Systemic vitamin D supplementation and local bone formation after maxillary sinus augmentation - a randomized, double-blind, placebo-controlled clinical investigation

Vitamin-D Insufficiency Leads to Interleukin-10 Reduction in Peri-Implant Tissues: A Case-Control Study

OBJECTIVES

Vitamin D has been reported to be crucial for bone mineralization and to play a significant role in immune and inflammatory responses. Its deficiency has been stated to be highly prevalent and might alter osseointegration of dental implants. Successful osseointegration has been claimed to be a critical aspect of implant survival and the effects of vitamin D on implant osseointegration have not been well documented. This study aimed to evaluate bone markers and cytokine levels of patients with or without vitamin D insufficiency.

MATERIAL AND METHODS

A total of 42 patients were included and divided into two groups: vitamin D insufficient (Group IN-S; n = 21) and vitamin D sufficient (Group S; n = 21). Besides clinical periodontal parameters and implant stability measurements, the levels of RANKL, OPG, osteocalcin (OC), calcium (Ca), tumor necrosis factor alpha (TNF-α), IL-1β, caspase-1 (CASP1), and IL-10 in bone biopsy from implant preparation sockets and peri-implant crevicular fluid (PICF) were determined by enzyme-linked immunosorbent assay (ELISA). The results were represented as concentration and total amount.

RESULTS

PICF RANKL levels (both concentration and total amount) were higher in patients with Vitamin D insufficiency compared to sufficient controls (p < 0.05). Concentration and total amount of IL-10 were significantly lower in vitamin D insufficient participants than those of vitamin D sufficient group (p < 0.05). No differences were detected between the groups in terms of other parameters. Bone levels of all evaluated parameters also did not differ between the groups (p > 0.05).

CONCLUSION

It may be concluded that a low serum level of vitamin D may affect peri-implant health through altering IL-10 and RANKL.

Resonance frequency analysis of dental implants in patients with vitamin D deficiency

OBJECTIVES

Vitamin D deficiency may influence dental implant osseointegration unfavourably. The aim of this study was to compare dental implant stabilities of patients with different levels of vitamin D and investigate the effects of vitamin D supplementation.

MATERIALS AND METHODS

One hundred and twenty-nine patients who underwent dental implantation were grouped regarding vitamin D levels and supplement use: Group A; vitamin D deficiency and supplement usage, Group B; insufficiency with supplement usage, Group C; insufficiency without supplements and Group D; vitamin D sufficiency. Resonance frequency analysis (RFA) measurements were performed at baseline and 3 months. Patients with vitamin D deficiency (Group A) and insufficiency (Group B) were prescribed supplements by specialists. Pearson correlation analysis was used to examine an association between vitamin D levels and implant stability.

RESULTS

Primary stability of Group D (76.34 ± 6.55) was significantly higher than Groups A, B and C at baseline (p < 0.05). At 3 months, Group C scored significantly lower than the other groups (p < 0.05). The results revealed a correlation between serum levels of vitamin D and RFA measurements at 3 months (p < 0.05).

CONCLUSION

It was observed that high vitamin D levels influenced implant stabilities positively, as evidenced by higher Implant Stability Quotient values. Low levels of vitamin D may be associated with a decrease in implant stability.

STATEMENT OF CLINICAL RELEVANCE

Vitamin D, concerning its impact on bone metabolism, is currently of particular interest in implant dentistry. The lower stability scores in patients with vitamin D deficiency reinforce the recommendation of Vitamin D supplementation when treating those patients with dental implants.

Correlation between marginal bone loss around dental implants and various systemic diseases: a cross-sectional study

PURPOSE

Diminished bone levels or the lack of osseointegration can lead to higher rates of failure of dental implants. The present study is aimed to evaluate the correlation between hypertension, diabetes mellitus and hyperlipidemia, on the marginal bone loss (MBL) surrounding dental implants among patients attending the University of Nevada, Las Vegas dental clinics.

METHODS

Clinical notes from patients at the University of Nevada, Las Vegas (UNLV) dental clinics were analyzed using AxiUm™ software. The study included patients with dental implants diagnosed with hypertension, diabetes mellitus, and hyperlipidemia who attended the UNLV School of Dental Medicine clinics from 2012 to 2022. Exclusions were made for patients with acquired immune deficiency syndrome and those with a limited number of radiographs. A search was conducted using keywords such as 'systemic disease,' 'marginal bone loss,' 'dental implant,' 'high cholesterol,' 'hypertension,' and 'diabetes' within the system.

