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Ask UsRheumatoid Arthritis: Contraindication for Implants?
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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?
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5 Responses to “ Rheumatoid Arthritis: Contraindication for Implants? ”
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.
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
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”
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.
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.
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