Systemic diseases affecting osseointegration therapy

Objectives: To evaluate the impact of systemic diseases and their treatment on the success of osseointegration therapy. Material and methods: A search was made to find human studies including subjects treated with osseointegrated oral implants, with a diagnosis of 11 systemic diseases, and reporting at least implant survival. Results: For most conditions, no studies comparing patients with and without the condition in a controlled setting were found. The evidence to recommend implant therapy was low and consisted in presentations of some successfully treated cases. With regard to diabetes, three types of reports were found: eight case series of diabetic patients treated with implants, six cross-sectional, longitudinal or retrospective evaluations of groups of subjects treated with implants, including some diabetic patients, and one matched control retrospective chart survey. The heterogeneity of the material and the method of data reporting precluded a formal meta-analysis. No unequivocal tendency for subjects with diabetes to have higher failure rates emerged, but the largest of these studies indicated a significant increase in the relative risk of implant failure with diabetes. The data obtained from 17 papers reporting data from osteoporotic patients were also heterogeneous. The evidence for an association of osteoporosis and implant failure was low. Conclusions: The level of evidence indicative of absolute and relative contra indications for implant therapy due to systemic diseases is low. Many conditions have been listed as potentially critical, but studies comparing patients with and without the condition in a controlled setting are sparse.