Prednisone: Contraindication for Implants?

Ruby, a dental implant patient, asks:

I have been on Prednisone 10mg each day for one year now due to fibrotic lung disease. My dentist wants to place dental implants after he removes several bad teeth. He says that my jaw bone has adequate bone support and quality. My primary care physician was concerned about complications because of the prednisone. The dentists said that there would be no increase in the chance of complications. Does this seem OK?

Editors Note: According to Medline: “Prednisone is in a class of medications called corticosteroids. It works to treat patients with low levels of corticosteroids by replacing steroids that are normally produced naturally by the body. It works to treat other conditions by reducing swelling and redness and by changing the way the immune system works…”

5 thoughts on “Prednisone: Contraindication for Implants?

  1. Sorry for the comment. I think that there are common sense thinking and in many cases the research is conflicting. As a past researcher, with statitics you can get the outcome you like many times. I never promote myself if I don’t have the facts. Usually the jury is out for years before you have the answere(s). Just be honest with your patients. However in the above case of prednisone. It would be reaasonable to inform the patient that the immune system is compromised. I certainly would look at any other medications or life styles the patient may have that may cause necrosis or failure of the implant. In my experience of many years in the implant business some patients just will not do the hygiene necessary to make it a successful outcome. In other patients it appears with very good home care and careful monitoring, that implants may be succesful with the use of antibiotics and again exceptional home care and proper diet. I would tread very carefully on a situation as presented. No all the facts are presented and most of the time we never know them all. Medicine and Dentistry are mergening and we all have a lot to learn. Jeff West, DDS,MD. What happened to spell check?

  2. The term “contraindication” is specific for situations where the anticipated treatement should never be attempted. There is no wiggle room for that term so it needs to be used carefully. What should be up for discussion is the precautions for placing dental implants in patients taking various drugs that impact bone remodeling. The effects of taking high-doses of corticosteriods (>70 mg daily predisone or the equivalent) on bone remodeling is clear. There is a net reduction of mineralization and loss of bone density. In this situation there is a possible increase in the risk of implant non-integration. 10 mgs of prednisone, however, is a relatively low dose and its affect on bone remodeling and integration risk is not well-established. So considering the assessment of adequate bone content and quality it would seem that your dentists assessment of the risks is reasonable.

  3. an example for all. i handle all surgery extractions,periodontal surgery with flaps, implants post.extractive with osseous surgery,along thirty years with this immediate therapy during the intervention: cefazolin cristalline powder and after 3-5 minutes betametasone cristalline powder.

    it is the best solution against pain and swelling and potential infections specially in loco, that i found in these years of my experimentations, On the other hand what was said for a long term therapy with betametasone i think it is right.

  4. Prednisone (or prednisolone) prescribed for the rheumatoid arthritis patients produces similar effects to those produced by cortisone or hydrocortisone with respect to antirheumatic action, influences on the metabolism of nitrogen, carbohydrate, and fat, suppression of pituitary-adrenocortical function, and influences on blood cells and the basal metabolic rate.However, two important differences are note worthy:(1) prednisone is at least four or five times as potent as cortisone or hydrocortisone, both in antirheumatic effects and in most of the metabolic effects, except those relating to electrolytes; (2) prednisone has relatively less effect on the metabolism of electrolytes and hence produces less retention of sodium, chloride, and water, and less excretion of potassium, in comparison with cortisone or hydrocortisone. In the event of an excessive stress, such as a major operation, serious infection, or severe trauma, supplementary amounts of cortisone or hydrocortisone should be administered and other special precautions should be taken to avoid the consequences of pituitary-adrenocortical insufficiency.Prednisone and hydrocortisone produce rather similar increases in blood lipids. Prednisone produces changes in circulating blood cells similar to those produced by cortisone or hydrocortisone, namely a tendency to an increase in haemoglobin and neutrophils and a decrease in lymphocytes, eosinophils, and basophils. Prednisone decreases the urinary excretion of 17-ketosteroids and increased the urinary excretion of formaldehydogenic corticosteroids. The lessened effect of prednisone on electrolytes is especially advantageous for patients who have a tendency to retain fluid or lose potassium, or for patients who require comparatively large doses of an antirheumatic steroid, as in acute rheumatic fever or a severe flare-up of systemic lupus erythematosus.The greatest impact of all the types of steroids on osseo-integrated implants is their osteoporotic effect and the impairment of wound healing process, making the patients more vulnerable to infection.

  5. it’s true, I have placed many dental implants on patients taking steroids with no problems, but i would worry more if they are taking large doses of sterois, i.e., more than 50mg/days for over 2 months, and concurrent medical conditions, e.g. SLE, emphysema, 2nd Sjogrens, other uncontrolled diseases, not just taking steroids.

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