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SYSTEMATIC REVIEW

Does HIV infection affect the survival of dental implants? A


systematic review and meta-analysis
Indumathi Sivakumar, BDS, MDS, MFDS RCPS,a Sivakumar Arunachalam, BDS, MDS, FDS RCSEd,b
Suchismita Choudhary, BDS, MDS,c and Muaiyed Mahmoud Buzayan, BDS, MClin Dent, AF AAMPd

Rehabilitation with dental im- ABSTRACT


plants for edentulous patients is
Statement of problem. Immunosuppression and coinfections associated with human
a compelling alternative to immunodeficiency virus (HIV) infection pose a relative contraindication for dental implant
traditional removable prosthe- therapy. However, although implants have been placed in patients with HIV with reasonable
ses, but the success of the dental success, how HIV infection affects their survival is unclear.
implant is based on osseointe-
Purpose. The purpose of this systematic review of the literature and meta-analysis was to analyze
gration. Any event that affects the data on the survival of dental implants in patients with HIV.
the integrity of the attachment
could compromise the dental Material and methods. A search for relevant articles published up to November 2019 was
performed in PubMed/Medline and Cochrane databases, Clinicaltrials.gov, and Google Scholar.
implant stability and result in
1-9
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adopted
failure. Nevertheless, the for the conduct of the systematic review. The most pertinent data were extracted and pooled for
survival of dental implants in a qualitative and quantitative analyses with 95% confidence intervals. Heterogeneity was analyzed
healthy population has been by using I-squared statistics.
reported to be about 96%.10 A Results. A total of 8 studies involving 411 individuals with HIV and 1109 implants were included in
few reports have assessed the the meta-analysis. The mean follow-up period was 2.8 years. A pooled estimate of 95% of implant
survival of dental implants in survival rate with 95% confidence interval(92% to 96%) was noted. Heterogeneity across the 8
immunocompromised in- studies was found to be 41% with moderate true variability.
dividuals, including those with Conclusions. This systematic review demonstrated that HIV infection does not pose a serious threat
human immunodeficiency virus to implant survival on short-term evaluation, but the evidence is of low quality. (J Prosthet Dent
(HIV) infection.11-18 2020;-:---)
HIV infection is a global
pandemic, impacting world public health. In accordancw the CD4 cell count increases as HIV infection is
with the World Health Organization, 37.9 million people controlled with appropriate treatment that is prescribed
worldwide were living with HIV at the end of 2019.19 HIV throughout life. The treatment comprises highly active
destroys specific CD4 helper lymphocyte cells in the antiretroviral therapy (HAART) to control the HIV
immune system, making the affected individuals more infection.24-27 At present, there are 7 classes of drugs to
susceptible to opportunistic infections.20 A diagnosis of treat HIV infection that have changed the course of the
acquired immune deficiency syndrome is rendered when disease from an acute life-threatening condition to a
the CD4 cell count drops below 200 cells/mm3 (normal long-term disease.28,29 Accordingly, patients with HIV
3 21-23
CD4 cell count: 500 to 1500 cells/mm ). Generally, increasingly demand functional and esthetic dental care.

a
Senior lecturer in Prosthodontics, Faculty of Dentistry, SEGi University, Selangor, Malaysia.
b
Associate Professor, School of Dentistry, International Medical University, Malaysia.
c
Lecturer in Prosthodontics, Faculty of Dentistry, SEGi University, Selangor, Malaysia.
d
Senior Lecturer, Faculty of Dentistry, University of Malaya, Malaysia.

