Vitamin D deficiency as a suspected causative factor in the failure of an immediately placed dental implant: a case report

Dental implant considerations in patients with systemic diseases: An updated comprehensive review

BACKGROUND

Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise.

AIM

The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population.

METHODS

The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts.

RESULTS

In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study.

CONCLUSION

In treating patients with systemic conditions, the cost-benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.

The Relationship of Low-Serum Vitamin D and Early Dental Implant Failure

The study is aimed to assess the effects of serum vitamin D levels and their relationship to early dental implant failures. A total of 174 implants in 109 patients were placed and serum vitamin D levels were noted on the day of implant placement. Implants were followed up until restoration, approximately 3-6 months later, and any implant failure was reported based on 50% or more bone loss or implant mobility. Eight individuals had an implant fail early and their vitamin D levels had a mean of 42.54 ng/mL compared with the successful patients' levels of 31.92 ng/mL. Although not statistically significant, there was no correlation between patients' low serum vitamin D levels and early implant failure.

Emerging factors affecting peri-implant bone metabolism

Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri-implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant-related factors, like implant surface or titanium particle release; surgical-related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti-hypertensives, nonsteroidal anti-inflammatory medication, and statins, and host-related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri-implant bone loss. Despite the infectious nature of peri-implant biological complications, these factors must be surveyed for the effective prevention and management of peri-implantitis.

Impact of Vitamin D on Osseointegration in Dental Implants: A Systematic Review of Human Studies

This systematic review evaluates the impact of Vitamin D levels on dental implant osseointegration, hypothesizing that optimal Vitamin D enhances success rates, and aims to synthesize data on its relationship with clinical outcomes in implantology. A comprehensive search across PubMed, Cochrane Library, and Web of Science databases included seven peer-reviewed articles meeting the criteria for the review. These studies, conducted between 2008 and 2021, included human subjects and explicitly correlated serum Vitamin D levels with dental implant outcomes, following PRISMA guidelines. The selected studies involved 1462 participants and examined 4450 dental implants. Key findings included a varied implant loss rate ranging from 3.9% to 11.4% across the studies. One study reported a 9.8% implant loss rate, yet found no significant association between Vitamin D receptor polymorphism and implant success. Another study indicated successful implantation following Vitamin D3 supplementation, even in severe deficiency cases. The highest implant loss rate (11.1%) was observed in severely Vitamin D-deficient patients, particularly when compounded by risk factors such as smoking and periodontal disease. Additionally, one study noted significantly improved bone density following post-surgical Vitamin D supplementation for up to 12 weeks. The review supports a link between sufficient Vitamin D levels and successful dental implant osseointegration, suggesting Vitamin D deficiency as a potential risk factor for increased failure and advocating for Vitamin D evaluations in pre-surgical planning to potentially enhance implantology outcomes.

Significance of 25(OH) D3 in Early Dental Implant Failure (EDIF) during osseointegration-A systematic review

Bone metabolism is a key factor for successful osseointegration, and low vitamin D levels may negatively impact the process of osseointegration after implant placement. The study was aimed at evaluating the relation of vitamin D levels with dental implant osseointegration and subsequently the success or failure of the implant. The focused questions were-What is the effect of vitamin D levels on successful dental implant osseointegration and what is the effect of vitamin D supplementation on successful implant osseointegration? A search was conducted on PubMed and Google Scholar using the terms "vitamin D," "cholecalciferol," "1,25(OH) D," "dental implant," "osseointegration," and "bone implant contact" for a period of 10 years from 2011 to 2020. Clinical trials, cross-sectional studies, case series, and case reports were included. A total of ten studies were included after the screening process. Five of these studies evaluated the effect of vitamin D supplementation on osseointegration, whereas five only evaluated the effect of vitamin D deficiency on dental implant osseointegration. Only five of these studies reported dental implant failure varying from 7% to 13% in vitamin D deficient/insufficient groups. Positive relationship exists between serum vitamin D levels and dental implant osseointegration; however, few studies failed to report any relation. More prospective clinical research studies as well as randomized controlled trials are needed to show a significant correlation between decreased serum levels of vitamin D and increased risk of dental implant failure in perspective of vitamin D supplementation which can promote the osseointegration of dental implants.

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.