RESULTS

Out of 1,310 potentially eligible patients, 57 fulfilled the inclusion criteria. The total number of evaluated implants was 165. 18% of the sample patients were 55 to 64 years of age, and 79% were 65 or above. 45.6% of patients reported having more than four systemic diseases and 67% of patients had four or more prescription medications. Patients diagnosed with hypertension (78.95%) or hyperlipidemia (73.68%) had the highest presence of marginal bone loss surrounding the dental implant(s) while those with diabetes (40.35%) had the least amount of MBL. Patients diagnosed with both hypertension and hyperlipidemia (29.82%) experienced the highest incidence of MBL around implants. The medications prescribed to combat these health issues, such as statins and antihypertensive, also showed the same trends and corresponded with a higher prevalence of MBL.

CONCLUSIONS

Within the limitations of the present investigation, patients diagnosed with hyperlipidemia and hypertension were more likely to exhibit MBL surrounding dental implants.

Jamil F, M. AL-Anee A, Jassim Muhsen S. Relationship Between the Level of Vitamin D3 Deficiency and Successful Osseointegration: A Prospective Clinical Study

Purpose: This study aimed to evaluate the influence of vitamin D3 levels on bone density, primary dental implant stability, and successful osseointegration. Materials and Methods: Clinical and radiological examination with a standardized cone-beam computed tomography (CBCT) machine and laboratory investigation for serum levels of vitamin D3 were performed for all patients. Only patients in need of single or multiple straightforward dental implant surgery in either jaw with no history of systemic disease or condition that may interfere with bone healing were included in this study to receive the dental implant by the same oral and maxillofacial surgeon, which re-opened 4 months later to assess the osseointegration and to complete the prosthetic part. Results: One hundred twenty-eight dental implants were inserted into 108 patients. Most of the patients in the study had insufficient vitamin D3 levels. The prognosis of dental implants regarding successful osseointegration 4 months after implant placement had a weak positive association with the insertion torque and bone mineral density and a statistically significant positive correlation with the serum vitamin D3 level. Conclusion: Preoperatively, it is advisable to request the serum vitamin D3 level of the patients along with the standard clinical and radiological examination. Severe vitamin D3 deficiency could be associated with early dental implant failure despite the favorable bone density and primary dental implant stability achieved. Trial Registration: ClinicalTrials.gov identifier: TCTR20200304001.

Can Vitamin D Levels Influence Bone Metabolism and Osseointegration of Dental Implants? An Umbrella Review

INTRODUCTION

Due to the large amount of scientific evidence on the subject and the limitations and incongruities in previous reviews, the primary aim of this umbrella review is to gather all the information regarding the importance of vitamin D levels in the osseointegration of dental implants.

METHODS

The literature search was performed in PubMed, Web of Science, CINAHL Plus, Cochrane Library, and Academic Search Complete throughout the search expression ["vitamin D" AND ("dental implant" OR "dental implants")].

RESULTS

The initial search yielded 351 results, but at the end of the process, only five systematic reviews were selected.

CONCLUSIONS

Vitamin D seems to have a positive effect on the osseointegration of dental implants and on the reduction of dental implant failures; however, it is recommended that future studies take into account the limitations mentioned in this study in order to increase the validity and quality of scientific evidence on the subject.

Tissue engineering innovations to enhance osseointegration in immediate dental implant loading: A narrative review

The demand for efficient and accelerated osseointegration in dental implantology has led to the exploration of innovative tissue engineering strategies. Immediate implant loading reduces treatment duration and necessitates robust osseointegration to ensure long-term implant success. This review article discusses the current studies of tissue engineering innovations for enhancing osseointegration in immediate dental implant loading in the recent decade. Keywords "tissue engineering," "osseointegration," "immediate implant loading," and related terms were systematically searched. The review highlights the potential of bioactive materials and growth factor delivery systems in promoting osteogenic activity and accelerating bone regeneration. The in vivo experiment demonstrates significantly improved osseointegration in the experimental group compared to traditional immediate loading techniques, as evidenced by histological analyses and biomechanical assessments. It is possible to revolutionize the treatment outcomes and patient satisfaction in dental implants by integrating bioactive materials and growth factors.

