ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Rheumatoid Arthritis Alone May Not Affect the Success of an Implant, but Combined with Connective Tissue Disorders, It Can Lead to Peri-Implant Tissue Discrepancies
Clinical Question In adult female patients, is the implant failure rate higher in those with rheumatoid arthritis compared to those without the condition?
Clinical Bottom Line Implant success may not be affected by rheumatoid arthritis (RA) alone in adult female patients. In contrast, patients with both RA and connective tissue disorders (CTD), peri-implant parameters were significantly influenced by their underlying diseases; this conclusion is based on a 3.5-year retrospective study.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20718894Krennmair/201034 adult females: 25 w/ isolated RA, 9 w/ RA + CTD Case Control Study
Key results3.5-year survival rate of implants ranged from 92.3% (RA with concomitant CTD) to 94.6% (isolated RA). Patients with RA and CTD displayed increased bone resportion (mean, 3.1 mm; SD, 0.7 mm) and a higher bleeding index, differing significantly from those with isolated RA (p<0.01).
#2) 20234887Weinlander/201022 female patients: 16 w/ isolated RA, 5 w/ RA + CTD, 1 w/ isolated CTDCase Control Study
Key resultsIn general, there was a high implant success rate of 96.1%. Isolated RA demonstrated acceptable marginal bone loss (mean, 2.1 mm) with soft tissues in good condition. In contrast, RA + CTD demonstrated increased bone resorption (mean, 3.1 mm). Sjogren’s Syndrome patients demonstrated the most severe reaction of the peri-implant tissues.
#3) 10453676Eder/199980 year old female with severe osteoporosis & chronic polyarthritis Case report
Key resultsThe patient, who was being treated with methotrixate disodium and acetaminophen, received a fixed mandibular prosthesis supported by 6 implants placed between the mental foramina. After 4 years, the patient demonstrated 1.38 mm peri-implant bone resorption (SD, 0.8 mm) and her pocket depths showed an average depth of 2.87 mm (SD, .53 mm). These result are indicative that her severe osteoporotic symptoms and her chronic polyarthritis had a mild to no effect on the success rate of her implants.
Evidence Search rheumatoid arthritis & dental implants
Comments on
The Evidence
Validity: The groups in both studies were similar (all adult females with RA plus a group with RA and CTD). The subjects were all evaluated to completion in the same manner, and bone loss and peri-implant tissue was evaluated on all patients at this point. However, these were retrospective studies on only 34 and 22 patients, and there is not enough evidence to definitively answer the PICO question.
Applicability These results can be helpful in treating patients with RA and CTD, because they show how the underlying disease can affect the success of the implant and how the peri-implant tissue is affected.
Specialty/Discipline (General Dentistry) (Periodontics) (Prosthodontics)
Keywords dental implants, rheumatoid arthritis
ID# 2878
Date of submission: 04/01/2015spacer
E-mail kingkj@livemail.uthscsa.edu
Author Karen King
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Concepcion Barboza, DDS
Faculty mentor/Co-author e-mail barbozaArgue@uthscsa.edu
Basic Science Rationale
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