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The systematic review conducted by Tarfa, et al. (2022) focused on 6 studies, with a total of 7999 patients, 1152 SSRI users (intervention)
and 6847 non-SSRI users (control). Average age of participants and follow-up times were not explicitly stated in the review, however, it is
stated that patients had undergone dental implant surgery over a time period from 1980 to 2016. Most of the selected studies had participant
exclusion criteria that included severe systemic disease or systemic conditions proven to alter bone metabolism and pharmacological con-
traindications. Fewer studies excluded for conditions such as diabetes or smoking. The review was conducted in accordance with PRISMA,
and based on the Newcastle-Ottawa Scale for cohort studies. All six of the included studies ranged from low to moderate risk of bias.

The study found, among SSRI users, implant failure rates ranged from 5.6% to 10.9%. As compared to non-SSRI users, it ranged from
1.85% to 4.6%. Calculated hazard rate of implant failure was 1.64 (95% CI [1.07–2.52]; p = 0.02) for patients with Sertraline SSRI use.
According to the review, SSRI users appear to have increased risk of failed dental osseointegration, to a statistically significant level, in
three of the six included studies.
The results of the three studies can be summarized in Table 1, found below:

Study Authors Study Type Implant Failure Implant Failure Risk Ratio of Hazard Ratio of
range among range among Implant Failure Implant Failure
SSRI users non-SSRI users among SSRI among Sertraline
users SSRI users
Sheriff, et al. Systematic patient lev- patient lev- patient level- N/A
(2023) Review and el-5.6% to 19.6% el-1.9% to 8.0% 2.44
Meta-Analysis
implant lev- implant lev- implant level-
el-5.6% to 12.5% el-1.9% to 5.8% 2.34
Harutyunyan, Systematic N/A N/A patient level- N/A
et al. (2024) Review and 2.44
Meta-Analysis
implant level-
2.44
Tarfa, et al. Systematic 5.6% to 10.9% 1.85% to 4.6% N/A 1.64
(2022) Review

Table 1: Results of selected systematic reviews on the effect of SSRI utilization on dental implant failure.
Table 1: Results of selected systematic reviews on the effect of SSRI utilization on dental implant failure.
Discussion:
Although all three systematic reviews claim to reveal some evidence to the association between the use of SSRI medication and dental im-
plant failure, they all suffer from common limitations. First and foremost, the lack of control over confounding variables such as diabetes
and smoking is discussed thoroughly throughout the journals. 12-13 Many of the selected studies viewed this as limitations rather than grounds
for exclusion. Additionally, when considering the intervention group (those taking SSRI’s), which is most traditionally those suffering from
clinical depression, it would be important to gauge their oral health compliance as compared to the control group, as it is noted throughout
the selected systematic reviews that those suffering from depression typically have worse oral health. Moreover, the lack of control over
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common SSRI side effects, such as xerostomia which can severely diminish oral health, or bruxism which can induce occlusal overload
on a implant, are seen as oversights in the selected studies when it is understood that they can have negative effects on implant success. 15-16

The duration of SSRI use is not explicitly mentioned in the journals, leaving to question the state at which participants were medicated
before or during the study. It stands to reason that further research would need to be conducted to better understand the chronic vs. acute
use of SSRI antidepressants on dental implants.

It is hypothesized throughout the literature that SSRI medication will likely lead to implant failure due to altered osseointegration, how-
ever, due to a wide range of follow-up times throughout the studies, and a lack of documentation as to when the implants may have failed,
it is still a question as to if SSRI medications affect implant osseointegration taking place in the first 3-6 months of placement, or if they
are associated with a later term of implant failure. This also calls into question the state of bone into which the implants are being placed.
The studies had little to no discussion of control over implant type, length, or location/bone quality throughout the review, all of which are
important factors to consider when an implant fails. 5-7

The three systematic reviews may show some evidence to the association of SSRI use and dental implant failure, and meta-analysis goes as
far to say the risk ratio is greater than two. However, although this is statistically significant, it does not prove clinical relevance. If the use
of SSRI medication is increasing the rate of implant failure by a factor of two, as shown in the literature, it means we can expect implants
to fail at a rate of 10-12%. Dental implants should still be considered a valid treatment option for this population because the success of the
procedure is still 90% successful in cases that follow clinical guidelines for implant placement.
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