Selective Serotonin Reuptake Inhibitors & Future of Near Zero Implant Complications 2 Articles of Interest
A retrospective cohort study of 2055 implants: 109 were in SSRI users. Median follow-up was 21 months. Failure rate was 5.6% for SSRI users and non-users had a 1.85% failure rate. This 3 x failure rate was statistically significant. Altay et al, J Oral Implantology, 2018. Another study by Wu et al in 2014, found 94 implants placed in SSRI users had a 10.6% failure rate compared to the control group with 4.6% failures. Another cohort study by Chrcanovic et al, Int J Oral Max Facial Surgery, 2017 reported a 12.5% overall failure rate for SSRI users versus 3.3 % for non-SSRi users. Richards and Diem in 2 independent studies found bone density lower with SSRI users which was related to increased hip fractures.
Clearly the effects of SSRI use affects implant prognosis due to its effects on bone. Yesterday I treated a patient with a trifecta of impediments: Proton Pump Inhibitor use, SSRI use and a history of bisphosphonate use (ep Prolia). I knew the bone wouldn’t heal well due to low vascularity. I was not surprised to see NO BLEEDING at the extraction sites. Corticotomy and RAP stimulation of the extraction sockets did not help induce bleeding. Empirically I used L-PRF to stimulate soft tissue healing and PDGF to up regulate VEG-F, increasing vascularity to the socket bone grafts, post extraction. I would enjoy hearing how others handle cases like this.
Dental implants are expected to grow 11% in the next 7 years: 1.5 % per year. Complications include technical, mechanical and biologic issues.
Simonis, Clinical Oral Implants Res, found in 2010 at 16 years there was aJagiar1976 83% cumulative implant survival rate and a 48% cumulative complication rate. The majority of implant failures were in a small group of patients. A Pub Med search in all dental journals from 2019 to April of this year revealed 1176 articles published on Dental complications. Steps taken by our orthopedic collages include prudent pre surgical assessments: Indications, risks and benefits and concluded an organized, systematic, coordinated multidisciplinary approach to the perioperative management of patients have resulted in decreased complications. Greenstein & Gorczyca, Clin Geriatr Med, 2019. ntent.
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