Can Dental Implants Cause Sarcoma?

Dr. F. asks:
I just read “Maxillary osteosarcoma associated with a dental implant” McGuff, et al in the current issue of the Journal of the American Dental Association 2008;139:1052. The authors conclude: “…the development of a malignancy in relation to the use of implanted biomaterials, while a rare occurrence, is a potential complication.” They report on a case of osteosarcoma that might potentially have been caused by a dental implant. Has anybody else read this journal article, and if so, how do we put this conclusion into perspective? What does this mean for the future of implant dentistry? Are we putting our patients at risk? What are the legal ramifications?



25 thoughts on “Can Dental Implants Cause Sarcoma?

  1. Dr. W. R. Watson, DDS, MS, FAAOMP says:

    The suggestion that osteosarcoma may be a be a side effect, albeit a rare one, is absolutely preposterous! How an article like this could actually pass muster and be published in our ‘official’ journal is an embarassment.

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  2. Alejandro Berg says:

    I copuld not agree more with DR Watson…. What kind of a journal wopuld print such a lie (flat out Lie). ther is NO relation and neither titanium nor Zyrconia implants contain any kind of hazardous materials. I will grant you that titanium oxide has been found far away from implants in some studies but even that is no indication of any kind of malignancy or you would not find titanium oxide in hundreds if not thousands of inocous products.

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  3. Ronald L. Katz, DMD says:

    I have to agree with Dr. Watson’s assessment. You cant establish a causal realtionship in a biologic sense. Hundreds of thousands of implants are placed in relation to the rare occurrence of osteosarcoma. To draw an inference of association without clinical studies to substantiate it is inappropriate.

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  4. Dr. Gerald Rudick says:

    I learned many years ago, when writing multiple choice exams…. to avoid words like “never” and “always”.

    While the possibility of inert materials that are implanted into living persons and animals have never been considered or found to cause cancer; that possibility could exist.

    We do not know which materials have this potential, nor do we know the frequency of occurance.

    It has been my experience to believe that undetected granlomatous tissue that might have been left behind from a previous pathological situation in the oral cavity, and has been dormant for many years; has the potential of being brought back to haunt us and detroy perfectly good dental implants.

    Science has not yet told us notr has proven what causes cancer. Is it possible that cancerous cells may lie dormant until conditions change that cause them to proliferate, metastasize, and bring on pathological destruction?

    I do not think we should be alarmed, but we should be concerned, and those researchers amongst us may want to investigate further.

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  5. registered nurse says:

    Did the patient have a bone graft? That could be the source sooner than a metal implant. Who donates bones after death- as a nurse I suspect unclaimed bodies are purchased by these graft companies. That’s just my opinion and the reason I have procrastinated in getting my implants as I need 2 bone grafts.

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  6. anon says:

    Nurse,

    Even if someone donated bone that had sarcomatous cells present, tell me how that would survive the processing of the bone, then re-proliferate, survive host recognition, and create a malignancy in another non-homologous host ?

    On implants, I guess we should begin to remove all implants and all bone plates and screws because some yahoo made some absurd correlation. Nice peer reviewed journal. How that slipped through editing and approval is beyond me. A letter of clarification should go out in print and the editor should be reprimanded or changed.

    Allowing statements and conclusions like that without serious retrospective studies, now seriously lowers that journal’s credibility.

    HOGWASH, Tripe !!!

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  7. Lee says:

    All of us need to take note of the fact of prions and cwd bacterias are very possible in any implant and/or bone graft. They are proving now that these critters so tiny are almost impossible to kill or filter. All dentists should be required to take a class in BOTH cwd bacteria and prions.

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  8. Smilin' Bill says:

    Response to registered nurse. There are artificial bone graft materials available as well as your own bone harvested from some other site in your body. You do not only have to rely on human bone from another source or animal bone from another species.

