Smoking, Radiotherapy, Diabetes and Osteoporosis as Risk Factors for Dental Implant Failure: A Meta-Analysis

Background There are conflicting reports as to the association between smoking, radiotherapy, diabetes and osteoporosis and the risk of dental implant failure. We undertook a meta-analysis to evaluate the association between smoking, radiotherapy, diabetes and osteoporosis and the risk of dental implant failure. Methods A comprehensive research on MEDLINE and EMBASE, up to January 2013, was conducted to identify potential studies. References of relevant studies were also searched. Screening, data extraction and quality assessment were conducted independently and in duplicate. A random-effects meta-analysis was used to pool estimates of relative risks (RRs) with 95% confidence intervals (CIs). Results A total of 51 studies were identified in this meta-analysis, with more than 40,000 dental implants placed under risk-threatening conditions. The pooled RRs showed a direct association between smoking (n = 33; RR = 1.92; 95% CI, 1.67–2.21) and radiotherapy (n = 16; RR = 2.28; 95% CI, 1.49–3.51) and the risk of dental implant failure, whereas no inverse impact of diabetes (n = 5; RR = 0.90; 95% CI, 0.62–1.32) on the risk of dental implant failure was found. The influence of osteoporosis on the risk of dental implant failure was direct but not significant (n = 4; RR = 1.09; 95% CI, 0.79–1.52). The subgroup analysis indicated no influence of study design, geographical location, length of follow-up, sample size, or mean age of recruited patients. Conclusions Smoking and radiotherapy were associated with an increased risk of dental implant failure. The relationship between diabetes and osteoporosis and the risk of implant failure warrant further study.

[1]  B. Seifert,et al.  Is mandibular reconstruction using vascularized fibula flaps and dental implants a reasonable treatment? , 2014, Clinical implant dentistry and related research.

[2]  M. Esposito,et al.  Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants. , 2013, The Cochrane database of systematic reviews.

[3]  J. Fiorellini,et al.  The effect of cigarette smoking and native bone height on dental implants placed immediately in sinuses grafted by hydraulic condensation. , 2012, The International journal of periodontics & restorative dentistry.

[4]  H. De Bruyn,et al.  Factors associated with failure of surface-modified implants up to four years of function. , 2012, Clinical implant dentistry and related research.

[5]  H. De Bruyn,et al.  The effect of smoking on survival and bone loss of implants with a fluoride-modified surface: a 2-year retrospective analysis of 1106 implants placed in daily practice. , 2012, Clinical oral implants research.

[6]  A. Banerjee,et al.  Factors affecting survival and usefulness of implants placed in vascularized free composite grafts used in post-head and neck cancer reconstruction. , 2012, Clinical implant dentistry and related research.

[7]  I. Rocchietta,et al.  A review assessing the quality of reporting of risk factor research in implant dentistry using smoking, diabetes and periodontitis and implant loss as an outcome: critical aspects in design and outcome assessment. , 2012, Journal of clinical periodontology.

[8]  I. Klineberg,et al.  Patient-related risk factors for implant therapy. A critique of pertinent literature. , 2011, Australian dental journal.

[9]  G. Watzek,et al.  Peri-implantitis and late implant failures in postmenopausal women: a cross-sectional study. , 2011, Journal of clinical periodontology.

[10]  H. De Bruyn,et al.  The effect of smoking on early bone remodeling on surface modified Southern Implants®. , 2011, Clinical implant dentistry and related research.

[11]  E. Valmaseda-Castellón,et al.  Postoperative complications in smoking patients treated with implants: a retrospective study. , 2011, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[12]  M. Goiato,et al.  Dental Implants in Patients With Osteoporosis: A Clinical Reality? , 2011, The Journal of craniofacial surgery.

[13]  A. Borges-Yáñez,et al.  Osteoporosis, the risk of vertebral fracture, and periodontal disease in an elderly group in Mexico City. , 2011, Gerodontology.