Is Vitamin D Deficiency a Risk Factor for Osseointegration of Dental Implants - A Prospective Study

Introduction

Early dental implant failure (EDIF) can occur even when optimal materials are used, surgical protocols are strictly followed and the quantity and quality of bone at the recipient site are sufficient. The existence of specific patient-related risk factors require an investigation into the regulatory mechanisms controlling bone metabolism, bone remodelling and bone turnover as well as serum Vitamin D. The implant stability quotient is used as a prognostic indicator for possible implant failure. The aim of the study is to investigate the relationship between serum Vitamin D levels and EDIF.

Materials and Methods

A total of 143 implant placement sites were identified in 53 patients enrolled in this study. All patients had the assessments of serum Vitamin D levels side by side with assessments of primary and secondary implant stability at proposed implant sites at the time of implant placement and after 12 weeks using a resonance frequency analysis device.

Results

Ten early failures (7%) were recorded. There was no correlation between gender, age, smoking, hyperglycaemia or an increased incidence of early failures. Statistical analysis reported two early failures (4.5%) in patients with serum levels of Vitamin D >30 ng/mL, two early failures (2.3%) in patients with levels between 10 and 30 ng/mL and six early failures (46.2%) in patients with levels <10 ng/mL.

Discussion

The role of Vitamin D as a risk factor for early implant failure should be considered in patients with Vitamin D deficiency. The incidence of early implant failures was higher in patients with low serum levels of Vitamin D. Patients with low serum Vitamin D levels had a greater rate of early implant failure.

Bone reconstruction of extensive maxillomandibular defects in adults

Reconstruction of significant maxillomandibular defects is a challenge that has been much discussed over the last few decades. Fundamental principles were developed decades ago (bone bed viability, graft immobilization). Clinical decision-making criteria are highly relevant, including local/systemic factors and incision designs, the choice of material, grafting technique, and donor site morbidity. Stabilizing particulated grafts for defined defects-that is, via meshes or shells-might allow significant horizontal and vertical augmentation; the alternatives are onlay and inlay techniques. More significant defects might require extra orally harvested autologous bone blocks. The anterior iliac crest is often used for nonvascularized augmentation, whereas more extensive defects often require microvascular reconstruction. In those cases, the free fibula flap has become the standard of care. The development of alternatives is still ongoing (i.e., alloplastic reconstruction, zygomatic implants, obturators, distraction osteogenesis). Especially for these complex procedures, three-dimensional planning tools enable facilitated planning and a surgical workflow.

Evaluation of Vitamin D-enriched Bone Graft in Surgically-induced Critical-sized Bone Defects: An Experimental Study

BACKGROUND

Restoration of bone defects in the craniac vault may require the use of autografts, allografts, xenografts, or synthetic grafts. There are promising data that vitamin D may play a positive role in graft incorporation. The purpose of the present study is the evaluation of the impact of vitamin D addition to human-derived bone grafts in the healing of critical-sized bone defects in porcine skulls.

MATERIALS AND METHODS

Four identical critical-sized defects were created in the calvaria of 8 adult Landrace Large White pigs. The first defect was left blank as control, the second defect was filled with human-derived bone graft, the third defect was filled with human-derived bone graft enriched with a low concentration of vitamin D (2 mg/mL), and the fourth defect was filled with human-derived bone graft enriched with a high concentration of vitamin D (10 mg/mL). The animals were sacrificed after 12 weeks. Harvested tissue specimens were qualitatively evaluated by histology. New bone formation (bone volume/tissue volume) was quantitatively measured by histomorphometry.

RESULTS

Signs of bone formation were evident in all bone sockets. Mean values of the bone volume/tissue volume of the 4 defects were 10.91%, 11.05%, 10.40% and 10.87% respectively, at 12 weeks. In 5 animals, high concentration of vitamin D caused a significant improvement in bone formation in relation to controls. In 3 animals, a high concentration of vitamin D was associated with decreased bone formation compared with controls. No statistical difference was observed in the graft healing among the 4 graft sites ( P > 0.05).

CONCLUSIONS

The results of this study have shown that the addition of vitamin D to human-derived bone grafts does not have a significant effect on bone formation and graft incorporation in critical-sized bone defects of the porcine calvaria. Further high-quality studies are needed to fully elucidate the role of vitamin D in bone formation and bone graft union.

