Title	Patients With HIV Do Not Experience Higher Dental Implant Failure Rates Than Patients Without HIV
Clinical Question	Are patients with HIV more likely to have dental implant failure than patients without HIV?
Clinical Bottom Line	Dental implant failure rates in patients with HIV is similar to that seen in patients without HIV. Factors that increase the probability of success in these patients are prophylactic antibiotics, highly active antiretroviral therapy (HAART), and controlled CD4+ T lymphocyte counts.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 25662560 Ata-Ali/2015 9 studies/173 implants Systematic review of non-randomized trials Key results The authors analyzed a total of 9 studies. Of the 173 total implants placed in the 9 studies, only 1 implant was reported to have osseointegration failure after 30 months of follow-up. Demineralizing bone metabolic disorders, such as osteoporosis and osteopenia, are increased in HIV-positive patients, but the studies found no associated increase in dental implant failure. Overall, the authors found that HIV-positive patients have a dental implant prognosis similar to HIV-negative patients, especially in conjunction with HAART, controlled CD4+ T lymphocyte counts, and administration of prophylactic antibiotics. They recommended further studies with larger sample sizes and longer durations to follow-up and confirm the results. 21881066 Oliveira/2011 40 patients Prospective Cohort Study Key results This study involved dental implant placement in 40 patients separated into 3 treatment groups: HIV-positive receiving protease inhibitor (PI)-based HAART, HIV-positive receiving nonnucleoside reverse transcriptase inhibitor-based HAART, and HIV-negative control group. 59 implants were placed and followed for 12 months after loading. Average bone loss around the implants after 12 months was 0.49 mm in group 1, 0.47 mm in group 2, and 0.55 mm in the control group. The authors concluded that dental implants can be a reasonable treatment option for HIV-positive patients, regardless of the type of HAART therapy.
Evidence Search	("hiv"[MeSH Terms] OR "hiv"[All Fields]) AND ("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])
Comments on The Evidence	The systematic review by Ata-Ali provides the best available evidence about the impact of HIV on dental implants. However, there has been a limited amount of studies on the subject, and short follow-up durations and small sample sizes limit the information about the long-term prognosis that can be expected from dental implants in HIV-positive patients. The current studies available found that there was little difference in the implant failure rates and peri-implant bone loss when comparing patients with HIV and patients without HIV up to 36 months after placement.
Applicability	Patients with HIV can have a good dental implant prognosis that is similar to patients without HIV. Factors that appear to improve the prognosis appear to be prophylactic antibiotic therapy, highly reactive antiretroviral therapy (HAART), and the control of CD4+ T lymphocyte counts.
Specialty	(General Dentistry) (Oral Surgery) (Periodontics)
Keywords	HIV, dental implant failure
ID#	2845
Date of submission	03/28/2015
E-mail	jonessd@livemail.uthscsa.edu
Author	Stephanie Jones
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Barbara MacNeill, DMD
Faculty mentor e-mail	macneill@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available