[14]  A. Vissink,et al.  Benefits of dental implants installed during ablative tumour surgery in oral cancer patients: a prospective 5-year clinical trial. , 2010, Clinical oral implants research.

[15]  T. Salinas,et al.  Clinical evaluation of implants in radiated fibula flaps. , 2010, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[16]  L. Levin,et al.  Smoking, Diabetes Mellitus, Periodontitis, and Supportive Periodontal Treatment as Factors Associated With Dental Implant Survival: A Long-Term Retrospective Evaluation of Patients Followed for Up to 10 Years , 2010, Implant dentistry.

[17]  M. Cuesta-Gil,et al.  Oral rehabilitation with osseointegrated implants in oncologic patients. , 2009, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[18]  Markus Martini,et al.  Long-term results of endosteal implants following radical oral cancer surgery with and without adjuvant radiation therapy. , 2009, Clinical implant dentistry and related research.

[19]  B. Al-Nawas,et al.  Functional Rehabilitation of Mandibular Continuity Defects Using Autologous Bone and Dental Implants – Prognostic Value of Bone Origin, Radiation Therapy and Implant Dimensions , 2009, European Surgical Research.

[20]  L. Levin,et al.  Long-Term Marginal Bone Loss Around Single Dental Implants Affected by Current and Past Smoking Habits , 2008, Implant dentistry.

[21]  A. Weaver,et al.  The effects of smoking on the survival of smooth- and rough-surface dental implants. , 2008, The International journal of oral & maxillofacial implants.

[22]  A. Weaver,et al.  Effect of osteoporotic status on the survival of titanium dental implants. , 2008, The International journal of oral & maxillofacial implants.

[23]  G. Tawil,et al.  Conventional and advanced implant treatment in the type II diabetic patient: surgical protocol and long-term clinical results. , 2008, The International journal of oral & maxillofacial implants.

[24]  M. Quirynen,et al.  Impact of local and systemic factors on the incidence of late oral implant loss. , 2008, Clinical oral implants research.

[25]  Morton L Perel,et al.  Implant success, survival, and failure: the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. , 2008, Implant dentistry.

[26]  W. Teughels,et al.  Impact of local and systemic factors on the incidence of failures up to abutment connection with modified surface oral implants. , 2007, Journal of clinical periodontology.

[27]  K. Nelson,et al.  Survival analysis and clinical evaluation of implant-retained prostheses in oral cancer resection patients over a mean follow-up period of 10 years. , 2007, The Journal of prosthetic dentistry.

[28]  G. Colella,et al.  Oral implants in radiated patients: a systematic review. , 2007, The International journal of oral & maxillofacial implants.

[29]  G. Zarb,et al.  The effect of smoking on osseointegrated dental implants. Part I: implant survival. , 2006, The International journal of prosthodontics.

[30]  R. Schepers,et al.  Effect of postoperative radiotherapy on the functional result of implants placed during ablative surgery for oral cancer. , 2006, International journal of oral and maxillofacial surgery.

[31]  D. Hinode,et al.  Influence of smoking on osseointegrated implant failure: a meta-analysis. , 2006, Clinical oral implants research.

[32]  C. Landes,et al.  Comparison of early telescope loading of non-submerged ITI implants in irradiated and non-irradiated oral cancer patients. , 2006, Clinical oral implants research.

[33]  A. Garg,et al.  Healing in smokers versus nonsmokers: survival rates for sinus floor augmentation with simultaneous implant placement. , 2006, The International journal of oral & maxillofacial implants.

[34]  R. Biffar,et al.  Private practice results of screw-type tapered implants: survival and evaluation of risk factors. , 2006, The International journal of oral & maxillofacial implants.

[35]  R. Ewers,et al.  Implant survival in mandibles of irradiated oral cancer patients. , 2006, Clinical oral implants research.

[36]  P. Moy,et al.  Dental implant failure rates and associated risk factors. , 2005, The International journal of oral & maxillofacial implants.