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Table 1. PICO framework


Clinical Implications Focus Question Does HIV Infection Affect the Survival of Dental Implants?
Participants Patients with HIV
Based on the limited evidence, dental implant Intervention Dental implants
therapy in patients with HIV is a viable option with Comparison HIV-negative patients
low morbidity. However, clinicians should be wary Outcomes 1. Cumulative survival and success of dental implants
of potential complications from drug therapy, the 2. Marginal bone loss and any other complications
infectious state of the virus, HIV coinfections, and Study design Randomized controlled trials
Nonrandomized controlled trials
peri-implant disease. Prospective cohort studies
Retrospective studies

HIV, human immunodeficiency virus; PICO, Participant, Intervention, Comparison, and


Outcome.
Little is known about the interaction between HIV
infection, drug therapy, and implant survival.30-33 Studies
have reported that certain drugs used in the HAART
criteria included review papers, animal studies, case re-
regimen (tenofovir disoproxil fumarate and protease in-
ports, and multiple publication of the same pool of
hibitors [PI]),34,35 and HIV infection per se36-38 are
participants.
associated with osteoporosis and osteopenia in the long
An electronic search was conducted in PubMed,
term. HIV infection has also been identified as only a
Cochrane Registry, CENTRAL, Google Scholar,
relative contraindication to implant therapy provided the
clinicaltrials.gov, and journal databases (Wiley, Elsevier,
infected individual is free of severe immunosuppression
Quintessence Publishing) up to November 2019 to
or bleeding disorders.39 Nevertheless, few reports have
identify relevant studies. The reference source from all
demonstrated the success of dental implants in patients
the selected full-text articles and review articles on the
with HIV in the short term.40-46 Baron et al18 reported
subject were also manually searched to identify relevant
complete oral rehabilitation using 12 Brånemark implants
studies. The databases search strategy and key words are
in a female patient infected with HIV, hepatitis B, and
presented in Table 2. Titles and abstracts of the poten-
hepatitis C. Two years after implant placement, she had
tially qualifying studies were scrutinized by 2 indepen-
minimal peri-implant bone loss with no signs of peri-
dent reviewers (I.S., S.A.). The reviewers conducted the
implantitis. A recent prospective cohort study with a
assessment of the full texts independently for relevance.
sample size of 16 noted a 10% failure rate in patients with
Any disagreement between the reviewers was resolved
HIV compared with 5% to 7% in healthy patients.47
by consensus with a third reviewer (S.C.).
Given the nature of HIV infection, associated HIV coin-
Data were extracted by 2 reviewers independently
fections, complications of drug therapy, and short-term
from each included study and entered into a specifically
reports on the success of dental implant therapy,48,49
designed electronic spreadsheet that included the
further analysis is warranted to provide a plausible
following information: name of the author, year of pub-
explanation. Thus, the purpose of this systematic review
lication, study design, sample size, total number of im-
and meta-analysis was to determine the survival of dental
plants, mean CD4 cell count, viral load, type of HAART
implants in patients with HIV.
therapy, number of patients with diabetes, smokers, type
of prosthesis, number of failed implants, reasons for
MATERIAL AND METHODS
implant failure, mean follow-up duration, mean marginal
This review followed the Preferred Reporting Items for bone loss, complications, cumulative implant survival,
Systematic Reviews and Meta-Analyses guidelines.50 The and cumulative prosthesis survival. Unclear data from the
review protocol was registered in the International Pro- primary studies were clarified by contacting the authors
spective Register of Systematic Reviews concerned.
(CRD42017073202). At the outset, a research question Assessment of the selected studies was performed
was formulated using the Population, Intervention, independently using the quality assessment tool for
Comparison, and Outcome framework (Table 1). observational cohort and cross-sectional studies.51 This
Scientific publications reporting studies involving assessment tool contained 14 questions focusing on the
patients who had tested positive for HIV and who had assessment of the internal validity of the study. Each
received at least 1 dental implant were considered. study was evaluated based on the information of the
Randomized controlled studies, nonrandomized study design and execution and how well the con-
controlled studies, prospective cohort studies, retrospec- founding factors were handled to minimize bias.
tive cohort studies, and case series were included. The Accordingly, the studies were rated as good, fair, or poor.
additional inclusion criterion was that the studies had a The kappa (k) coefficient was used to formalize an
minimum mean follow-up of 6 months. No restriction agreement between the reviewers with data extraction.
was placed on the language of the publication. Exclusion Heterogeneity was evaluated by using the I-squared

