Aim: To evaluate the survival and clinical outcomes (crestal bone loss, sulcular bleeding index and pocket depth) of dental implants in patients with osteoporosis and their comparison with matched control patients.

Material and Method: After ethical approval from institutional ethical board, a retrospective cohort study was performed with the use of records of 50 years or older patients received one or more endosseous dental implants in Department of Prosthodontics between May 2011 and December 2015. Forty patients, diagnosed with osteoporosis at the time of implant placement and their matched controls were selected based on predetermined inclusion and exclusion criteria. Demographic and clinical variables recorded at the time of implant placement and follow-up examination were analyzed and compared using statistical package and social science (SPSS) software (version 17.0).

Result: Total 70 implants were placed in the osteoporotic patients, while, the control sample had 68 implants. Thirty six osteoporotic subjects were taking bisphosphonates either from oral or parenteral route. Delayed loading protocol was used to rehabilitate all implants in both the groups. An overall success rate of 95.8% was seen in the osteoporotic samples as compared to 97% within the control samples.

The mean crestal bone loss (1.596 ± 0.10 mm vs.1.57 ± 0.088 mm, p=0.74), mean sulcular bleeding index (1.82 ± 0.08 vs. 1.80 ± 0.07, p=0.15) and mean probing depth (1.91 ± 0.12 vs. 1.83 ± 0.07, p=0.36) of osteoporotic and control groups were statistically insignificant from implant placement to the follow-up examination.

Conclusion: Within limitation of the study, it can be concluded that clinical outcomes of dental implants placed in osteoporotic patients and non- osteoporotic patients are comparable. Osteoporosis is not contraindicated for dental implant therapy if medical control is adequate.

Keywords: Bisphosphonate, bone density,crestal bone loss, pocket depth.

1. WHO Study Group: Assessment of fracture risk and its implications to screening for postmenopausal osteoporosis. WHO Technical Report. Volume 843. Geneva, World Health Organization, 1984
2. Ana Mellado-Valero, Juan Carlos Ferrer-García, Javier Calvo-Catalá, Carlos Labaig-Rueda. Implant treatment in patients with osteoporosis. Med Oral Patol Oral Cir Bucal. 2010 Jan 1; 15 (1):e52-7.

1. Carey JJ, Delaney MF, Love TE, et al. DXA-Generated Z-Scores and T-Scores May Differ Substantially and Significantly in Young Adults. J Clin Densitom 2007; 10:351-8.

4. Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporos Int 1994; 4:368-81.

1. Jeffcoat MK, Chesnut CH 3rd. Systemic osteoporosis and oral bone loss: evidence shows increased risk factors. J Am Dent Assoc 1993; 124:49-56.
2. White SC, Rudolph DJ. Alterations of the trabecular pattern of the jaws in patients with osteoporosis. Oral Surg Oral Med Oral Pathol Oral Radio Endod 1999; 88:628-35.
3. Bollen AM, Taguchi A, Hujoel PP, Hollender LG. Case-control study on self-reported osteoporotic fractures and mandibular cortical bone. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90:518-24.
4. von Wowern N, Gotfredsen K: Implant-supported overdentures, a prevention of bone loss in edentulous mandibles? A 5-year follow-up study. Clin Oral Impl Res 2001;12:19-25

9. Tsolaki IN, Madianos PN, Vrotsos JA. Outcomes of Dental Implants in Osteoporotic Patients. A Literature Review. Journal of Prosthodontics 2009;18:309-23
10. Holahan et al. Effect of osteoporotic status on the survival of titanium dental implants. Int J Oral Maxillofac Implants. 2008 Sep-Oct; 23(5):905-10.
11. Ravichandra Juluri et al. Association of postmenopausal osteoporosis and periodontal disease: A Double-Blind Case-Control Study. Journal of International Oral Health 2015; 7(9):1-5.
12. Lekholm U, Zarb G. Patient selection and preparation. In: Tissue integrated prostheses: osseointegration in clinical dentistry. Brånemark PI, Zarb GA Albrektsson T, editors. Chicago: Quintessence; 1985. p 199-209.
13. Turkyilmaz I, McGlumphy EA. Influence of bone density on implant stability parameters and implant success: a retrospective clinical study. BMC Oral Health 2008; 8:32.
14. Friberg B, Jemt T, Lekholm U. Early failures in 4,641 consecutively placed Brånemark dental implants: a study from stage 1 surgery to the connection of completed prostheses. Int J Oral Maxillofac Implants 1991; 6:142-6.
15. Slagter KW, Raghoebar GM, Vissink A. Osteoporosis and edentulousjaws. Int J Prosthodont. 2008; 21:19-26.
16. Amorim MA, Takayama L, Jorgetti V, Pereira RM. Comparativestudy of axial and femoral bone mineral density and parameters of mandibular bone quality in patients receiving dental implants. Osteoporos Int. 2007; 18:703-9.
17. Schwartz-Arad D, Laviv A, Levin L. Failure causes, timing, and cluster behavior: an 8-year study of dental implants. Implant Dent 2008; 17:200-7.
18. Grant BT, Amenedo C, Freeman K, Kraut RA. Outcomes of placing dental implants in patients taking oral bisphosphonates: a review of 115 cases. J Oral Maxillofac Surg. 2008 66(2):223-30.

19. Corcuera- Flores JR et al. Relationship between osteoporosis and marginal Bone Loss in osseointegrated implants: A 2-year retrospective study. J Periodontol.2016 Jan; 87(1):14-20.
20. Abdelhamid A, Elkholy S. Evaluation of implants using flapless technique to retain mandibular overdentures in controlled type 2 diabetic patients. Int J Prosthet Dent. 2013; 4:40-47.
21. Carranza FA, Rapley JW. Clinical features of gingivitis. In: Newman MG, Takei HH, Carranza FA, editors. Clinical periodontology, 9th ed. Philadelphia: Saunders; 2003. 263-268.
22. Lang NP, Wetzel AC, Stich H, Caffesse RG. Histologic probe penetration in healthy and inflamed peri-implant tissues. Clin Oral Implants Res 1994; 5:191-201.

Dr Mohd Anwar

Department of Prosthodontics, King George`s Medical University, Lucknow, Uttar Pradesh, India