Risk Factors in Implant Therapy

Systemic Conditions and Treatments

Stuttgart 2008

General Comments
The aim of this review was to assess various systemic conditions and their treatments as risk factors for
implant therapy.

Many patients who may benefit from implant placement present with concomitant systemic diseases. For
many systemic diseases, there are no reports on the use of oral implants. The largest amount of information
exists for diabetes mellitus, osteoporosis, and radiotherapy. Most of the information is in the form of case
reports and case series.

The possibility of publication bias, leading to an overestimation of success, needs to be considered, and this
is a major problem of case reports and case series. The published literature does not allow distinguishing
between subtypes of systemic diseases, such as diabetes mellitus type 1 and 2, or primary and secondary
osteoporosis. Patients may present with multiple risks that may be interrelated, making the estimation of the
impact of a single factor difficult.

Clinical Recommendations
With respect to systemic conditions and treatments as risk factors for implant therapy, the following
recommendations can be made:

 A thorough medical history is essential to identify potential systemic risks.

 Risks for implant failure and risks for medical complications should be differentiated and evaluated. In some
instances, conditions and their treatments may pose increased risks for implant failure, whereas the risk for the patient
may be minimal. As an example, there are no data to support withholding implant treatment for patients with diabetes
or osteoporosis. However, these patients need to be informed of the possibility of implant complications.

Where there is a potential risk of a medical complication - for example, osteonecrosis of the jaw in patients
taking oral bisphosphonates and patients undergoing radiotherapy - the option of implant therapy should be
chosen restrictively, and the patient should be informed specifically, taking into account the current level of
uncertainty with regard to the consequences. For patients with a life-threatening systemic disease, implant
placement should be postponed until the patient’s medical condition is stabilized and has improved.

Treatment Guidelines

References

 Systemic Conditions and Treatments as Risks for Implant Therapy