Page 9 - GP Spring 2025

Selective Serotonin Reuptake Inhibitors and Dental Implant Failure:
A Literature Review

Author: Mitch Engel

Introduction: Methodology: studies, and Funnel plots and Eggers tests
With advancements in modern science and A literature search was conducted using revealed no risk of publication bias.
healthcare, the general population is older MeSH terms (“serotonin uptake inhibitors”
than ever. The prevalence of edentulism di- [All Fields] OR “selective serotonin uptake The study found that among SSRI users, im-
rectly increases with age, indicating a rising inhibitors” OR (“serotonin”[All Fields] AND plant failure rates ranged from 5.6% to 19.6%
demand for dental implants. Furthermore, “uptake”[All Fields] AND “inhibitors”[All at the patient level and from 5.6% to 12.5%
with the ever-growing mental health crisis, Fields]) OR “serotonin uptake inhibitors” at the implant level, and in non-SSRI users,
total prescriptions of antidepressants in- [All Fields] OR “SSRI”[All Fields]) AND implant failure rates ranged from 1.9% to
crease each passing year, selective serotonin implant[All Fields] AND failure[All Fields], 8.0% at the patient level and from 1.9% to
reuptake inhibitors (SSRIs) being the most across PubMed, Cochrane, and Embrase da- 5.8% at the implant level. The calculated risk
common prescription drug used to treat clin- tabases. The resulting journals were filtered ratio of implant failure at the patient and im-
ical depression. However, research study- to show only systematic reviews. Articles plant level was 2.44 (95% confidence inter-
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ing the effects of such medications on dental were first screened by title, then by abstract, val [CI]: 1.68–3.55, P < .01) and 2.34 (95%
implants and the possible association with with the final inclusion only being deter- CI: 1.74–3.15, P < .01), respectively.
implant failure is not well documented. The mined after a full review of the text.
aim of this literature review is to analyze and The systematic review and meta-analysis
discuss the limited evidence that suggests a Results: conducted by Harutyunyan et al. (2024) fo-
connection between the use of SSRI antide- After screening potential articles, three sys- cused on 11 studies comparing patients us-
pressants and dental implant failure. tematic reviews were selected for this review ing SSRI medication (intervention) vs. those
of available literature on the potential asso- not taking SSRI medication (control) and the
Dental implant failure can be defined as a ciation of SSRI antidepressant use on dental resulting incidence of dental implant failure.
lack of osseointegration of an implant with- implant failure: Age, number of participants, and follow-up
in bone, resulting in the implant having to times were not explicitly stated in the review.
be removed. This can be classified further 1. Shariff, Jaffer Ahmed., et al. (2023), The review noted that a variety of implant
as a failure on the implant level or on the Selective Serotonin Reuptake In- types were included in the study. Most of the
patient level. The most common symptoms hibitors and Dental Implant Fail- selected studies did not exclude for specific
of implant failure include implant mobility, ure: A Systematic Review and Me- confounders like smoking or diabetic status.
peri-implant bone loss, or even osteomyeli- ta-Analysis. This review did not explicitly state exclusion
tis. The accepted failure rate of modern 2. Harutyunyan, Liza., et al. (2024), for severe systemic diseases, systemic con-
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dental implants is considerably low, ranging The Effect of Anti-Depressants on ditions that effect bone metabolism, or phar-
around 5%. Factors that influence the suc- Dental Implant Failure: A System- macological contraindications. The review
cess rate of implants are implant type/length, atic Review and Meta-Analysis. was conducted in accordance with PRISMA.
oral hygiene compliance, patient comorbid- The included studies were considered with
ities, and the quality of bone in which the 3. Tarfa, Rahilla A., et al. (2022), Is a moderate risk of bias based on the ROB-
implant is placed. mandibular osteomyelitis a sequela of INS-I criteria. Heterogeneity could be de-
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SSRI-induced dental implant failure? scribed as low for the patient-level analysis
The use of SSRI antidepressants is hypoth- A systematic review & case report. and moderate for the implant-level analysis.
esized to alter bone formation and has been
shown in medical literature to increase the The systematic review and meta-analysis The study found the risk ratio of failure at
incidence of bone fractures, lower cortical conducted by Sheriff, et al. (2023) focused the patient level was 2.44 (95% CI= 1.75 to
bone density, and osteoporosis in chronic on 6 studies which included 2959 patients 3.39, p< 0.0001), and risk ratio of failure at
SSRI users. The mechanism behind this with 7122 dental implants. Of the patients, the implant level was 2.44 (95% CI= 1.73 to
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stems from the bodily increase in available 384 patients were SSRI users (interven- 3.46, p< 0.0001). Risk ratio of failure at the
serotonin when taking SSRI medication; this tion) and 2575 patients were non-SSRI us- patient and implant level in patients taking
increase in serotonin in the central nervous ers (control). The average follow-up time SSRI’s and other antidepressants was 3.20
system is the primary reason for the drugs ranged from 1.8 to 7.5 years, and the mean (95% CI= 1.61 to 6.36, p= 0.0009) and 4.45
antidepressant properties. However, the in- age of participants ranged from 56 to 67.3 (95% CI= 2.70 to 7.35, p< 0.0001), respec-
creased peripheral serotonin in the systemic years old. Most of the selected studies had tively. There was little discussion elaborat-
tissues directly binds to receptors expressed participant exclusion criteria that included ing on possible interactions between SSRI’s
by osteoblasts, leading to a decrease in their severe systemic disease or systemic condi- and other antidepressants and how it may
proliferation, resulting in decreased bone tions proven to alter bone metabolism and impact bone metabolism.
formation. 8-11 This mechanism is the founda- pharmacological contraindications. Fewer
tion for retrospective cohort studies claiming studies excluded for conditions such as dia-
to have found an association between dental betes or smoking. The review was conducted
implant failure and selective serotonin re- in accordance with PRISMA. No hetero-
uptake inhibitor medications. geneity was observed across the selected
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