Medical Complications in Dental Implantology

  • Stephanie J. Drew
  • James Davis
  • Steven M. RoserEmail author


In the patient with systemic disease, risk stratification must be undertaken for each patient assessing the risks of the surgery and ability of the patient to maintain the planned implant supported prosthesis. Any systemic disease that results in delayed wound healing can affect implant healing and lead to implant failure. Current evidence supports high implant survival rates in most patients with systemic diseases when co-risk factors which include smoking, periodontitis, and poor oral hygiene are removed. Evidence does support a higher implant failure and incidence of peri-implantitis in patients having received radiation therapy for head and neck cancer, high doses of anti-resorptive therapy for osteoporosis, multiple myeloma or metastatic cancer to the skeleton and poorly controlled diabetics. Heavy alcohol consumption also appears to lead to a higher implant failure rate. A thorough medical history, knowledge of the patients’ medications and schedule, optimization of the patient for the surgery, consulting with the patient’s medical providers, and assuring the patient understands when there are increased risks and the absolute need of excellent oral hygiene can lead to implant healing and similar high survival rates that are seen in healthy patients.


Systemic diseases Implant failure Medical complications 


  1. 1.
    OPTN. Data as of January 8, 2019.
  2. 2.
    Moy PK, Medina D, Shetty V, Aghaloo TL. Dental implant failure rates and associated risk factors. Int J Oral Maxillofac Implants. 2005;20(4):569–77.PubMedGoogle Scholar
  3. 3.
    Hwang D, Wang HL. Medical contraindications to implant therapy: part I: absolute contraindications. Implant Dent. 2006;15(4):353–60.PubMedGoogle Scholar
  4. 4.
    Abu-Ta'a M, Quirynen M, Teughels W, van Steenberghe D. Asepsis during periodontal surgery involving oral implants and the usefulness of peri-operative antibiotics: a prospective, randomized, controlled clinical trial. J Clin Periodontol. 2008;35(1):58–63.PubMedGoogle Scholar
  5. 5.
    Bain CA, Moy PK. The association between the failure of dental implants and cigarette smoking. Int J Oral Maxillofac Implants. 1993;8(6):609–15.PubMedGoogle Scholar
  6. 6.
    Da Silva JD, Kazimiroff J, Papas A, Curro FA, Thompson VP, Vena DA, et al. Outcomes of implants and restorations placed in general dental practices: a retrospective study by the Practitioners Engaged in Applied Research and Learning (PEARL) Network. J Am Dent Assoc. 2014;145(7):704–13.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Brägger U, Aeschlimann S, Bürgin W, Hämmerle CH, Lang NP. Biological and technical complications and failures with fixed partial dentures (FPD) on implants and teeth after four to five years of function. Clin Oral Implants Res. 2001;12(1):26–34.PubMedGoogle Scholar
  8. 8.
    Moraschini V, Barboza ED. Success of dental implants in smokers and non-smokers: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2016;45(2):205–15.PubMedGoogle Scholar
  9. 9.
    American dental association antibiotic prophylaxis prior to dental treatment.
  10. 10.
    Mancha de la Plata M, Gias LN, Diez PM, Munoz-Guerra M, Gonzalez-Garcia R, Lee GY, Castrejon-Castrejon S, Rodriguez-Campo FJ. Osseointegrated implant rehabilitation of irradiated oral cancer patient. J Oral Maxillofac Surg. 2012;70:1052–63.PubMedGoogle Scholar
  11. 11.
    Linsen SS, Martini M, Stark H. Long-term results of endosteal implants following radical oral cancer surgery with and without adjuvant radiation therapy. Clin Implant Dent Relat Res. 2012;14:250–8.PubMedGoogle Scholar
  12. 12.
    Schoen PJ, Reinstema H, Raghoebar GM, Vissink A, Roodenburg JL. The use of implant retained mandibular prosthesis in the oral rehabilitation of head and neck cancer patients. A review and rationale for treatment planning. Oral Oncol. 2004;40:862–71.PubMedGoogle Scholar
  13. 13.
    Buddula A, Assad DA, Salinas TJ, Garces YI. Survival of dental implants in native and grafted bone in irradiated head and neck cancer patients: a retrospective analysis. Indian J Dent Res. 2011;22:644–8.PubMedGoogle Scholar
  14. 14.
    Hessling SA, Wehrhan F, Schmitt CM, Weber M, Schlittenbauer T, Scheer M. Implant-based rehabilitation in oncology patients can be performed with high long-term success. J Oral Maxillofac Surg. 2015;73:889–96.PubMedGoogle Scholar
