P064 TREATMENT OF CROHN’S DISEASE AND ULCERATIVE COLITIS WITH PROTON PUMP INHIBITORS: EFFECT ON BONE LOSS AT DENTAL IMPLANTS

Abstract

Proton pump inhibitors (PPI) are used to reduce the clinical manifestations of gastrointestinal reflux disease, but there is an increased risk of complications from Crohn’s disease and ulcerative colitis (IBD) associated with the use of PPI. PPI may affect the GI and oral microbiota as well as influence bone metabolism. In addition, IBD has been positively associated with an inflammatory host response following bacterial infection characteristic of peri-implantitis. Consequently, we hypothesized that the severity of bone loss around dental implants might be related to the use of PPI. Such a relationship in a patient taking PPI might affect treatment decisions related to both IBD and dental implant therapy. This retrospective study was reviewed and approved by the SUNY Buffalo (SUNYAB) IRB. We examined medical and dental history records, as well as radiographic data, of patients receiving dental implants at the SUNYAB School of Dental Medicine from 2010-2017 (1480 implants; 635 patients). We measured the extent of radiographic bone loss for each implant, with correction for radiographic distortion. We also enumerated the number of exposed threads around each implant secondary to crestal bone loss. Use of PPI medications was confirmed by review of patient medical records. Populations were adjusted for smoking, diabetes, and use of systemic steroids. The 95% confidence interval (CI) and P-value of the difference between the means of each group was calculated using IBM SPSS Statistics v25. More bone loss was found around implants from patients taking PPI: We found mean bone loss of 1.60 mm around implants from patients taking PPI, vs. 1.01 mm around implants from patients not taking PPI (mean difference= 0.59 mm, 58.4% increase, 95% CI= 0.08-1.09, P=0.024). After adjusting for diabetes, smoking and use of systemic steroids, this relationship persisted: There was mean bone loss of 1.87 mm in implant patients taking PPI, vs. 1.04 mm in patients not taking PPI (mean difference= 0.83 mm, 79.8% increase, 95% CI= 0.09-1.56 mm, P=0.028). Similarly, there were 0.63 exposed threads/implant from patients taking PPI, vs. 0.38 exposed threads from patients not taking PPI (mean difference =0.25 threads, 65.8% increase, 95% CI= 0.01-0.50, P=0.039). After adjusting for diabetes, smoking and systemic steroids, there were 0.79 vs. 0.36 exposed threads in patients taking vs. not taking PPI, respectively (mean difference=0.43, 119.4% increase, 95% CI=0.09-0.77, P=0.014). Our results suggest that use of PPI is associated with greater bone loss around dental implants. Consequently, more frequent periodontal maintenance therapy might be considered for Crohn’s and colitis patients with dental implants for whom PPI are prescribed as a component of their IBD treatment. Supported in part by the W.M. Feagans Endowed Chair Fund, and the Dept. of Periodontics and Endodontics, SUNYAB.