Title Selective Serotonin Reuptake Inhibitor Use May Increase the Risk of Dental Implant Failure
Clinical Question Does history of selective serotonin reuptake inhibitor (SSRI) use affect implant success as compared to patients with no history of SSRI use?
Clinical Bottom Line For a patient with a history of selective serotonin reuptake inhibitor use, evidence shows an association for an increased risk of dental implant failure. However, evidence from a prospective cohort study would be needed to show a true “cause-effect” relationship. Clinicians and patients should be aware that use of certain medications may affect bone homeostasis and osseointegration of dental implants.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
30328197Chappuis/201868 patients in 2 included studiesSystematic Review of Retrospective Cohorts
Key resultsThis is a systematic review and meta-analysis of two articles and 68 patients. The results of the meta-analysis show that implants placed in patients with history of selective serotonin reuptake inhibitor use had an odds ratio of 2.92 (95% CI, 1.64-5.19) and a mean difference of 7.48% (95% CI, 6.96-8.00) for increased implant failure as compared to a control group of patients without use of SSRI.
30637850Carr/20195,456 patientsRetrospective Review
Key resultsA retrospective review of 5,456 patients that received their first implant and took a selective serotonin reuptake inhibitor in a 20-year period. The medications included were: citalopram, escitalopram, fluvoxamine, fluoxetine, paroxetine, and sertraline. A history of sertraline use was associated with an increased risk of implant failure (hazard ratio of 1.60, 95% CI, 1.15-2.23: p=0.006). “History” was defined as medication used before or concurrent with the date of first implant placement. Patients taking two or more selective serotonin reuptake inhibitors presented a greater risk for implant failure. Active selective serotonin reuptake inhibitor use with any of the listed medications evaluated was not associated with increased implant failure outcome (hazard ratio of 1.21, 95% CI, 0.93-1.58: p=0.15).
Evidence Search ("serotonin uptake inhibitors"[Pharmacological Action] OR "serotonin uptake inhibitors"[MeSH Terms] OR ("serotonin"[All Fields] AND "uptake"[All Fields] AND "inhibitors"[All Fields]) OR "serotonin uptake inhibitors"[All Fields] OR ("selective"[All Fields] AND "serotonin"[All Fields] AND "reuptake"[All Fields] AND "inhibitors"[All Fields]) OR "selective serotonin reuptake inhibitors"[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]) AND failure[All Fields]
Comments on
The Evidence
Validity: Chappuis et al. systematically reviewed the literature through May 2017 using specific review criteria. The review and meta-analysis included two retrospective cohort studies with a total of 68 patients. Mean follow up time of implant placement ranged from 36-90 months. No data was reported on the dose or duration of medication, the clinical severity of depression for each patient, patient compliance with oral hygiene, or frequency of professional dental implant maintenance. Each article in the review had a control population with exclusion criteria for patients with systemic diseases, cigarette use (<10 per day), or additional medications that may impact implant osseointegration (corticosteroids, antiepileptic drugs, antihypertensives, proton pump inhibitors, or bisphosphonates). Carr et al. performed a retrospective cohort study and found slightly different results in that only a history of sertraline use specifically was related to implant failure. The review included 5,456 patients over the previous 20 years. There was no control group of patients with no SSRI use in the cohort. There is no comment in the review on potential confounding factors such as systemic diseases, use of other medications which could alter dental implant healing, and patient smoking status. The same implant system was used for all the patients. Perspective: Dental implant failure may be increased in patients who have history of selective serotonin reuptake inhibitors; however, the level of evidence available is only able to provide a potential association between SSRI use and dental implant failure, not a “cause-effect” relationship. In order to determine causality of SSRI use and implant failure, additional prospective studies would be needed that should account for other confounding variables (systemic diseases, severity of mental illness, plaque control, smoking, oral hygiene, etc.).
Applicability In clinical practice, patient use of selective serotonin reuptake inhibitors and other medications that could affect dental implant osseointegration or bone homeostasis is common. A comprehensive medical exam of each patient should be performed prior to dental implant surgery. This evidence shows that SSRIs may increase dental implant failure, and the clinician should include this potential association in their informed consent so patients may be aware of the potential effect of these medications on dental implant failure.
Specialty (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords Selective serotonin reuptake inhibitors, dental implant failure
ID# 3400
Date of submission 11/26/2019
E-mail zellner@uthscsa.edu
Author Jacob Zellner
Co-author(s) Nathan Loughridge
Co-author(s) e-mail loughridge@uthscsa.edu
Faculty mentor Angela Palaiologou-Gallis
Faculty mentor e-mail PalaiologouA@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
None available