Influence of Serum Vitamin D Levels on Survival Rate and Marginal Bone Loss in Dental Implants: A Systematic Review

This systematic literature review set out to investigate the relationship between serum vitamin D levels and dental implants in terms of survival rates, marginal bone loss, and associated complications. The review was conducted according to PRISMA guidelines, performing an electronic search in four databases (Pubmed, Web of Science, Cochrane, and Scopus), complemented by a manual search up to April 2022. Four articles were selected for analysis. The Newcastle-Ottawa Quality Assessment Scale tool was used to assess the quality of evidence of cohort studies, and the Cochrane bias assessment tool was used to assess the quality of evidence of randomized clinical trials. The study included 1089 patients restored with 1984 dental implants, with follow-up periods ranging from 20-240 months. Cases presenting lower serum vitamin D levels obtained slightly worse results in terms of marginal bone loss. Longer follow-up periods are needed in order to determine whether serum vitamin D levels affect implant survival rates and osseointegration over time.

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 Supplementation for Prevention of Dental Implant Failure: A Systematic Review

Background

Many factors play a significant role in osseointegration and healing after dental implant insertion and restoration. Some factors are related to dental biomaterials, such as the dental implant, prosthesis, and grafting materials. Other factors can be connected to operator skills and accumulated experience. Local and systemic patient-related factors are crucial in determining the success of the dental implant. Thorough examination and analysis of local factors using available examination tools are vital to prepare the implant candidate for such treatment. The patient's systemic condition directly affects the healing of the dental implant. One of the most overlooked systemic factors is the patients' vitamin D level, which influences bone formation around the implant and subsequent osseointegration. The current review examined the available literature regarding the association between vitamin D supplementation and dental implant osseointegration.

Methods

Data of this review were derived from recent research available on PubMed, Google Scholar, and Scopus. Inclusion criteria were the relation between the vitamin D serum and dental implant osseointegration or failure. The Systematic Reviews and Meta-Analyses (PRISMA) checklist was followed to perform the review. The study's outcome was the need for vitamin D supplementation to prevent implant failure.

Results

Five human studies (including case reports, case series, and retrospective studies) and six animal studies. All included studies discussed the relationship between vitamin D, early dental implant failure, and bone implant contact. Three retrospective studies found no significant relationship between vitamin D supplementation and EDIFs in humans. On the other hand, one retrospective study showed a significant relationship in humans. A case report and case series claimed that the implant was successfully placed after vitamin D supplementation. A total of four animal studies showed a significant relationship between vitamin D supplementation and osseointegration of the dental implant. Two animal studies showed no significant association.

Conclusion

To ensure optimal treatment outcomes, it is recommended to supplement the patient with vitamin D if the serum level is not within the normal range. Further clinical studies and case reports are needed to confirm the association between serum vitamin D levels and osseointegration.

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.

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.

The Relationship Between Serum Level of Vitamin D3 and Osseointegration Around the Dental Implant

At present, dental implants are used more than before, and their high success rate is attributed to sufficient osseointegration, which depends on prosthetic-, implant-, and patient-related factors. The quality and quantity of bone and the host response are the main patient-related factors. Vitamin D3 affects bone metabolism by stimulating both osteoclasts and osteoblasts. This study aimed to review the human studies on the efficacy of vitamin D3 for dental implant osseointegration. Search of the literature yielded only 4 studies on human models, of which 2 showed the optimal efficacy of vitamin D3 for dental implant osseointegration, whereas the remaining 2 did not report any positive effect. However, this finding may be related to the small sample size of the vitamin D3-deficient group, which can compromise statistical analyses. In conclusion, vitamin D3 seems to be effective for dental implant osseointegration, although further research is required on human models.

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.

Do Dietary Supplements and Nutraceuticals Have Effects on Dental Implant Osseointegration? A Scoping Review

Several factors affect dental implant osseointegration, including surgical issues, bone quality and quantity, and host-related factors, such as patients' nutritional status. Many micronutrients might play a key role in dental implant osseointegration by influencing some alveolar bone parameters, such as healing of the alveolus after tooth extraction. This scoping review aims to summarize the role of dietary supplements in optimizing osseointegration after implant insertion surgery. A technical expert panel (TEP) of 11 medical specialists with expertise in oral surgery, bone metabolism, nutrition, and orthopedic surgery performed the review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) model. The TEP identified micronutrients from the "European Union (EU) Register of nutrition and health claims made on foods" that have a relationship with bone and tooth health, and planned a PubMed search, selecting micronutrients previously identified as MeSH (Medical Subject Headings) terms and adding to each of them the words "dental implants" and "osseointegration". The TEP identified 19 studies concerning vitamin D, magnesium, resveratrol, vitamin C, a mixture of calcium, magnesium, zinc, and vitamin D, and synthetic bone mineral. However, several micronutrients are non-authorized by the "EU Register on nutrition and health claims" for improving bone and/or tooth health. Our scoping review suggests a limited role of nutraceuticals in promoting osseointegration of dental implants, although, in some cases, such as for vitamin D deficiency, there is a clear link among their deficit, reduced osseointegration, and early implant failure, thus requiring an adequate supplementation.