  15. 15.
    Pompa G, Saccucci M, Di Carlo G, Brauner E, Valentini V, Di Carlo S, Gentile T, Guarino G, Polimeni A. Survival of dental implants in patients with oral cancer treated by surgery and radiotherapy: a retrospective study. BMC Oral Health. 2015;15:1–6.Google Scholar
  16. 16.
    Doll C, Nack C, Raguse JD, Stricker A, Duttenhoefer F, Nelson K, Nahles S. Survival analysis of dental implants and implantretained prostheses in oral cancer patients up to 20 years. Clin Oral Invest. 2015;19:1347–52.Google Scholar
  17. 17.
    Barrowman RA, Wilson PR, Wiesenfeld D. Oral rehabilitation with dental implants after cancer treatment. Aust Dent J. 2011;56:160–5.PubMedGoogle Scholar
  18. 18.
    Chrcanovic BR, Albrektsson T, Wennerberg A. Dental implants in irradiated versus non-irradiated patients: a meta-analysis. Head Neck. 2016;38:448–81.PubMedGoogle Scholar
  19. 19.
    Javed F, Al-Hezaimi K, Al-Rasheed A, Almas K, Romanos GE. Implant survival rate after oral cancer therapy: a review. Oral Oncol. 2010;46:854–9.PubMedGoogle Scholar
  20. 20.
    Schiegnitz E, Al-Nawas B, Kammerer PW, Grotz KA. Oral rehabilitation with dental implants in irradiated patients: a meta-analysis on implant survival. Clin Oral Invest. 2014;18:687–98.Google Scholar
  21. 21.
    Tanaka TI, Chan HL, Tindle DI, MacEachern M, Oh TJ. Updated clinical considerations for dental implant therapy in irradiated head and neck cancer patients. J Prosthodont. 2013;22:432–8.PubMedGoogle Scholar
  22. 22.
    Yerit KC, Posch M, Seemann M, Hainich S, Dortbudak O, Turhani D, Ozyuvaci H, Watzinger F, Ewers R. Implant survival in mandibles of irradiated oral cancer patients. Clin Oral Implants Res. 2006;17:337–44.PubMedGoogle Scholar
  23. 23.
    Curi MM, Condezo AFB, Ribeiro KCB, Cardoso CL. Lomg term success of dental implantsin patient with head and neck cancer after radiation therapy. Int J Oral Maxillofac Surg. 2018;47:783–8.PubMedGoogle Scholar
  24. 24.
    Marx RE, Johnson RP. Studies in the radiobiology of osteoradionecrosis and their clinical significance. Oral Surg Oral Med Oral Pathol. 1987;64:379–90.PubMedGoogle Scholar
  25. 25.
    Claudy MP, Miguens SA Jr, Celeste RK, Camara Parente R, Hernandez PA, da Silva Jr AN. Time interval after radiotherapy and dental implant failure: systematic review of observational studies and meta-analysis. Clin Implant Dent Relat Res. 2015;17:402–11.PubMedGoogle Scholar
  26. 26.
    Eckert SE, Desjardins RP, Keller EE, Tolman DE. Endosseous implants in an irradiated tissue bed. J Prosthet Dent. 1996;76:45–9.PubMedGoogle Scholar
  27. 27.
    Larsen PE. Placement of dental implants in the irradiated mandible: a protocol involving adjunctive hyperbaric oxygen. Int J Oral Maxillofac Surg. 1997;55:967–71.Google Scholar
  28. 28.
    Kovács AF. The fate of osseointegrated implants in patients following oral cancer surgery and mandibular reconstruction. Head Neck. 2000;22(2):111–9.PubMedGoogle Scholar
  29. 29.
    Kovács AF. Influence of chemotherapy on endosteal implant survival and success in oral cancer patients. Int J Oral Maxillofac Surg. 2001;30(2):144–7.PubMedGoogle Scholar
  30. 30.
    Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005;63(11):1567–75.PubMedGoogle Scholar
  31. 31.
    Fugazzotto PA, Lightfoot WS, Jaffin R, Kumar A. Implant placement with or without simultaneous tooth extraction in patients taking oral bisphosphonates: postoperative healing, early follow-up, and the incidence of complications in two private practices. J Periodontol. 2007;78(9):1664–9.PubMedGoogle Scholar
  32. 32.
    Grant BT, Amenedo C, Freeman K, Kraut RA. Outcomes of placing dental implants in patients taking oral bisphosphonates: a review of 115 cases. J Oral Maxillfac Surg. 2008;66(2):223–30.Google Scholar
  33. 33.
    Jeffcoat MK. Safety of oral bisphosphonates: controlled studies on alveolar bone. Int J Oral Maxillofac Implants. 2006;21(3):349–53.PubMedGoogle Scholar
  34. 34.
    Shapiro CL, Yarom N, Peterson DE, Bohlke K, Saunders DP. Medication-related osteonecrosis of the Jaw: MASCC/ISOO/ASCO clinical practice guideline summary. J Clin Oncol. 2019;22
  35. 35.
    Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O'Ryan F. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. J Oral Maxillofac Surg. 2014;72(10):1938–56.PubMedGoogle Scholar