Effects of Hyperlipidemia on Osseointegration of Dental Implants and Its Strategies

Hyperlipidemia refers to the abnormal increase in plasma lipid level exceeding the normal range. At present, a large number of patients require dental implantation. However, hyperlipidemia affects bone metabolism, promotes bone loss, and inhibits the osseointegration of dental implants through the mutual regulation of adipocytes, osteoblasts, and osteoclasts. This review summarized the effects of hyperlipidemia on dental implants and addressed the potential strategies of dental implants to promote osseointegration in a hyperlipidemic environment and to improve the success rate of dental implants in patients with hyperlipidemia. We summarized topical drug delivery methods to solve the interference of hyperlipidemia in osseointegration, which were local drug injection, implant surface modification and bone-grafting material modification. Statins are the most effective drugs in the treatment of hyperlipidemia, and they also encourage bone formation. Statins have been used in these three methods and have been found to be positive in promoting osseointegration. Directly coating simvastatin on the rough surface of the implant can effectively promote osseointegration of the implant in a hyperlipidemic environment. However, the delivery method of this drug is not efficient. Recently, a variety of efficient methods of simvastatin delivery, such as hydrogels and nanoparticles, have been developed to boost bone formation, but few of them were applied to dental implants. Applicating these drug delivery systems using the three aforementioned ways, according to the mechanical and biological properties of materials, could be promising ways to promote osseointegration under hyperlipidemic conditions. However, more research is needed to confirm.

The role of Vitamin D as an adjunct for bone regeneration: A systematic review of literature

Background and objectives

In spite of bone's healing capacity, critical-size bone defect regeneration and peri-implant osseointegration are challenging. Tissue engineering provides better outcomes, but requires expensive adjuncts like stem cells, growth factors and bone morphogenic proteins. Vitamin D (Vit.D) regulates calcium and phosphorus metabolism, and helps maintain bone health. Vit.D supplements in deficient patients, accentuates bone healing and regeneration. Therefore the aim of this systematic review was to evaluate the role of adjunctive Vit.D on bone defect regeneration.

Methods

Comprehensive database search of indexed literature, published between January 1990 and June 2022, was carried out. English language articles fulfilling inclusion criteria (clinical/in vivo studies evaluating bone regeneration including osseointegration and in vitro studies assessing osteogenic differentiation, with adjunct Vit.D) were identified and screened.

Results

Database search identified 384 titles. After sequential title, abstract and full-text screening, 23 studies (in vitro - 9/in vivo - 14) were selected for review. Vit.D as an adjunct with stem cells and osteoblasts resulted in enhanced osteogenic differentiation and upregulation of genes coding for bone matrix proteins and alkaline phosphatase. When used in vivo, Vit.D resulted in early and increased new bone formation and mineralization within osseous defects, and better bone implant contact and osseointegration, around implants. Adjunct Vit.D in animals with induced systemic illnesses resulted in bone defect regeneration and osseointegration comparable to healthy animals. While systemic and local administration of Vit.D resulted in enhanced bone defect healing, outcomes were superior with systemic route.

Conclusions

Based on this review, adjunct Vit.D enhances bone defect regeneration and osseointegration. In vitro application of Vit.D to stem cells and osteoblasts enhances osteogenic differentiation. Vit.D is a potentially non-invasive and inexpensive adjunct for clinical bone regeneration and osseointegration. Long term clinical trials are recommended to establish protocols relating to type, dosage, frequency, duration and route of administration.

Evaluation of Correlation between Vitamin D Levels and Implant Stability in Indian Population: A Prospective Study in Bangalore

Purpose

Dental implants have become a definitive method for the esthetic and functional rehabilitation of both partially and completely edentulous arch. There is a significant role of vitamin D in bone metabolism and there are only few human studies that evaluate the effect of vitamin D deficiency on stability of dental implants. The study thus aims to evaluate the correlation of vitamin D deficiency and implant stability in delayed endosseous implant.

Methods

The study included 20 subjects of either gender in the age group of 20-50 years, who required implant placement for rehabilitation of partially edentulous condition. Vitamin D status was evaluated for all subjects preoperatively. Implant stability was checked postoperatively at three months and six months using Electronic Technology Resonance Frequency Analysis.

Results

The study found that for every 1 ng/ml increase in Vitamin D levels, the implant stability Quotient value (ISQ) significantly increased by 0.48 at 3 months and 0.62 units at 6 months, which was statistically significant at P = 0.01 and P = 0.002, respectively. Statistical analysis was done using Student Paired t test, Pearson Correlation test and Simple Linear regression analysis.

Conclusion

Albeit the smaller sample size, the results of the study showed the positive influence of vitamin D on stability of implant. The study thus emphasizes on the significance of screening the vitamin D status of subjects prior to implant placement.

