Selective Serotonin Reuptake Inhibitors (SSRI) and Dental Implant Failure: A Systematic Review and Meta-Analysis.

Abstract

Selective Serotonin Reuptake Inhibitors (SSRI) are commonly prescribed to treat mental health disorders, and although scarce, previously published literature has shown a significant association between SSRI use and dental implant failure. This systematic review and meta-analysis aimed to examine if such association exists, and if so, determine its strength. Reviewers performed an extensive search of the literature, last accessed June 2022 in PubMed/Medline, Embase, and Cochrane databases using MeSH terms. Retrospective and prospective observational cohort and experimental studies that evaluated the role of SSRI on dental implant failure among individuals≥18 years of age, with a minimum follow-up of 6 months after implant placement, were deemed eligible. The search yielded a total of six eligible studies, all retrospective cohorts. The statistical analyses were performed using the statistical software R 4.1.3. Results showed higher implant failure rates among SSRI users vs. non-SSRI users at both patient level (5.6-19.6% vs. 1.9-8.0%) and at implant level (5.6-12.5% vs. 1.9-5.8%). The pooled relative risk (pooled-RR) of implant failure was more than double among SSRI users at patient (pooled-RR: 2.44, 95% CI : 1.68-3.55, p <0.01) and implant levels (pooled-RR: 2.34, 95% CI : 1.74-3.15, p <0.01) compared to non-SSRI users. DerSimonian and Laird estimates showed homogeneity of the studies ( I 2 =0%, p >0.05), and funnel plots and Egger's test determined no publication bias across all selected studies at both patient and implant levels. In conclusion, SSRI use is significantly associated with higher implant failure. Providers should be aware of this association and educate their patients on their risk of implant therapy when obtaining informed consent.