  36. 36.
    Chrcanovic BR, Albrektsson T, Wennerberg A. Smoking and dental implants: a systematic review and meta-analysis. J Dent. 2015;43(5):487–98.PubMedGoogle Scholar
  37. 37.
    Alfadda SA. Current evidence on dental implants outcomes in smokers and nonsmokers: a systematic review and meta-analysis. J Oral Implantol. 2018;44(5):390–9.PubMedGoogle Scholar
  38. 38.
    Clementini M, Rossetti PHO, Penarrocha D, Micarelli C, Bonachela WC, Canullo L. Systemic risk factors for peri-implant bone loss: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2014;43:323–34.PubMedGoogle Scholar
  39. 39.
    Nogueira-Filho-Gda R, Cadide T, Rosa BT, Neiva TG, Tunes R, Peruzzo D, Nociti FH Jr, César-Neto JB. Cannabis sativa smoke inhalation decreases bone filling around titanium implants: a histomorphometric study in rats. Implant Dent. 2008;17(4):461–70.PubMedGoogle Scholar
  40. 40.
    Abt E. Smoking increases dental implant failures. Evid Based Dent. 2009;10:79–80.PubMedGoogle Scholar
  41. 41.
    Sampson HW, Perks N, Champney TH, DeFee B II. Alcohol consumption inhibits bone growth and development in young actively growing rats. Alcohol Clin Exp Res. 1996;20(8):1375–84.PubMedGoogle Scholar
  42. 42.
    Alissa R, Oliver RJ. Influence of prognostic risk indicators on osseointegrated dental implant failure: a matched case–control analysis. J Oral Implantol. 2012;38(1):51–61.PubMedGoogle Scholar
  43. 43.
    Carr BR, Boggess WJ, Coburn JF, Chuang SK, Panchal N, Ford BP. Is alcohol consumption associated with protection against peri-implantitis? A retrospective cohort analysis. J Oral Maxillofac Surg. 2019;pii:S0278-2391(19)31076-6.Google Scholar
  44. 44.
    Fu JF, Bushutski JD, Al-Hezaimi K, Wang HL. Statins, glucocorticoids, and nonsteroidal anti-inflammatory drugs: their influence on implant healing. Implant Dent. 2012;21(5):362–7.PubMedGoogle Scholar
  45. 45.
    Cranin AN. Endosteal implants in a patient with corticosteroid dependence. J Oral Implantol. 1991;17(4):414–7.PubMedGoogle Scholar
  46. 46.
    Werner SB, Tessler J, Guglielmotti MB, Cabrini RL. Effect of dexamethasone on osseointegration: a preliminary experimental study. J Oral Implantol. 1996;22(3–4):216–9.PubMedGoogle Scholar
  47. 47.
    Strietzel FP, Schmidt-Westhausen AM, Neumann K, Reichart PA, Jackowski J. Implants in patients with oral manifestations of autoimmune or muco-cutaneous diseases – a systematic review. Med Oral Patol Oral Cir Bucal. 2019;24(2):e217–30.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Starup-Linde J, Rosendahl SB, Storgaard M, Langdahl B. Management of osteoporosis in patients living with HIV—a systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2020;83(1):1–8.PubMedGoogle Scholar
  49. 49.
    Sakakura CE, Lopez BM, Margonar R, Pereira Queiroz T, Nociti FH Jr, et al. Cyclosporine-A and bone density around titanium implants: a histomeric study in rabbits. J Osseointegration. 2011;2(3):25–9.Google Scholar
  50. 50.
    Duttenhoefer F, Fuessinger MA, Beckmann Y, Schmelzeisen R, Groetz KA, Boeker M. Dental implants in immunocompromised patients: a systematic review and meta-analysis. Int J Implant Dent. 2019;5(1):43.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Marchand F, Raskin A, Dionnes-Hornes A, Barry T, Dubois N, Valero N, et al. Dental implants and diabetes: conditions for success. Diabetes Metab. 2012;38:14–9.PubMedGoogle Scholar
  52. 52.
    Schimmel M, Srinivasin M, McKenna G, Muller F. Effects of advanced age and/or systemic medical conditions on dental implant survival: a systematic review and meta analysis. Clin Oral Implants Res. 2018;29(Supp. 16):311–30.PubMedGoogle Scholar
  53. 53.
    Wu X, Al-Abedalla K, Rastikerdar E, Abi Nader S, Daniel NG, Nicolau B, et al. Selective serotonin reuptake inhibitors and the risk of osseointegrated implant failure: a cohort study. J Dent Res. 2014;93(11):1054–61.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Stephanie J. Drew
    • 1
  • James Davis
    • 2
  • Steven M. Roser
    • 3
    Email author
  1. 1.Division of Oral and Maxillofacial Surgery, Department of SurgeryEmory University School of MedicineAugustaUSA
  2. 2.TuckerUSA
  3. 3.Division of Oral and Maxillofacial SurgeryEmory University School of MedicineAugustaUSA

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