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Ask UsHIV: Contraindication for Dental Implant?
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Dr. O. asks:
I have a 28 yro male patient with HIV and Hepatitis C. His lab values are good. He is being well maintained by his physician and he is an intelligent and compliant patient. He fractured a mandibular second molar which I had to extract. He wants me to replace it with a dental implant. He has an opposing maxillary second molar. Are the HIV and Hep C are contra-indication to placing implants? Does he really need an implant replacing his second molar?
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6 Responses to “ HIV: Contraindication for Dental Implant? ”
Dr O,
There isnt a contraindication to placing implants in a HIV or Hep C Patient but you need to check the labs. Assuming his lab values are in order- TCELL count, Neutraphil count and viral load as far as the HIV and liver function and bleeding panel as far as the Hep C are normal. Then the patient shouldnt be treated any differently then any other patient.
HIV patients are living longer with the cocktail. Know the labs, consult when necessary and treat as any other patient.
Help thats helpful
Is it a really good second molar spot? Frequently it is not worth replacing a second molar as a lone implant due to stress, bone quality, anatomical considerations apically and lingually, and access is difficult.
I completed implant placement and restoration of tooth # 18 on an HIV positive patient. His MD cleared him for the procedure. The final crown was placed 4 months ago. I know that this is a relatively short time for long term evaluation…but everything is doing well..good alveolar support. I was very careful about the occlusion on the crown….very light contact in centric occlusion with the patient closing down with good moderate-heavy force…no lateral excursive contact on the crown. I do not want the implant to be overloaded by any occlusal load.
He also had an implant/PFM on tooth # 20 that was completed two years ago…everything stable.
HIV interferes with body’s ability to effectively fight off viruses, bacteria and fungi,by damaging or destroying the cells of the immune system. It causes more susceptibility to certain types of cancers and opportunistic infections , such as pneumonia and meningitis.At the early stages of infection with HIV, there may be no symptoms at all, although it’s more common to develop a brief flu-like illness two to six weeks after becoming infected, which may include fever, headache, sore throat, swollen lymph glands and even rashes.While the patient is symptomless, he/she is still able to transmit the virus to others. As soon as the virus enters the body, it multiplies in the lymph nodes and slowly begins to destroy helper T cells (CD4 lymphocytes), the white blood cells that coordinate immune system activities.During the last phase of HIV, which occurs approximately 10 or more years after the initial infection, more serious symptoms may appear.The development of an opportunistic infection such as Pneumocystis carinii pneumonia or oral candidiasis is an incative of CD4 lymphocyte count of 200 or less.The patient is also more prone to develop certain cancers, especially Kaposi’s sarcoma, cervical cancer and lymphoma.Lower CD4+ count remains the major risk factor relative to development of oral infections. It appears that other oral mucosal immune factors, including tissue-associated pro-inflammatory and T-helper cytokines, may also contribute to inflammation around implants, loss of soft tissue seal and disintegration.In my opinion, a patient who has been serologically tested positive for HIV, cannot be a suitable candidate for dental implant therapy.
hi Dr.O,
in my opinion replacing a second molar is not a wise thing b’coz it contributes only 5%to masticatory efficiency and hygiene maintenance is difficult in this region HIV and HEP-C are relative contraindications depending on the viral load and TLC count
If the patient really wants an implant for a mand. second molar, his status is not a contraindication if he is medically stable. I have done successful impants on HIV patients and I agree with the other docs that he shouldn’t be treated any differently.
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