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Table 2. Search strategy


Population HIV-positive patients #1 (((((((("hiv infections"[MeSH Terms] OR ("hiv"[All Fields] AND "infections"[All Fields]) OR "hiv infections"[All Fields] OR
AIDS ("hiv"[All Fields] AND "infection"[All Fields]) OR "hiv infection"[All Fields])) OR ("acquired immunodeficiency
HIV infection syndrome"[MeSH Terms] OR ("acquired"[All Fields] AND "immunodeficiency"[All Fields] AND "syndrome"[All Fields]) OR
HIV Coinfections "acquired immunodeficiency syndrome"[All Fields] OR "aids"[All Fields])) OR "medically compromised"[All Fields]) OR
("hiv infections"[MeSH Terms] OR ("hiv"[All Fields] AND "infections"[All Fields]) OR "hiv infections"[All Fields] OR ("hiv"[All
Fields] AND "coinfections"[All Fields]) OR "hiv coinfections"[All Fields]))
Intervention Dental implants #2 ("dental implants"[MeSH Terms] OR ("dental"[All Fields] AND "implants"[All Fields]) OR "dental implants"[All Fields] OR
("dental"[All Fields] AND "implant"[All Fields]) OR "dental implant"[All Fields])) OR "oral implants"[All Fields]))
Comparison HIV-negative patients #3 ("hiv"[MeSH Terms] OR "hiv"[All Fields]) AND negative[All Fields] AND ("patients"[MeSH Terms] OR "patients"[All
Fields])
Outcome Success, survival #4 ((("survival"[All Fields] OR "survival"[MeSH Terms]) OR ("survival rate"[MeSH Terms] OR ("survival"[All Fields] AND
"rate"[All Fields]) OR "survival rate"[All Fields])) OR success[All Fields]) OR success[All Fields] AND ("dental
implants"[MeSH Terms] OR ("dental"[All Fields] AND "implants"[All Fields]) OR "dental implants"[All Fields])
Databases d 1. PubMed
2. Cochrane registry, CENTRAL
3. Clinicaltrails.gov, Google scholar, journal database (Wiley, Elsevier, Quintessence Publishing)
Search strategy d Database 1: 1,2,3,4
Database 2,3: “HIV infection,” “AIDS,” “HIV coinfections,” “dental implants,” “oral implants,” “HIV
negative,” “survival,” “success”
Filters d None
Journals searched d Journal of Prosthetic Dentistry, International Journal of Prosthodontics, Clinical Oral Implants Research, Clinical Implant
through journal Dentistry and Related Research, Journal of Periodontology, International Journal of Oral and Maxillofacial Implants,
database Journal of Oral Implantology and Journal of Prosthodontics.

