Effects of selective serotonin reuptake inhibitors (SSRIs) on bone tissue and dental implants

Depression is a frequently occurring mental disorder with millions of people worldwide receiving antidepressant medications. SSRIs (selective serotonin reuptake inhibitors) are the most widely prescribed medication for the treatment of depression. A large proportion of the population has lost one or more teeth, and partial or total tooth loss is nowadays more and more frequently treated with dental titanium implants. Therefore, there is a high possibility that patients receiving SSRIs will be subjected to implant therapy. The success of dental implants is based on the stabilization of the implant within the bone tissue of mandible and maxilla, through osseointegration, a phenomenon associated with the dynamic processes of bone healing and bone regeneration following surgical implant placement. Serotonin receptors, on which SSRIs act, other than nerve tissue, may be detected in the digestive system, platelets, and bone tissue. When bone serotonin receptors are activated, bone metabolism alters in favor of osteoclastic activity. Based on that, it has been suggested that SSRI intake may increase the risk of implant failure, since osseointegration may be compromised. The aim of the present literature review is to investigate the above hypothesis. Available clinical studies indicate higher implant failure rates when dental implants are placed in patients treated with SSRIs. However, the statistical significance of these increased failure rates is not universally shown. The multifactorial nature of implant therapy mandates caution and careful analysis of every probable risk factor, besides SSRIs use, so as the clinician to proceed to implant therapy with beneficial outcomes for such patients.