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Rheumatoid Arthritis: Contraindication for Implants?

posted in Dental Implant Contraindications, advice

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Dr. M. asks:

I have a 55 year old female patient with rheumatoid arthritis (RA). She is otherwise healthy. I have treatment planned her for multiple implant placement to support a bridge. I believe that rheumatoid arthritis is a disorder that is caused by a pathological autoimmune response and this also results in depression of the immune system. Is this a contraindication to placing dental implants? Does the patient need an antibiotic prophylaxis to place implants?

7 Responses to “ Rheumatoid Arthritis: Contraindication for Implants? ”

• charles Schlesinger, DDS May 19th, 2008

  
  

  I believe the bigger issue would be if the patient has been on long term steroid therapy for the treatment of her RA. That would definately be a contra-indication. Does she have trouble performing oral hygiene? That would be a consideration also.

  If she is good on both of the above, then she should be Ok for treatment. Go ahead and give antibiotics- it is a belt and suspenders approach.

• Alejandro Berg May 20th, 2008

  
  

  Arthritis is not a contraindication at all, steroids its a matter to consider but besides from that… remember implants were created a long long time ago for old patients most of which had arthritis and that wasnt a real consideration then.
  cheers

• Dale Miles May 21st, 2008

  
  

  Hi all….just a clarification, Alejandro…not all athritides are the same…RA is most often early onset, biateral and symmetrical as well as destructive, often resulting in anterior open bites if condyles are involved. OA on the other hand is the one you’re characterizing in your description below…

  So, while not a total contraindication, patient’s with RA whould be considered at higher risk for implant failure if there is condylar change…cone beam imaging of the condyles would be indicated, initially and possibly at some later interval if any signs or symptoms are encountered in the TM joints….so you cannot say “not at all”…

  Hope this help clarify, Dale

  “Arthritis is not a contraindication at all, steroids its a matter to consider but besides from that… remember implants were created a long long time ago for old patients most of which had arthritis and that wasnt a real consideration then.
  cheers”

• Dr. Mehdi Jafari May 22nd, 2008

  
  

  Rheumatoid arthritis is an exaggerated inflammatory process that attacks the synovium of the joints and eventually results in their deformity. Since rheumatoid arthritis is an ever-lasting condition, the patients need to cope with all its complications and sequelae for the rest of their life. In that case, it is very difficult to deprive them from a high quality life and a good nutrition. On the other hand, the problem of the patients’ medications comes along, which does not merely limit to steroids and their complications.A vast majority of rheumatoid arthritis patients are under treatment by immunosuppressive agents.These kinds of drugs suppress the patient’s immune system, which is usually over-active in rheumatoid arthritis. In addition, some of these drugs attack and eliminate white blood cells that not only are associated with the disease, but have a key role in body defense mechanim as well. Some of the commonly used immunosuppressants include leflunomide, azathioprine, cyclosporine, and cyclophosphamide that can have serious side effects such as increased susceptibility to infections and eventual loss of the implants.

• Robert Lemke May 27th, 2008

  
  

  The above medications are all very important to consider. I have had one patient who came off of 2 of three arthritic medications AFTER a full mouth extraction, immediate implant placement and load of her implants. I believe the poor periodontal condition was a chronic inflammatory stimulator for her arthritic condition. Removing the baseline inflammatory “seeding” allowed her arthritic condition to calm down.

• Beverly January 12th, 2009

  
  

  I am an RA patient (47 years old), on two medications (methotrexate and Enbrel) for my arthritis. I had a dental implant, bottom left molar (last one in back), and after several weeks of excruciating pain, I rejected the implant, (lifted right out). After the pain and disapointing outcome, I declined a second attempt. Now I have lost a top molar and my dentist would like to revisit the implant option. I would like any and all feedback on your collective experience as to whether my RA and/or immunosuppressive meds, (and one failure), would make me a poor risk.

  Thank you

• Eileen February 2nd, 2009

  
  

  I am hearing conflicting information on the safety of dental implants for people with Rheumatoid Arthritis. I recently went to a Periodontist who I like. He seems very patient and sincere. He said that I do need 3 implants. He also said that my dental hygiene is excellent. I was diagnosed with Rheumatoid Arthritis almost 1 year ago. The medicine I am taking is methotrexate, sulfasalzine and mobic. He mentioned that I would need to come off of methotrexate at least 2 weeks before the scheduled implant and 1 month after the procedure. My R.A. level when first tested was very high. My mother has severe R.A. and she is taking methotrexate, enbrel, fosomax and prednisone. We both have heard that there could be deterioration in the jaw bone especially the lowere jaw bone. Is this something that I should be concerned about? What are the chances that this would happen to me? I may eventually have to go on biologics, and my mom thinks that I may eventually have to go on fosomax. Where can I find a good resource of information?

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