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  9. R. Hughes says:

    We have to remember SCIENCE. We have known for years or have valid theories as per the cause of osteosarcomas. Either a mitogenic event occured, Padgets Disease, other cancers/leulemis ar a genetic predisposition is usually the cause. Even trauma is an unlikely cause but usually brings attention to the condition. Case reports of bone sarcomas arising from the area where dental /orthopaedic implants (metallic) have been implanted has been published. The rarety of there unfortuitous clinical events are absolutely rare, and is relative to the almost ubiquitous use of these devices. Considering this, a causual relationship is most unlikely. I do believe syudy of the influence of the regional acceleratory phenomenon and systemic acceleratory phenomenon and a relationship of sarcomas may be in order. I seriously doubt that titanium is an issue, other metals such as cobalt metal powder, nickel metal powder, thin foils of silver, gold, tin, steel,vitallium and tantalum have also produced sarcomas in rats. These are laboratory studies performed under close parameters. So all in all possable—–yes, probable—NO!

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  10. Dr.Serge says:

    First of all if someone can publish the article so that we see it please…
    Second a single case of osteosarcoma leading to this conclusion, i am pretty surprised how that passed through publishers…A question i may ask to the writers of the article…Does the osteosacoma was before implant placement or appeared after? of course at a macroscopic level it wasn’t before but probably may have been present at a microscopic level…so maybe i will agree on something, an implant as procedure not as metal may be a trigger for some pathologic lesions such as osteocarcoma that are already present at the microscopic level.

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  11. mk says:

    What makes an individual susceptible to cancer is not well understood. It is possible that in the right individual, cancer can develop under various environmental influences. Osteosarcoma is such a rare and devastating disease, anything that can be learned about it is important.

    The important thing to remember here is that this is a case report and it should be viewed as such; i.e. bringing to our attention that there is has been an osteosarcoma occurance at an implant site/previous graft site; nothing more, nothing less. This observation, unfortunate as it is for the individual, still did occur and requires reflection and deserves to be brought to our attention.

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  12. anonymous says:

    Osteosarcoma of the jaws is a rare yet potentially deadly disease. There are different variants with different prognostic indicators. The few cases that I have seen and virtually all cases in the literature are in patients without any dental implants. As the world of dental implantology widens and becomes the standard of care to replace missing teeth, we often have to wander what happens long term to the patients who receive them. Can the patient that previously received an implant not develop an odontogenic cyst or tumor at or adjacent to the implant site?? Can the patient with all the risk factors for oral cancer not develop squamous cell carcinoma adjacent to the implant? Can the patient not be involved in a motor vehicle collision and have a fractured jawbone through the implant? Coincidence, or should we automatically blame the implant?
    In light of this, I do believe in solid scientific evidence, based on sound research. To my knowledge there is no evidence that titanium nor any titanium alloy is carcinogenic. However, let’s not forget about surface treatment of implants. Most companies have propriotory surface treatments. Several companies distribute knockoff implants at hugely discounted prices, and are manufactured abroad. And that may raise an issue.
    Having said that, I do believe there is a low likelyhood of carcinogenicity associated with dental implants and or associated products, however history has taught us to never say never.

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  13. Dr. Mehdi jafari says:

    Dear colleagues, before making any strict or decisive bid, I would like you to read these two article abstracts:
    Keel, S B. Jaffe, K A. Petur Nielsen, G. Rosenberg, A E.