Does vitamin D have an effect on osseointegration of dental implants? A systematic review

Purpose

The aim of this study was to systematically review the available evidence to evaluate the efficacy of vitamin D supplementation or vitamin D depletion on the osseointegration of implants in animals and humans.

Methods

The focus questions addressed were “Do vitamin D deficient subjects treated with (dental) implants have an inferior osseointegration than subjects with adequate serum vitamin D level?” and “Do vitamin D supplemented subjects treated with (dental) implants have a superior osseointegration than subjects with adequate serum vitamin D level?” Humans and animals were considered as subjects in this study. Databases were searched from 1969 up to and including March 2021 using different combination of the following terms: “implant”, “bone to implant contact”, “vitamin D” and “osseointegration”. Letters to the editor, historic reviews, commentaries and articles published in languages other than English and German were excluded. The pattern of the present systematic review was customize to primarily summarize the pertinent data.

Results

Thirteen experimental studies with animals as subject, two clinical studies and three case reports, with humans as subjects, were included. The amount of inserted titanium implants ranged between 24 and 1740. Results from three animal studies showed that vitamin D deficiency has a negative effect on new bone formation and/or bone to implant contact (BIC). Eight animal studies showed that vitamin D supplementation has a enhancing effect on BIC and/or new bone formation around implants. Furthermore, enhancing the impact of vitamin D supplementation on the osseointegration of implants in subjects with diabetes mellitus, osteoporosis and chronic kidney disease (CKD) were assessed. Studies and case reports involving human subjects showed that patients with a low serum vitamin D level have a higher tendency to exhibit an early dental implant failure. When supplemented with vitamin D the osseointegration was successful in the case reports and a beneficial impact on the changes in the bone level during the osseointegration were determined.

Conclusions

Vitamin D deficiency seems to have a negative effect on the osseointegration of implants in animals. The supplementation of vitamin D appears to improve the osseointegration in animals with systemic diseases, such as vitamin D deficiency, diabetes mellitus, osteoporosis, and CKD. Slight evidence supports the hypothesis that humans similarly benefit from vitamin D supplementation in terms of osseointegration. Further investigation is required to maintain these assumptions.

The Relationship Between Low Serum Vitamin D Level and Early Dental Implant Failure: A Systematic Review

The variety in shape and type of dental implants in the present time is considered one of the most successful evolutions in dentistry. This facilitates dental treatment options to restore patient function and appearance. However, numerous significant factors influence the predictability of survival or the success rates of dental implants, some of which, such as vitamin D levels, have not been included in many studies. The main purpose of this systematic review was to investigate whether there is a relationship between low serum levels of vitamin D and early dental implant failures (EDIFs). Our literature search involved international databases including PubMed, Directory of Open Access Journals (DOAJ), and Web of Science. Initially, according to our search criteria, 1200 studies were found. After excluding duplicates, incomplete studies, and studies not meeting our inclusion criteria, only six human studies were included in this research and analyzed. Finally, upon meticulous analysis of included studies, this systematic review revealed inconsistent results in articles with respect to the association between vitamin D deficiency and implant failures. Large-scale studies, especially clinically relevant studies, on this subject is recommended.

Vitamin D and Its Role in Oral Diseases Development. Scoping Review

Vitamin D is a fat-soluble secosteroid that plays a significant role in the whole body, including the maxillofacial region. The discovery of its receptors in many cells and organs made it possible to reveal the participation of vitamin D not only in the regulation of calcium phosphate metabolism, but also in immune processes, in providing anti-inflammatory and antimicrobial effects, slowing down cell proliferation and stimulating differentiation. In this literature review, we demonstrate the association between low vitamin D levels and the development of recurrent aphthous stomatitis, the course and response to treatment of squamous cell carcinoma of the oral cavity, the severity of periodontal diseases, and the processes of osseointegration and bone remodeling during dental implantation and guided tissue regeneration. The aim of our article was to demonstate a possible connection between vitamin D level and the oral diseases that can be presented at an oral surgery appointment, which will help clinicians to reduce the risk of early dental implant failure, ensure favorable outcomes of augmentative operations, as well as decrease the destructive effects of severe periodontitis and other conditions throug knowledge and timely lab tests and endocrinologist prescriptions.

