Title

Evidence Shows That Hormone Replacement Therapy (HRT) Has No Effect on Implant Success

Clinical Question

For a patient receiving a dental implant, does Hormone Replacement Therapy (HRT) affect implant success?

Clinical Bottom Line

There is no evidence to support that HRT prescription affects implant success.

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
30739380	Chaves/2019	3 studies (356 implants in HRT+ patients, 998 implants in HRT- patients)	Systematic review of non-randomized trials
Key results	This study evaluated different parameters including clinical attachment loss, probing pocket depth, bleeding on probing, radiographic bone loss, and osseointegration. For osseointegration, three retrospective studies were included. It was concluded that implant loss is either not affected or increased in menopausal women receiving HRT; reports were inconsistent. Two observational studies evaluated loss of implants after 5-21 years (August et al., 2001; Moy et al., 2005). The number of lost implants decreased by 5.5% in the maxilla and increased by 0.7% in the mandible with administration of HRT (August et al., 2001). 3.9% to 11.21% increase in implant loss was evident when both the maxilla and mandible were evaluated (Minsk & Polson, 1998; Moy et al. 2005). Only one study showed a significant difference in implant loss rate (Moy et al. 2005): RR (CI95%): 2.55 (1.72-3.77) for HRT+ patients. Therefore, there is no evidence as of to date to support the administration of HRT for either men or women for purposes of implant therapy.
30306695	Stavropoulos/2018	7 studies that included 10 or more patients, with controls not taking HRT	Meta-Analysis
Key results	For patients receiving HRT, this study concluded that HRT has no negative effect on the implant level. On the other hand, it appears that there is a marginally significant negative effect regarding peri-implant marginal bone loss and implant survival on the patient level. This study evaluated the effects of several drugs that have antiresorptive effects on bone, and which included HRT in their analysis. Inconsistencies in the included papers led to inconsistencies in the numbers among the failure rates shown in the article.

Evidence Search

PubMED Search; ("hormone replacement therapy"[MeSH Terms] OR ("hormone"[All Fields] AND "replacement"[All Fields] AND "therapy"[All Fields]) OR "hormone replacement therapy"[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

In Chaves/2019 two reviewers screened for titles and performed study selection. In cases of no consensus, a third reviewer was consulted to resolve disputes. Only one randomized controlled trial was been included; it did not properly report randomization and allocation concealment. The studies that investigated osseointegration in this article were three retrospective studies in which patients on HRT were compared with patients with no reported use of HRT. Due to the nature of those studies, there is a risk of recall bias. One of the included studies in this article (Minsk and Polson, 1998) did not report the follow-up period. The second article (Stavropoulos/2018) only involved two independent reviewers. Newcastle‐Ottawa‐Scale (NOS) was was used to evaluate study quality on the basis of selection, comparability, and exposure factors. Only smoking and/or augmentation were judged as the most relevant parameters. NOS values for HRT studies in this article ranged between 0-100%, showing a variety of low to high quality for the included studies.

Applicability

This information can help general dentists, periodontists, oral surgeons, and prosthodontists in treatment planning for patients that will be undergoing or have previously been administered hormone replacement therapy. The practitioner will be able to provide this information to his patients, which will in turn help them make an informed decision on their dental implant therapy.

Specialty

(Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)

Keywords

Success, failure, dental implants, hormone replacement therapy

ID#

3423

Date of submission

12/16/2019

E-mail

basha@uthscsa.edu

Author

Basil Basha, DDS

Co-author(s)

Mohammed Alsalem, DMD

Co-author(s) e-mail

Alsalem@uthscsa.edu

Faculty mentor

Panagiotis Gakis, DDS

Faculty mentor e-mail

gakis@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