How does osteoporosis affect implant treatment? – Jonathan Fleet – Nobel Biocare
Featured Products Promotional FeaturesPosted by: Dental Design 21st June 2019
As dental implant treatment becomes more widely available, it’s likely that more and more patients will prefer it to other solutions such as removable prostheses.
However, there are cases where existing health conditions may affect patients’ suitability for treatment. One of these conditions is osteoporosis.
What is osteoporosis?
Osteoporosis is a disorder that weakens bones, making them fragile and more prone to fractures and breakages. Often only diagnosed after a fall or impact causes a fracture, the condition can take many years to develop and affects every bone in the skeleton, resulting in steady bone loss throughout the whole body.
The condition affects over three million people in the UK alone, and there are a number of factors that can increase the risk of developing the disease. These include a family history of the condition, heavy drinking or smoking, a long-term use of steroids and having a low body mass index (BMI). The disorder is also more likely to affect women, especially those who are post-menopause, though it can strike people in any age group.[1]
Osteoporosis, edentulism and the elderly
As osteoporosis is more common among the elderly population, it raises an important factor to consider when evaluating these patients for implant surgery. Edentulism too is more common amongst the older generation, and studies have found that incremental tooth loss occurs naturally in people over the age of 65.[2]This means that a large proportion of people seeking implant treatment may also have osteoporosis and the associated levels of bone loss, and therefore it’s necessary for professionals to see what options they can provide these patients.
A full assessment
Due to the uncertainty around implants in those with osteoporosis, a full patient assessment is necessary. This will help identify the bone volume available for surgery and will dictate whether the procedure is viable. In cases where very little bone is available, it might be worth exploring other alternatives with patients – such as dentures – that don’t rely on good bone levels for functionality. Bone grafting is also an option, and professionals should explore implant systems that can operate well even in comprised bone. During this assessment it’s also important to discuss the patient’s aims regarding factors such as esthetics, as this could impact the type of implants used should the surgery go forward.
Why bone loss matters
Bone loss is often cited as one of the main causes of implant failure,[3]and as osteoporosis directly affects quality of bone, it could also impact implant survival rates in patients with the condition. One study found that osteoporotic patients did suffer from a higher incidence of implant loss, but the authors stressed that this wasn’t necessarily due to the effect the condition has on bone healing as no randomized clinical studies were available for analysis.[4]
One possible reason for this result is that individuals with osteoporosis are often prescribed bisphosphonates in order to maintain their bone levels. In rare cases the use of these can lead to a related condition called osteonecrosis of the jawbone. This side effect causes the cells in the bone to die, leaving them unable to heal if damaged.[5]Invasive surgery such as implant placement could therefore result in implants being unable to osseointegrate, causing failure.
Another potential reason for these higher rates of implant loss in patients with osteoporosis is that steady bone loss caused by the condition could lead to increased mobility of the implant, eventually resulting in failure. Achieving good primary stability is considered integral to allow the implant to become successfully osseointegrated for maximum implant success.[6]In cases of compromised bone level where implant surgery is still deemed achievable, finding the right implant is therefore paramount.
Choose an implant system that can help
Selecting an implant system that can help to achieve primary stability and make use of the available bone is one way of providing osteoporotic patients with a solution.
NobelActive®implants are particularly recommended as they can provide a high level of primary stability and are compatible with a wide array of Nobel Biocare restorations. These implants are effective even in cases of soft bone because of their hexagonal internal locking mechanism that offers high mechanical strength.
Assess the options
When treating patients with osteoporosis it’s important to evaluate all options available to ensure that you can give them the most appropriate and effective treatment. Although osteoporosis only rarely prevents implant treatment, it may affect survival rates and therefore it is paramount to warn patients about this when considering implant surgery.
For more information, contact Nobel Biocare on 0208 756 3300, or visit www.nobelbiocare.com
References
[1]NHS Choices. Osteoporosis. Link: https://www.nhs.uk/conditions/osteoporosis/ [Last accessed June 18].
[2]Thomson, W., Ma, S. An Ageing Population Poses Dental Challenges. Singapore Dental Journal. 2014; 35: 3-8.
[3]Duan, X., Wu, T., Guo, Y., Zhou, X., Lei, Y., Xu, X., Mo, A., Wang, Y., Yuan, Q. Marginal Bone Loss Around Non-Submerged Implants is Associated With Salivary Microbiome During Bone Healing. International Journal of Oral Science 2017; 9: 95–103.
[4]Giro, G. Chambrone, L., Goldstein, A., Rodrigues, J., Zenobio, E., Feres, M., Figueiredo, L., Cassoni, A., Shibli, J. Impact of Osteoporosis in Dental Implants: A Systematic
Review. World Journal of orthopaedics 2015; 6(2): 311-315.
[5]NHS Choices. Osteoporosis Treatment. Link: https://www.nhs.uk/conditions/osteoporosis/treatment/ [Last accessed June 18].
[6]Rao, P., Gill, A. Primary Stability: The Password of Implant Integration. Journal of Dental implants 2012; 2(2): 103-109.