Spontaneous cranial bone regeneration following craniectomy for traumatic brain injury in a pregnant woman: A case report

Introduction and importance

Spontaneous bone formation following craniectomy is an extremely rare in adult. As in the medical literature, this is the first case report on total spontaneous ossification following craniectomy in a pregnant woman.

Case presentation

In this paper, we reported a 20-year-old female currently in the 30th week of her pregnancy suffered from head trauma following motorcycle accident. On admission to our hospital, her GCS score was 3 points. She was treated with emergency extradural hematoma evacuation with craniectomy and Caesarean section with uterine artery ligation. 3 weeks post-operation, the patient and her daughter were discharged from the hospital. At follow-up, spontaneous cranial bone generation was observed.

Clinical discussion

The presentation, diagnosis and strategy of treatments were discussed.

Conclusion

Diagnostic imaging in traumatic pregnant patient is often postponed for the concern of fetus exposure to radiation. Traumatic pregnant patient with possible head trauma should be transferred to a center with expertise in neurotrauma and obstetrical care. Spontaneous cranial bone regeneration following craniectomy in adult is rare. Surgery techniques and hormones in pregnancy contribute to bone formation.

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Diagnostic imaging in traumatic pregnant patient is often postponed for the concern of fetus exposure to radiation.

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Pregnant woman with brain trauma should be transferred to a center with expertise in neurotrauma and obstetrical care.

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Spontaneous cranial bone regeneration following craniectomy in adult is rare.

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Surgery techniques and hormonal changes in pregnancy may contribute to this phenomenon.

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In case of extensive spontaneous bone regeneration, cranioplasty is unnecessary.

Possible Roles of Vitamin D in Bone Grafting

Bone grafting is one of the most commonly used options to treat large bone defects. Evidence has shown that vitamin D may affect osseointegration, a major component for successful bone grafting. In vitro studies have proved that implants coated with activated vitamin D stimulate bone production and reduce bone resorption around implants. Animal studies have noticed that oral administration of vitamin D may stimulate bone formation as well as strengthen and support the interaction between bone and implants. Vitamin D insufficiency may affect negatively the cortical peri-implant bone formation, suggesting a negative effect in graft incorporation. Few clinical studies have observed that vitamin D administration enhanced graft incorporation and bone formation, while severe vitamin D deficiency is associated with failed implant osseointegration. Even though there are encouraging results of vitamin D supplementation on graft incorporation in animal studies, the use of vitamin D as an adjuvant in bone grafting procedures cannot be fully supported at the moment. However, there is theoretical support in the use of vitamin D after surgery and the use of bone grafts to support the bone structure, relieve pain and increase graft absorption. Further experimental and clinical studies are required to support the administration of vitamin D and its analogues in such cases.

The Possible Role of Vitamin D Deficiency in Early Implant Failure

Background. Dental implants are one of the most successful treatments for restoring tooth function and beauty. Identifying the causes of dental implant failure is useful and vital. This review was aimed at studying the possible role of vitamin D in early implant failure. Method and Material. This review was designed based on the PRISMA guideline. Data was collected using keywords including implant, vitamin D, deficiency, failure, dental, OR tooth in international databases including PubMed, Scopus, Web of Science, Cochrane, and Embase, until 2020. Based on the inclusion and exclusion criteria, data were extracted and gathered in a checklist. Results. Finally, twelve studies were selected from five different countries. In 6 studies (2 animal studies and four human studies), there was no significant relationship between vitamin D deficiency and dental implant failure. In the other six studies (1 animal study and five human studies), there was a significant relationship in this regard. Conclusion. It is difficult to conclude the association between vitamin D and implant failure based on the literature’s researches. However, vitamin D appears to play an essential role in implant success through its effects on immune system modulation.

Vitamin D Effects on Guided Bone Regeneration and Osseointegration of Dental Implants (Literature Review)