[37]  James S. Brown,et al.  Oral rehabilitation after treatment for head and neck malignancy , 2005, Head & neck.

[38]  S. Redding,et al.  Dental implants for patients who have had radiation treatment for head and neck cancer. , 2003, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[39]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[40]  T. Jørgensen,et al.  Short‐term pre‐operative smoking cessation intervention does not affect postoperative complications in colorectal surgery: a randomized clinical trial , 2003, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[41]  S. Vermilyea,et al.  An investigation of the relationship between systemic bone density and clinical periodontal status in post-menopausal Asian-American women. , 2003, International dental journal.

[42]  M. Quirynen,et al.  The relative impact of local and endogenous patient-related factors on implant failure up to the abutment stage. , 2002, Clinical oral implants research.

[43]  Akshay Kumar,et al.  The effect of smoking on achieving osseointegration of surface-modified implants: a clinical report. , 2002, The International journal of oral & maxillofacial implants.

[44]  M. Quirynen,et al.  Biologic outcome of implant-supported restorations in the treatment of partial edentulism. Part 2: a longitudinal radiographic study. , 2002, Clinical oral implants research.

[45]  M. Quirynen,et al.  Biologic outcome of implant-supported restorations in the treatment of partial edentulism. part I: a longitudinal clinical evaluation. , 2002, Clinical oral implants research.

[46]  N. Ferrigno,et al.  A long-term follow-up study of non-submerged ITI implants in the treatment of totally edentulous jaws. Part I: Ten-year life table analysis of a prospective multicenter study with 1286 implants. , 2002, Clinical oral implants research.

[47]  I. Wang,et al.  Retrospective radiographic analysis of sinus graft and implant placement procedures from the Academy of Osseointegration Consensus Conference on Sinus Grafts. , 2001, The International journal of periodontics & restorative dentistry.

[48]  Susan R. Johnson,et al.  Osteoporosis prevention, diagnosis, and therapy. , 2001, JAMA.

[49]  H. F. Morris,et al.  Implant survival in patients with type 2 diabetes: placement to 36 months. , 2000, Annals of periodontology.

[50]  P. Lambert,et al.  The influence of smoking on 3-year clinical success of osseointegrated dental implants. , 2000, Annals of periodontology.

[51]  H F Morris,et al.  Long-term assessment (5 to 71 months) of endosseous dental implants placed in the augmented maxillary sinus. , 2000, Annals of periodontology.

[52]  D. Buser,et al.  Basic surgical principles with ITI implants. , 2000, Clinical oral implants research.

[53]  G. Chaushu,et al.  The clinical effectiveness of implants placed immediately into fresh extraction sites of molar teeth. , 2000, Journal of periodontology.

[54]  C. Goodacre,et al.  Effects of smoking on implant success in grafted maxillary sinuses. , 1999, The Journal of prosthetic dentistry.

[55]  E. Keller,et al.  Maxillary antral-nasal inlay autogenous bone graft reconstruction of compromised maxilla: a 12-year retrospective study. , 1999, The International journal of oral & maxillofacial implants.

[56]  D van Steenberghe,et al.  Survival of the Brånemark implant in partially edentulous jaws: a 10-year prospective multicenter study. , 1999, The International journal of oral & maxillofacial implants.

[57]  M. Imoberdorf,et al.  Evaluating the clinical performance of the Osseotite implant: defining prosthetic predictability. , 1999, Compendium of continuing education in dentistry.

[58]  J. V. Van Sickels,et al.  A 5-year comparison of hydroxyapatite-coated titanium plasma-sprayed and titanium plasma-sprayed cylinder dental implants. , 1999, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[59]  H. De Bruyn,et al.  Clinical outcome of Screw Vent implants. A 7-year prospective follow-up study. , 1999, Clinical oral implants research.

