticosteroids on osseointegration of dental ed to the success/failure of dental implants bone grafting.
implants. on patients taking corticosteroids for chron-
ic conditions. Forty-six articles discussed Conclusions
Long-term use of corticosteroids is asso- corticosteroid use and dental implants. Of From the available evidence, it seems that
ciated with adverse systemic events (AEs) the forty-six articles, eight studies con- glucocorticosteroids were not associated
including bone fracture, infection, and tained results that were relevant to dental with complications for osseointegration and
gastrointestinal bleeding. Prednisone and implant survival/failure and corticosteroid implant survival. The authors concluded
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prednisolone are routinely prescribed for use. Of the eight studies, only two studies that glucocorticosteroid intake for systemic
autoimmune and inflammatory diseases. were non-animal studies, which utilized real diseases should not be considered a contra-
These medications are associated with im- human subjects. The two studies were ret- indication for dental implant placement.
munosuppression and their side effects on rospective cohort studies, which looked at
bone biology are well documented. Corti- survival rates for implants on patients who Both studies failed to establish the definition
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costeroids decrease the production of new were taking glucocorticosteroids. of “implant failure.” Note that the studies
osteoblast precursors, cause early apoptosis only evaluated survival, not success. “Sur-
of the mature osteoblasts, and increase the Results vival” simply means the implant exists in the
lifespan of osteoclasts. 7 The study, Risk of Dental Implant Failure mouth. The definition of the success of den-
Associated with Medication Use, conducted tal implants implies much more than that.
Case report: A 44-year-old patient pre- by Carr et al., looked to identify correlations
sented to the clinic with a chief complaint between dental implant failure and medi- The results from these two research studies
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of, “I fell and lost my tooth.” The patient cation use, including corticosteroids. The should be applied with caution in the shared
sought consultation for dental implants. The overall result of the study highlighted that decision-making process with the patient
patient’s medical history was significant corticosteroid use at the date of first implant considering different reconstruction options

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