Background.Due to the prevalence of Vitamin D deficiency as well as the frequency of reconstructive surgical interventions followed by dental implantation, the issue arises concerning the effect of Vitamin D on reparative regeneration of bone and osseointegration of dental implants.The purpose using literature data we are conducting an impact assessment of vitamin D on reparative regeneration of bone tissue, in particular, after oral reconstruction surgeries and dental implantation.Methods.Retrieval, systematization and analysis of scientific data on application of vitamin D supplementation and its effect on reparative regeneration of jaw bone tissue.The conclusions.For the most part, the positive effect exerted on reparative regeneration of jaw bone tissue and osseointegration of dental implants is due to the role of vitamin D in physiological processes evolving in bone tissue, namely maintenance of calcium and phosphate exchange through intestinal absorption and TNF, RANKL (Receptor activator of nuclear factor kappa-B ligand) and consequently differentiation of precursors to osteoclasts into osteoclasts through VDR stimulation (VitaminD Receptor) receptors for further osteogenesis. Also, according to literature data, FGF23 (Fibroblast Growth Factor) protein is a marker of osteoblasts differentiation into osteocytes, it is also known that FGF23 and 1,25(ОН)2D3 are genetically related. FGF23 is the main regulator of both phosphate exchange in bones and metabolism of vitamin D and its metabolites. Besides, indirect anti-inflammatory effect has been observed thanks to inhibition of pro-inflammatory cytokine secretion. Taking into account the abovementioned data, of particular relevance is the definition of serum concentration 25(ОН)D and development of schemes of vitamin D level pre-surgery correction in patients, who have to undergo oral reconstruction surgeries and dental implantation. Mass spectrometry is a promising diagnostic method for determining the level of vitamin D in a body, as it allows to identify the actual amount of vitamin D free from admixture of other steroid hormones. The introduction of this method into clinical practice will allow to monitor the level of vitamin D in patients, receiving reconstructive and rehabilitative treatment.

Comparative evaluation of crestal bone level in patients having low level of Vitamin D treated with dental implant with or without Vitamin D3 supplements

INTRODUCTION

Vitamin D has been shown to play a vital role in bone mineral homeostasis by stimulating the intestinal absorption of calcium and phosphate. The critical role of Vitamin D in bone metabolism triggered the need to evaluate the effect of Vitamin D deficiency and hence replacement of the same on osseointegration of dental implants. This prospective study evaluated the crestal bone level in patients having low level of Vitamin D treated with dental implant with or without Vitamin D3 supplements.

MATERIALS AND METHODS

A prospective clinical study was conducted on 32 patients based on the inclusion and exclusion criteria. Patients were divided into two groups on the basis of Vitamin D level < 30 ng/ml (Group I: patients receiving Vitamin D3 supplements, i.e., cholecalciferol 1 g sachet 60,000 IU/month) or <30 ng/ml (Group II: not receiving Vitamin D3 supplements). The crestal bone level measurements were made with the help of Digimizer Image Analysis, MedCalc software.

RESULTS

All implants showed clinically acceptable crestal bone level at interval of 1 week (baseline), 3 months, and 6 months. There was a statistically nonsignificant difference seen for the values between the groups (P > 0.05) for all other values at various time intervals. However, there was a statistically significant/highly significant difference seen for the values between the groups (P < 0.01, 0.05) for 3 months distal with higher values for Group I as compared to Group II.

CONCLUSION

From the study, it can be concluded that cholecalciferol has systemic effects on accelerating bone formation around titanium implant.

Effect of micronutrient malnutrition on periodontal disease and periodontal therapy

Periodontitis is a complex chronic inflammatory noncommunicable disease, initiated by the development of a dysbiotic microbial plaque biofilm below the gingival margin. Whilst the pathogenic biofilm is a "necessary cause" of periodontitis, it is insufficient on its own to cause the disease, and a destructive immune-inflammatory response is a key to the translation of risk to destructive events. Other exposures or "component causes" include individual genetic predisposition, lifestyle (including smoking and nutrition), and environmental factors. Dietary nutrients are essential for life as they provide crucial energy sources in the form of macronutrients, as well as important cofactors in the form of micronutrients, which regulate the functionality of enzymes during the regulation of anabolic and catabolic processes in human cells. Moreover, micronutrients can regulate gene transcription factors, such as the proinflammatory nuclear factor kappa B and the anti-inflammatory nuclear factor (erythroid-derived 2)-like 2. This review focuses on the role of vitamins (vitamin A, carotenoids, the vitamin B complex, vitamins C, D, and E, and coenzyme Q10) and minerals (calcium, magnesium, iron, zinc, potassium, copper, manganese, and selenium) in human physiology and the impact of their deficiencies upon periodontal health and disease.

Low serum vitamin D and early dental implant failure: Is there a connection? A retrospective clinical study on 1740 implants placed in 885 patients

Background. Since osseointegration depends on bone metabolism, low levels of vitamin D in the blood may negatively affect bone formation around dental implants. To date, only a few studies have investigated the possible connection between serum levels of vitamin D and early dental implant failure (EDIF), i.e. failure that occurs within 4 months after placement, before the connection of the prosthetic abutment. The aim of this study was to investigate whether there is a relationship between low serum levels of vitamin D and EDIF.