statistics. When the I-squared value was more than 75%, undertaken by the patients with HIV, with the most
substantial heterogeneity was determined, and accord- common drug being PI and nucleoside/nucleotide
ingly, a random-effects model meta-analysis was reverse transcriptase inhibitors (NNRTI). Amoxicillin was
preferred.52 the drug of choice for most authors as a postoperative
antibiotic, although 2 studies40,46 noted a preference for
amoxicillin plus clavulanic acid.
RESULTS
Most of the included studies used the criteria of
Three hundred ninety-one publications were obtained Albrektsson et al53 for measuring implant success, except
from the electronic search and 3 records from hand for one study44 that did not describe the criteria for
searching. Ninety-one records were obtained after the measuring the study outcome (Table 3). Of the 1109
removal of duplicates. Screening the titles and abstracts implants, 51 implants failed, and the most common
excluded 65 records, making 26 records eligible for full- reason for failure was peri-implantitis (15 implants),
text screening. After full-text assessment, 18 records followed by primary infection (7 implants) and osseoin-
were excluded because they were case reports, systematic tegration failure (2 implants). The common complication
reviews, multiple publications of the same pool of par- that the studies encountered included either peri-
ticipants, conference presentations, or letters to the implantitis or prosthesis failure. The marginal bone
editor. Eight studies40-47 were subjected to qualitative loss levels ranged from 0.06 mm to 2.5 mm, and the
synthesis and meta-analysis (Fig. 1). Inter-reviewer weighted mean values for marginal bone loss based on
agreement was found to be good to excellent (k=0.96, the patient number and implant number was 0.88 mm
95% confidence interval [CI]: 0.94 to 0.98). and 1.02 mm, respectively. The implant survival rate
Detailed descriptive data of the included studies are ranged between 90.9% and 100%, and the weighted
listed in Supplementary Table 1, available online. Of the mean values for implant survival, based on the patient
8 included studies, 5 were prospective,40,41,43,46,47 and 3 number and the implant number, were 95.54% and
were retrospective.42,44,45 No randomized clinical studies 95.39%, respectively. The success rate of the included
were identified. The year of publication of the included studies ranged between 68.4% and 100%.
studies ranged from 2007 to 2019. The mean follow-up The assessment revealed “fair” quality for 4 studies
period was 2.8 years. Four hundred eleven patients and “poor” quality for the remaining 4 studies (Table 4).
with HIV received 1109 implants. Nevertheless, 29 pa- The studies did not explain the rationale for choosing the
tients had diabetes, and 146 patients had a history of participant numbers and failed to calculate the sample
smoking, although 2 studies excluded smokers. The CD4 size, possibly indicating that the studies lacked adequate
cell count was reported to range from 141.24 cells/mm3 to size and effect. Statistical analysis to control the potential
726.3 cells/mm3, and viral load was lower than 50 copies/ confounding variables which were not of interest was
mL. Most studies reported a specific type of HAART measured in 4 of the included studies.40,41,44,46 Unlike

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Identification
391 records identified through 3 additional records identified
database searching through other sources

91 records after
duplicates removed
Screening

91 records screened 65 records excluded

26 full-text articles
Eligibility

18 full-text articles
assessed for eligibility excluded
12- case reports
3- systematic reviews
1-same pool of patients
8 studies included in 2-conference
qualitative synthesis presentation/letter to the
editor
Included

8 studies included in
quantitative synthesis
(meta-analysis)

Figure 1. Flow diagram of study selection according to PRISMA statement. PRISMA, Preferred Reporting Items for Systematic Reviews and
Meta-Analyses.

randomized controlled trials, cohort studies need to pay different survival rates, the data were pooled in a meta-
more attention to controlling the confounding factors analysis to estimate overall survival. Because no ran-
with robust statistical analysis. The overall quality of the domized controlled trials have been published, other
included studies was rated as fair to poor with a mod- study designs, including cohort studies and retrospective
erate risk of bias. Eight studies contributed data to the studies, were included for the review, based on the
meta-analysis. Each study had reported the implant presumption that a better internal validity could be
survival rate ranging from 90% to 99%.40-47 After pooling found.54 The quality assessment tool used in this study
all the data from the 8 studies, a forest plot was gener- was intended to assess specifically the nature of the
ated, which revealed a pooled estimate of 95% of implant relationship between exposure and outcome and
survival rate with 95% CI (92% to 96%). Heterogeneity examine the strength of the study design.51
across the 8 studies was measured by using the I-squared The criteria of Albrektsson et al 53 for evaluating the
statistics of 41% with moderate true variability (Fig. 2). success of dental implants was adopted in most of the
research because of its simplicity and reliability. The
DISCUSSION
question related to outcome measures in the assess-
Three systematic reviews30-32 concerning the survival of ment tool is an important attribute that determines the
dental implants in patients with HIV have been pub- quality of the studies. Accordingly, 1 study was rated
lished. The articles studied the survival of dental implants poor. The meta-analysis in the present study showed
in patients with HIV but also included case reports, case the pooled estimate of the survival rate for implants in
series, and letters to the editor in the qualitative analysis. patients with HIV to be 95% with 95% CI (92% to
Although the results demonstrated the suitability of 96%) with a mean 2.8-year follow-up. These meta-
dental implants for patients with HIV, they were unable analysis results are comparable with those of a recent
to justify it quantitatively through meta-analysis. In the systematic review that reported that the survival of
current review, the heterogeneity was at a moderate implants in a healthy population was 96.4%.10 The
level, with the survival rate ranging from 90% to 99%. As survival rate was slightly lower for patients with HIV
the heterogeneity did not arise because of studies with than that of a healthy population.