[60]  U. Joos,et al.  Rehabilitation with dental implants of oral cancer patients. , 1999, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[61]  G. Carlsson,et al.  Association between Marginal Bone Loss around Osseointegrated Mandibular Implants and Smoking Habits: A 10-year Follow-up Study , 1997, Journal of dental research.

[62]  G. Smith,et al.  Bias in meta-analysis detected by a simple, graphical test , 1997, BMJ.

[63]  W. Wagner,et al.  Dental implants following radical oral cancer surgery and adjuvant radiotherapy. , 1997, The International journal of oral & maxillofacial implants.

[64]  C. Bain,et al.  Smoking and implant failure--benefits of a smoking cessation protocol. , 1996, The International journal of oral & maxillofacial implants.

[65]  M. Listgarten,et al.  Outcome failures of endosseous implants from a clinical training center. , 1996, Compendium of continuing education in dentistry.

[66]  H. De Bruyn,et al.  The effect of smoking on early implant failure. , 1994, Clinical oral implants research.

[67]  Sheldon Winkler,et al.  Dental Implant Clinical Research Group , 1994 .

[68]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[69]  R. Marx.  Osteoradionecrosis: a new concept of its pathophysiology. , 1983, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[70]  P. Rubin,et al.  Regeneration of bone marrow in rabbits following local, fractionated irradiation , 1973, Cancer.

[71]  S. Gurav,et al.  Dental implants in irradiated jaws: a literature review. , 2012, Journal of cancer research and therapeutics.

[72]  Heather J. Conrad,et al.  Retrospective cohort study of the predictors of implant failure in the posterior maxilla. , 2011, The International journal of oral & maxillofacial implants.

[73]  M. Esposito,et al.  The influence of smoking on the survival of dental implants: a 5-year pragmatic multicentre retrospective cohort study of 1727 patients. , 2011, European journal of oral implantology.

[74]  V. Konstantinovic,et al.  Effects of radiation therapy on craniofacial and dental implants: a review of the literature. , 2009, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[75]  M. Bornstein,et al.  Systemic conditions and treatments as risks for implant therapy. , 2009, The International journal of oral & maxillofacial implants.

[76]  A. Vissink,et al.  Prosthodontic rehabilitation of oral function in head-neck cancer patients with dental implants placed simultaneously during ablative tumour surgery: an assessment of treatment outcomes and quality of life. , 2008, International journal of oral and maxillofacial surgery.

[77]  P. Klokkevold,et al.  How do smoking, diabetes, and periodontitis affect outcomes of implant treatment? , 2007, The International journal of oral & maxillofacial implants.

[78]  R. Pereira,et al.  Comparative study of axial and femoral bone mineral density and parameters of mandibular bone quality in patients receiving dental implants , 2006, Osteoporosis International.

[79]  M. R. M. Tehrani,et al.  Osteoporosis, prevention, diagnosis and treatment , 2005 .

[80]  U. Braegger,et al.  Conservative dental surgery: Six-year success rates of occlusal amalgam and glass-ionomer restorations placed using minimal intervention approaches , 2003, British Dental Journal.

[81]  G. Widmark,et al.  Rehabilitation of patients with severely resorbed maxillae by means of implants with or without bone grafts: a 3- to 5-year follow-up clinical report. , 2001, The International journal of oral & maxillofacial implants.

[82]  R. Wallace.  The relationship between cigarette smoking and dental implant failure. , 2000, The European journal of prosthodontics and restorative dentistry.

[83]  P. Lambert,et al.  The effect of smoking on implant survival at second-stage surgery: DICRG Interim Report No. 5. Dental Implant CLinical Research Group. , 1994, Implant dentistry.

[84]  P. Lambert,et al.  THE EFFECT OF SMOKING ON IMPLANT SURVIVAL AT SECOND-STAGE SURGERY: DICRG INTERIM REPROT NO. 5 , 1994 .

[85]  P. Moy,et al.  The association between the failure of dental implants and cigarette smoking. , 1993, The International journal of oral & maxillofacial implants.