Abstract
This systematic review investigates the failure rate and marginal bone loss (MBL) of dental implants placed in patients undergoing solid-organ transplant (SOT) compared to healthy controls. Three databases (PubMed, Web of Sciences, and the Cochrane Library) were searched up to June 2020 (PROSPERO CRD42019124896). Case-control and cohort studies reporting data failure rate and marginal bone loss (MBL) of dental implants placed in SOT patients were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Four case-control studies fulfilled the inclusion criteria; all had low risk of bias. Meta-analyses revealed consistently lower implant failure rate than control populations at patient and implant levels. SOT patients had a significant difference of −18% (p-value < 0.001) MBL compared to healthy patients. SOT status poses no serious threat to implant survival. Overall, this group of patients presented lower levels of dental implant failure rate and marginal bone loss compared to otherwise healthy patients. Further intervention trials with larger sample size and longer follow-ups are necessary to confirm these summarized results.
Highlights
Dental implants restore missing teeth, in both partially and fully edentulous patients [1,2,3]
Unclear what the impact of systemic diseases is on the outcome of implant therapy and whether medically compromised patients may have different success and survival rates [6,7]
According to Global Observatory on Donation and Transplant (GODT), in 2017, more than 139 thousand organ transplants were performed, corresponding to 16 organ transplants per hour. These patients undergo a chronic regimen of immunosuppressants, which puts them at higher risk of infections and inflammation [13,14,15,16]
Summary
Dental implants restore missing teeth, in both partially and fully edentulous patients [1,2,3]. Implants have consistent long-term success, with high survival rates and significant improvements in the patient’s function, aesthetics, and quality of life [4,5] It is, unclear what the impact of systemic diseases is on the outcome of implant therapy and whether medically compromised patients may have different success and survival rates [6,7]. These patients undergo a chronic regimen of immunosuppressants, which puts them at higher risk of infections and inflammation [13,14,15,16] In patients taking these medications, there is evidence that wound healing and bone metabolism may be impaired, due to either inhibition of osteoblast function and osteogenesis or to a concomitant increase of bone resorption and osteoporosis, which may result in decreased bone-to-implant contact [17,18,19,20]. These patients often take concomitant systemic steroid medication, which can cause wound healing alteration and opportunistic colonisation by oral pathogens [10,21]
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