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Table 3. Outcomes of included studies


Criteria for Peri-Implant Follow- Implant Implant Prosthesis Survival
Assessment of No. of Failed Bone Loss up Rate Survival Rate Success Rate/Failure Rate
Study Implant Success Implants (mm) Complication (%) (%) Rate (%) (%)
Rubinstein Albrektsson et al 0 Mesial bone Crown in hyperocclusion 100 100 90% Not specified
et al (2019)45 loss e 0.7 Mesial bone loss e 5.3 mm,
Distal bone distal e 6mm, overall close to
loss e 0.4 50% loss
Sabbah et al No defined criteria to 27 Not specified Not specified 100 94.4 Not Not specified
(2019)44 measure outcome specified
May et al Defined their own 3 Not specified Not specified 100 90.9 Not Not specified
(2016)47 criteria to measure (1 e Infection specified
outcome 2 e Osseo
integration
failure)
Gherlone Buser et al 15 1.19 ±0.87 7 e Peri-implantitis 100 92.1 92.1 Prosthesis failure
et al (2016)40 (5 e Infection 2 e Prosthetic failure rate e 2.9
10 e Peri-
implantitis)
Oliveira et al Roos et al 0 0.49 - 0.47 None 100 100 Not Not specified
(2011)41 Albrektsson et al. specified
Stevenson Albrektsson et al 0 0.06 None 75 100 100 Not specified
et al (2007)43
Gay-Escoda Albrektsson et al 1 e Peri- 2.5 ±1.9 22.2% e Mucositis 100 98.3 68.4 Not specified
et al (2016)42 implantitis 44.4% e Peri-implantitis
Gastaldi et al Defined their own 5 Maxilla e 3.7 % e Peri-implantitis 100 95.37 Not 96.3
(2017)46 criteria to measure (4 e Peri- 0.98 ±0.21 7.42% e Fracture of provisional specified
outcome implantitis Mandible prosthesis
1 e Primary e0.88 ±0.32
infection)
Total d 51 Weighted d d Weighted mean d d
(Peri-implantitis e mean value value (P) e
15 (P) e 0.88 95.54
Infection e 7 (I)-1.02 (I)-95.39
Osseointegration
failure e 2)

I, implant number; P, patient number.

Osteoporosis and osteopenia are noted as long-term (range 141 to 726 cells/mm3), and specific type of HAART
complications of HIV infection and the HAART drugs41,42,44,45,47 undertaken by the study group. Sabbah
regimen.34-38 However, the recent integrase et al44 reported a significant increase in implant failure
inhibitors dolutegravir and tenofovir alafenamide have rate when preplacement, the CD4 was  20% (the
been reported to have lesser effects on bone mineral count is under 200 cells/mm3). However, others did not
density.25-27 However, reports on the use of these newer report any significant correlation between implant suc-
drugs in patients with HIV with dental implants are cess and CD4 cell count or viral load.40,41
lacking. In addition, the presence of osteoporosis may Sabbah et al44 reported a high implant failure rate in
not be a definitive condition to contraindicate dental patients who received PI with a 4.4% risk of failure at 1
implant treatment.9,55 The placement of dental implants year and 8.9% at 3 and 5 years than patients who fol-
with a high degree of clinical acuity addressing lowed another HAART regimen. The study by Oliveira et
methodical treatment planning tactics and choosing al41 was the only study which tried to analyze whether
appropriate implant geometry and surface treatment is the HAART drug might affect implant success by
the key to successful osseointegration even in morbid recording the baseline levels of bone resorption
conditions. markers pyridinoline and deoxypyridinoline. Higher
Viral load is used as a surrogate marker of disease levels of pyridinoline and deoxypyridinoline were asso-
progression because a significant association has been ciated with lower bone mineral density and higher risk of
reported between decreased viral load and clinical out- fracture. Among patients with HIV, a majority (68%) had
comes.22,23 A rise in viral load is often followed by a pyridinoline and deoxypyridinoline levels higher than
decrease in the CD4 count and subsequent illness. Hence, normal limits, indicating increased bone resorption.
knowing the type of HAART regimen, viral load level, and However, the authors concluded that the higher levels of
CD4 cell count before the start of implant therapy is bone resorption markers did not contribute to implant
important for successful implant-supported restorations. failure after 12 months of follow-up.41 The effects of
In the current review, 5 of the 8 included studies recorded higher levels of bone resorption markers on implant
the viral load (˂50 copies/mL),41,42,44,46,47 CD4 cell count success could only be reflected in long-term