Evaluation of FGF-23 and 25(OH)D3 levels in peri-implant sulcus fluid in peri-implant health and diseases

BACKGROUND

There are limited studies to date investigating vitamin D and fibroblast growth factor (FGF)-23 in different peri-implant conditions.

PURPOSE

To evaluate the peri-implant sulcus fluid (PISF) FGF-23 and 25-hydroxy-vitamin D₃ (25(OH)D₃ ) levels in peri-implant health and diseases.

MATERIALS AND METHODS

A total of 90 dental implant sites (peri-implant healthy group [n = 30], peri-implant mucositis group [n = 30], and peri-implantitis group [n = 30]) in 53 participants were included in the study. Probing depth (PD), clinical attachment level (CAL), suppuration (S), modified plaque index (mPI), gingival index (GI), modified sulcus bleeding index (mSBI), and keratinized mucosa width (KMW) were recorded as clinical parameters, and PISF samples were obtained. FGF-23 and 25(OH)D₃ levels were analyzed by enzyme-linked immunosorbent assay.

RESULTS

There were no statistically significant differences in FGF-23 concentrations among the groups (P > .05). The 25(OH)D₃ concentration was significantly lower in peri-implantitis group compared with the other two groups (P < .05). The mean total amount of FGF-23 in the peri-implantitis group was significantly higher than the peri-implant healthy group whereas 25(OH)D₃ total amount was significantly lower in the peri-implantitis group than the peri-implant healthy group. The 25(OH)D₃ concentration was significantly negatively correlated with CAL, PD, mPI, S, GI, and mSBI and statistically significant relationship was found between FGF-23 total amount and these clinical parameters (P < .05). There was a negligible positive correlation between 25(OH)D₃ and FGF-23 concentrations (τ = 0.169; P = .018).

CONCLUSION

Within the limitations of this study, it can be concluded that FGF-23 and vitamin D seems to affect peri-implant bone health, and further studies are needed to explain the association between FGF-23 and 25(OH)D₃ in peri-implant conditions.

Dental implant treatment for renal failure patients on dialysis: a clinical guideline

Chronic kidney disease (CKD) is a worldwide public health problem that is growing in prevalence and is associated with severe complications. During the progression of the disease, a majority of CKD patients suffer oral complications. Dental implants are currently the most reliable and successful treatment for missing teeth. However, due to complications of CKD such as infections, bone lesions, bleeding risks, and altered drug metabolism, dental implant treatment for renal failure patients on dialysis is more challenging. In this review, we have summarized the characteristics of CKD and previous publications regarding dental treatments for renal failure patients. In addition, we discuss our recent research results and clinical experience in order to provide dental implant practitioners with a clinical guideline for dental implant treatment for renal failure patients undergoing hemodialysis.

Titanium biomaterials with complex surfaces induced aberrant peripheral circadian rhythms in bone marrow mesenchymal stromal cells

Circadian rhythms maintain a high level of homeostasis through internal feed-forward and -backward regulation by core molecules. In this study, we report the highly unusual peripheral circadian rhythm of bone marrow mesenchymal stromal cells (BMSCs) induced by titanium-based biomaterials with complex surface modifications (Ti biomaterial) commonly used for dental and orthopedic implants. When cultured on Ti biomaterials, human BMSCs suppressed circadian PER1 expression patterns, while NPAS2 was uniquely upregulated. The Ti biomaterials, which reduced Per1 expression and upregulated Npas2, were further examined with BMSCs harvested from Per1::luc transgenic rats. Next, we addressed the regulatory relationship between Per1 and Npas2 using BMSCs from Npas2 knockout mice. The Npas2 knockout mutation did not rescue the Ti biomaterial-induced Per1 suppression and did not affect Per2, Per3, Bmal1 and Clock expression, suggesting that the Ti biomaterial-induced Npas2 overexpression was likely an independent phenomenon. Previously, vitamin D deficiency was reported to interfere with Ti biomaterial osseointegration. The present study demonstrated that vitamin D supplementation significantly increased Per1::luc expression in BMSCs, though the presence of Ti biomaterials only moderately affected the suppressed Per1::luc expression. Available in vivo microarray data from femurs exposed to Ti biomaterials in vitamin D-deficient rats were evaluated by weighted gene co-expression network analysis. A large co-expression network containing Npas2, Bmal1, and Vdr was observed to form with the Ti biomaterials, which was disintegrated by vitamin D deficiency. Thus, the aberrant BMSC peripheral circadian rhythm may be essential for the integration of Ti biomaterials into bone.

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.