Methods. Data used for this retrospective study were derived from the records of a private dental clinic. Inclusion criteria were patients who had been treated with dental implants, inserted with a submerged technique from January 2003 to December 2017. EDIF was the outcome of this study. Chi-squared test was used to investigate the effect of patient-related variables (age, gender, smoking habit, history of periodontal disease and serum levels of vitamin D) on EDIF.

Results. Originally, 885 patients treated with 1,740 fixtures were enrolled in this study. Overall, 35 EDIFs (3.9%) were reported. No correlation was found between EDIF and the patients' gender (P=0.998), age (P=0.832), smoking habit (P=0.473) or history of periodontal disease (P=0.386). Three EDIFs (11.1%) were reported in 27 patients with serum levels of vitamin D <10 ng/mL, 20 EDIFs (4.4%) in 448 patients with levels between 10 and 30 ng/mL, and 12 EDIFs (2.9%) in 410 patients with levels >30 ng/mL. Although there was a clear trend toward an increased incidence of EDIF with lowering of serum vitamin D levels, no statistically significant difference (P=0.105) was found among these three groups.

Conclusion. Within its limitations (retrospective design, low number of patients with severe blood levels of vitamin D enrolled), this study failed to demonstrate a significant relationship between low serum levels of vitamin D and increased risk of EDIF. However, since a dramatic increase in EDIFs with lowering of vitamin D levels in the blood has been reported, further clinical studies with appropriate design (prospective or randomized controlled studies on a larger sample of severely deficient patients) are needed to better investigate this topic

Vitamin D deficiency in early implant failure: two case reports

An association between vitamin D deficiency and early dental implant failure is not properly verified, but its role in osteoimmunology is discussed. This article illustrates two case reports with vitamin D deficiency and early implant failure. Prior to implant placement, the first patient received crestal bone grafting with autologous material. Both patients received dental implants from different manufacturers in the molar region of the mandible. In the case of bone grafting in the first patient, all implants were placed in a two-stage procedure. All implants had to be removed within 15 days after implant placement. Vitamin D serum levels were measured: Both patients showed a vitamin D deficiency (serum vitamin D level <20 μg/l). After vitamin D supplementation, implant placement was successful in both patients. Prospective, randomized clinical trials must follow to affirm the relationship between vitamin D deficiency, osteoimmunology, and early implant failure.

Is Low Serum Vitamin D Associated with Early Dental Implant Failure? A Retrospective Evaluation on 1625 Implants Placed in 822 Patients

Aim. To investigate whether there is a correlation between early dental implant failure and low serum levels of vitamin D. Methods. All patients treated with dental implants in a single centre, in the period 2003–2015, were considered for enrollment in this study. The main outcome was early implant failure. The influence of patient-related variables on implant survival was calculated using the Chi-square test. Results. 822 patients treated with 1625 implants were selected for this study; 27 early failures (3.2%) were recorded. There was no link between gender, age, smoking, history of periodontitis, and an increased incidence of early failures. Statistical analysis reported 9 early failures (2.2%) in patients with serum levels of vitamin D > 30 ng/mL, 16 early failures (3.9%) in patients with levels between 10 and 30 ng/mL, and 2 early failures (9.0%) in patients with levels <10 ng/mL. Although there was an increasing trend in the incidence of early implant failures with the worsening of vitamin D deficiency, the difference between these 3 groups was not statistically significant (P = 0.15). Conclusions. This study failed in proving an effective link between low serum levels of vitamin D and an increased risk of early implant failure. Further studies are needed to investigate this topic.

The Role of Nutrition in Periodontal Health: An Update

Periodontal health is influenced by a number of factors such as oral hygiene, genetic and epigenetic factors, systemic health, and nutrition. Many studies have observed that a balanced diet has an essential role in maintaining periodontal health. Additionally, the influences of nutritional supplements and dietary components have been known to affect healing after periodontal surgery. Studies have attempted to find a correlation between tooth loss, periodontal health, and nutrition. Moreover, bone formation and periodontal regeneration are also affected by numerous vitamins, minerals, and trace elements. The aim of this review is to critically appraise the currently available data on diet and maintenance of periodontal health and periodontal healing. The effects of nutritional intervention studies to improve the quality of life and well-being of patients with periodontal disease have been discussed.