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Table 4. Quality assessment using quality assessment tool for observational cohort and cross-sectional studies
Gay-
May Gherlone Oliveira Stevenson Escoda Gastaldi Sabbah Rubinstein
et al et al et al et al et al et al et al et al
47
Criteria (2016) (2016)40 (2011)41 (2007)43 (2016)42 (2017)46 (2019)44 (2019)45
Was research question or objective in article clearly stated? d d d d d d d d
Was study population clearly specified and defined? d d d d d d d d
Was participation rate of eligible persons at least 50%? d d d d d d d d
Were all participants selected or recruited from same or similar d d d d x d x x
populations (including the same time period)? Were inclusion and
exclusion criteria for being in study prespecified and applied uniformly to
all participants?
Was sample size justification, power description, or variance and effect x x x x x x x x
estimates provided?
For analyses in this article, were exposure(s) of interest measured before d d d d d d d d
outcome(s) being measured?
Was timeframe sufficient so that one could reasonably expect to see d d d x d d d d
association between exposure and outcome if it existed?
For exposures that can vary in amount or level, did study examine NA NA NA NA NA NA NA NA
different levels of exposure as related to outcome (such as categories of
exposure or exposure measured as continuous variable)?
Were exposure measures (independent variables) clearly defined, valid, d d d d d d d d
reliable, and implemented consistently across all study participants?
Was exposure(s) assessed more than once over time? NA NA NA NA NA NA NA NA
Were outcome measures (dependent variables) clearly defined, valid, d d d d d d x d
reliable, and implemented consistently across all study participants?
Were outcome assessors blinded to exposure status of participants? NA NA NA NA NA NA NA NA
Was loss to follow-up after baseline 20% or less? d d d d d d d d
Were key potential confounding variables measured and adjusted x d d x x d d x
statistically for their impact on relationship between exposure(s) and
outcome(s)?
Quality rating Fair Fair Fair Poor Poor Fair Poor Poor

-, yes; x-, no, CD, cannot determine; NA, not applicable; NC, not recorded.

