implant lit review- winnett 2016- nsaids use might impair osseointegration
TRANSCRIPT
![Page 1: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/1.jpg)
Implant����������� ������������������ Literature����������� ������������������ Review����������� ������������������
Hosan����������� ������������������ Park����������� ������������������ ����������� ������������������ PG����������� ������������������ Perio����������� ������������������
![Page 2: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/2.jpg)
Perioperative use of non-steroidal anti-inflammatory drugs might impair dental implant osseointegration
!
Winnett et al 2016
![Page 3: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/3.jpg)
Background
![Page 4: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/4.jpg)
Cluster Failures ; • Multiple implant failures can cluster in single
individuals ( Weyant & Burt 1993 )
![Page 5: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/5.jpg)
Why..?• Surgical trauma ?
• Inadequate interdental space?
• Premature prosthetic loading?
• Titanium allergy?
• Poor quality control of the manufacturer ?
![Page 6: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/6.jpg)
So far, clinical science can’t identify individual risk for dental implant osseointegration failure
- Cochrane et al 2009
Good and persuasive evidence is currently lacking
-Salvi & Brägger 2009
![Page 7: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/7.jpg)
!
..May be simply the unlikely result of a combination of several things going wrong in an single patient, or they may reflect an as yet unknown alternative single etiology
-Jemt & Häger 2006
![Page 8: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/8.jpg)
!
In the University of Toronto PG prosth clinic, they found 2 consecutive failures without any significant local or systemic risk factor..
..Persistent bleeding + Rapid bone loss
![Page 9: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/9.jpg)
![Page 10: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/10.jpg)
!
Common peri-operative use of
Celebrex ( celecoxib)
![Page 11: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/11.jpg)
!
During 1979 -> 2010 .. ( appx 30 years )
.. only 14 of 1705 patients had celecoxib before !
9 of 14
.. severe idiopathic bone loss subsequent to the implant surgery
![Page 12: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/12.jpg)
!
9 of 14
.. severe idiopathic bone loss subsequent to the implant surgery
![Page 13: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/13.jpg)
Clecoxib;• Belongs NSAIDs ( non-steroidal anti-inflammatory drugs)
• Selective inhibitor of COX-2
• Suppressing prostaglandins synthesis -
• associated with inflammation and pain
![Page 14: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/14.jpg)
![Page 15: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/15.jpg)
• Severe GI adverse effects ..
• Thrombotic cardivascular events ..
• heart attack, stroke, and even death found..
![Page 16: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/16.jpg)
• Recently, in 2011,
• COX-2 pathway is suspected to play an important role in tissue homeostasis
-Riccioti & FitzGerald 2011
![Page 17: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/17.jpg)
• Animal study - effect of NSAIDs .. unreliable for predicting outcomes in human
-Chen & Dragoo 2013
• NSAIDs also interfere with clot formation..
-Davies 2003
![Page 18: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/18.jpg)
Methodology
![Page 19: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/19.jpg)
• 1979-2010; 1705 patients received 5829 implants
• 10% osseointegration failure of one or more implants ( 168/1705 ) - patient level
• 5% failures - implant level ( 292/5829 )
![Page 20: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/20.jpg)
• Adverse biological event;
• Mesial or distal annual bone loss > 0.2mm
• or Peri-implant PD > 5mm
• or PD 5mm AND BoP (+)
![Page 21: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/21.jpg)
• Early failure ;
• prior to the restoration and loading
• “Suspected” early failures
• within 1 year of restoration and loading
• AND clinical signs of steady progression of failing implants
• Late failure;
• more than 1 year after restoration and loading
![Page 22: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/22.jpg)
• Cluster failures defined ;
• Surgical removal of 50% or more of the implants,
• when 3 or more implants were placed at the same time in one surgical session
![Page 23: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/23.jpg)
Surgical protocol;
• Branemark standard two-stage protocol
• Submerged surgery with 4-6 mo healing time
• No immediate placement / loading
• Only NobelBiocare implants until 2006, later Straumann
![Page 24: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/24.jpg)
Results
![Page 25: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/25.jpg)
- 15 Supervising faculties - 1 ~ 7.6% failures - Simple cases
- Perio or Prosth resident - Complex cases
- OS resident
![Page 26: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/26.jpg)
Among 168 patients who had failures,
104 patients consented AND had sufficient records
42% had failure of osseointegration
(197 /468 implants)
![Page 27: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/27.jpg)
![Page 28: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/28.jpg)
![Page 29: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/29.jpg)
![Page 30: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/30.jpg)
![Page 31: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/31.jpg)
Discussion
![Page 32: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/32.jpg)
There is a limitation of Retrospective study,
But, it will be difficult to run the clinical study, knowing that there is possible harmful effect on osseointegration.
![Page 33: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/33.jpg)
• NSAIDs as a potential cause of altered bone healing?
• Dentistry..
• Perio - sees as a favorable medication
• Ortho - sees as problematic element
![Page 34: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/34.jpg)
• Perio - Jeffcoat, Williams group 1989 -1995
• Beagle dog study found significant reduction of periodontal disease -
• Similar result on human study
![Page 35: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/35.jpg)
• Ortho
• NSAID use causes impairment of the tooth movement process
- Walker and Buring 2001
• Possibly by inhibiting osteoclast activity
![Page 36: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/36.jpg)
Opposite evidence..
- Use of ibuprofen on bone healing around dental implants : randomized clinical trial
- Found no differences in peri-implant bone levels after 6 mo
- Alissa 2009
![Page 37: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/37.jpg)
Dose?
Time - course of NSAID therapy ?
..
.. wide variety of different factors..
![Page 38: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/38.jpg)
Process of osseointegration of implant
= Bone fracture healing ?
Bone metabolism is altered by the NSAID-medicated inhibition of prostaglandin synthesis
- Geusens 2013
![Page 39: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/39.jpg)
Conclusion
![Page 40: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/40.jpg)
!
..May be simply the unlikely result of a combination of several things going wrong in an single patient, or they may reflect an as yet unknown alternative single etiology
-Jemt & Häger 2006
![Page 41: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/41.jpg)
Use of NSAIDs is biologically evident that it is affecting the course of bone healing.
It is not clear that whether or not it is making changes on clinically significant point..
![Page 42: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/42.jpg)
Still, evidence is weak to confirm the causality.
However, use of caution of NSAIDs might be needed.
![Page 43: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/43.jpg)
!
..May be simply the unlikely result of a combination of several things going wrong in an single patient, or they may reflect an as yet unknown alternative single etiology
-Jemt & Häger 2006
![Page 44: Implant Lit Review- Winnett 2016- NSAIDs use might impair osseointegration](https://reader031.vdocuments.us/reader031/viewer/2022030305/587170dd1a28ab58758b77b9/html5/thumbnails/44.jpg)
Thank����������� ������������������ you!