As we study more systemic effects of various drugs that affect bone healing: Bisphosphonates, SSRI's, and Proton Pump Inhibitors we now have yet another source of loss of or lack of osseointegration caused by a Vitamin D deficiency. I know, here in the Valley of the Sun, we should get plenty of sun. Studies however show that 70% of society is Vitamin D deficient. The deficiency relates to lower-quality fast food, an increased demonstrated genetic deficiency, a more indoor lifestyle and is more pronounced in the aging population: those that most need implant dentistry.
This deficiency plays a substantial role in depression, dementia, Alzheimer's disease, asthma, cancer, cardiovascular disease and diabetes. Vitamin D is also essential for GI absorption of calcium, mineralization of osteoid tissue and maintenance of serum-inonized calcium levels. There is an even more extensive list of physiological, neuromuscular, hormonal and immune requirements for vitamin D.
The first animal studies of dental implant osseointegration and vitamin D deficiency were in 2009 and it was found that the "push out" force dental implants in the vitamin D deficient group was 66% less. This deficiency is well known in osteoporotic patients and has been linked to an up to 300% increase in dental implant failure.
My notations: I am now testing the Vitamin D levels for any patient that presents an increased risk profile from normal or has an implant failure. I will be testing patients that are undergoing more extensive implant dentistry in the future. So far I am finding the results quite varied. The most extreme test to date, was for a patient that took 5000 units per day of Vitamin D for years yet was tested as deficient. As time goes on, much like routine testing of BP, blood sugar, pulse etc. I imagine modern implantology will include a test panel of various risk factors that can be quantified, much as this Vitamin D test and bisphosphonate history's now allow me to do.
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