observations, as the patients with HIV receive HAART Smoking is another important patient-related factor
drugs for their lifetime. that has been attributed to implant failure.4 Various trials
Peri-implantitis is a common complication occurring and cohort studies reported a range of 6.5% to 20%
after implant therapy. It could result in bone loss around failure rate of endosseous implants in patients who
dental implants and lead to implant failure.2 The prev- smoked compared with nonsmokers.5-7 Smoking indi-
alence of peri-implantitis in a healthy population was rectly affected the stability and integrity of the dental
analyzed in a recent systematic review that reported implants because of marginal bone loss and peri-
about 9.25% and 19.83% at 95% CI for implant-based implantitis. Smoking in patients with HIV increases
and participant-based peri-implantitis, respectively.3 susceptibility to oral infections, including candidiasis, and
The current systematic review noted a failure of 15 compromises the capillary blood flow.8 Five of the 8
implants because of peri-implantitis and 7 implants studies in the current systematic review included 146
because of infection. In the study by Gherlone et al40, patients with smoking habits who experienced a higher
peri-implantitis and primary infection contributed to number of implant failures (41.6% at 1-year follow-up
implant failure of about 5.2% (10 of 190 implants) and and 10.1% at 5-year follow-up) than nonsmokers or
2.7% (5 of 190 implants). The authors linked the occasional smokers.40,42-44,46 Furthermore, they had a
immunologic status in patients with HIV to the occur- higher incidence of peri-implantitis, pus, and pain.
rence of infection. Gay-Escoda et al42 reported peri- A follow-up period is important to ensure a conse-
implant disease at 66.6% in 77 months of mean quential assessment of the relationship between a dental
follow-up, but the researchers failed to rectify the con- implant and its survival rate in patients with HIV. Clinical
dition. This contributed to an implant success rate researchers in implant dentistry have reported that a
of 68.4%, which is quite low and which implicated minimum mean of 5-year follow-up period allows for
the relationship between implant success and peri- optimal scientific deliberation in research related to
implantitis. May et al47 reported a slightly higher dental implants.56 In the current systematic review, only
failure rate of 10% in patients with HIV than healthy 2 included studies had a follow-up period of 5 years or
patients at 5% to 7%. Sabbah et al44 reported 27 implant more.42,47 The follow-up rate of the studies was 75% to
failures, though no reason was given. 100%. Short follow-up periods and loss to follow-up

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Implant Survival Rate


Study Name Statistics for Each Study Event Rate and 95% CI
Event Lower Upper
Rate Limit Limit Z-Value P
Rubinstein et al, 2019 0.997 0.947 1.000 3.990 <.001
Sabbah et al, 2019 0.944 0.920 0.961 14.283 <.001
May et al, 2016 0.909 0.753 0.970 3.803 <.001
Gherlone et al, 2016 0.921 0.873 0.952 9.132 <.001
Oliveira et al, 2011 0.992 0.882 0.999 3.377 .001
Stevenson et al, 2007 0.992 0.879 0.999 3.353 .001
Gay-Escoda et al, 2016 0.982 0.886 0.998 3.990 <.001
Gastaldi et al, 2017 0.954 0.894 0.981 6.606 <.001
0.950 0.922 0.969 11.919 <.001

–1.00 –0.50 0.00 0.50 1.00


Survival Rate

Figure 2. Meta-analysis of included studies (95% confidence interval [CI]).

could undermine the validity of any study. Participants dental implants in the long term should be studied.33
who were lost to follow-up could have a different Conducting randomized controlled trials with dental
prognosis than those who complete the study. With an implants in patients with HIV is difficult. However, well-
implant survival rate of about 96% at 10-year follow-up designed prospective trials with larger sample sizes and
in healthy individuals, it is imperative to study the longer follow-up periods could add more patient-
survival of dental implants in immunocompromised centered evidence to implant therapy.
conditions such as HIV infection with longer follow-up
terms. In addition, prosthesis-related factors including CONCLUSIONS
overload, suboptimal implant design, and improper
prosthetic designs could contribute to implant failure. In Based on the findings of this systematic review and
the current review, 2 studies observed the prosthesis- meta-analysis, the following conclusions were drawn:
related failure rate to be 2.9% and 3.7%, but other 1. Short-term evaluation suggests that HIV infection
studies failed to report or did not observe prosthesis does not pose a serious threat to implant survival.
related failures.40,46 The disease status of HIV infection, However, the evidence is relatively weak.
risk of coinfections (hepatitis C virus, hepatitis B virus, 2. Methodologically sound clinical trials controlling for
myocardial infarction, long-term liver diseases, long- confounding factors including complications of drug
term kidney diseases, and fracture of bone),48,49 adverse therapy, the status of HIV infection, and HIV co-
effects of HAART drugs in the long term, and compli- infection are required to provide higher levels of
cations associated with implant therapy could influence evidence.
the success of implant therapy.
HIV can change into a new form or subtype every
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A prospective longitudinal study on implant prosthetic rehabilitation in https://doi.org/10.1016/j.prosdent.2020.04.001

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