    Orthopaedic implant-related sarcoma: a study of twelve cases.
    Modern Pathology. 14(10):969-77, 2001 Oct.
    Sarcoma developing in association with a metallic orthopaedic prosthesis or hardware is an uncommon, but well recognized complication. We review 12 cases of sarcomas arising in bone or soft tissue at the site of orthopaedic hardware or a prosthetic joint. Nine patients were male, and three were female. Their ages ranged from 18 to 85 (mean 55) years at the time of diagnosis of the malignancy. Five patients had undergone hip arthroplasty for degenerative joint disease, four had been treated with intramedullary nail placement for fracture, two had staples placed for fixation of osteotomy, and one had hardware placed for fracture fixation followed years later by a hip arthroplasty. The time interval between the placement of hardware and diagnosis of sarcoma was known in 11 cases and ranged from 2.5 to 33 (mean 11) years. The patients presented with pain, swelling, or loosening of hardware and were found to have a destructive bone or soft tissue mass on radiography. Two sarcomas were located primarily in the soft tissue and 10 in bone. Seven patients developed osteosarcoma, four malignant fibrous histiocytoma, and one a malignant peripheral nerve sheath tumor. All sarcomas were high grade. Three patients had metastatic disease at the time of diagnosis. Follow-up was available on eight patients: five patients died of disease 2 months to 8 years (mean 26 months) after diagnosis; two patients died without evidence of disease 7 and 30 months after diagnosis; and one patient is alive and free of disease 8 years after diagnosis. Sarcomas that occur adjacent to orthopaedic prostheses or hardware are of varied types, but are usually osteosarcoma or malignant fibrous histiocytoma. They behave aggressively and frequently metastasize. Clinically, they should be distinguished from non-neoplastic reactions associated with implants, such as infection and a reaction to prosthetic wear debris. [References: 45]

    AND:
    Tazawa, Hiroshi 1,2,*; Tatemichi, Masayuki 1,3; Sawa, Tomohiro 1; Gilibert, Isabelle 1; Ma, Ning 4; Hiraku, Yusuke 4; Donehower, Lawrence A. 5; Ohgaki, Hiroko 1; Kawanishi, Shosuke 4; Ohshima, Hiroshi 1,6

    Oxidative and nitrative stress caused by subcutaneous implantation of a foreign body accelerates sarcoma development in Trp53+/- mice.
    Carcinogenesis. 28(1):191-198, January 2007.
    Chronic inflammation is a recognized risk factor for human cancer at various sites because of persistent oxidative and nitrative tissue damage. Trp53+/- mice show the predisposition to tumor development, such as sarcomas and lymphomas, compared with Trp53+/+ mice. We investigated the effects of chronic inflammation, especially oxidative and nitrative stress, induced by subcutaneous implantation of a plastic plate (10 x 5 x 1 mm) as a foreign body on tumorigenesis in Trp53+/- and Trp53+/+ mice. The plastic plates were implanted at the age of about 11 weeks. Thirty out of 38 Trp53+/- mice (79%) developed sarcomas around the implant (mean time of tumor appearance was 45.8 +/- 12.0 weeks of age), whereas only one of 10 Trp53+/+ mice with an implant (10%) developed a tumor, at 56 weeks. No sarcomas developed at a sham-operation site. Two of 10 Trp53+/- mice with no implant (20%) also developed three sarcomas spontaneously at 77, 81 and 84 weeks. Increased immunostaining for markers of oxidative and nitrative stress (8-oxo-7,8-dihydro-2′-deoxyguanosine, 8-nitroguanine and 3-nitrotyrosine) and expression of inducible nitric oxide synthase in tumor cells and inflammatory cells were detected in implant-induced sarcomas compared with spontaneous sarcomas in Trp53+/- mice. Furthermore, p53 loss of heterozygosity was observed in 26 out of 29 implant-induced sarcomas (90%). These results indicate that implanted foreign bodies significantly enhanced sarcoma development in Trp53+/- mice, and this may be associated with increased oxidaive and nitrative stress. Loss of the remaining wild-type p53 allele and loss of p53 function appears to be, at least in part, underlying molecular mechanisms during the development of sarcomas at the implantation site in Trp53+/- mice. Such implant-induced sarcoma development in Trp53+/- mice could be useful for studying molecular mechanisms and developing new strategies for chemoprevention in human carcinogenesis induced by chronic inflammation and/or foreign bodies.

    Thank you.

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  14. Dr. K. F. Chow says:

    Please note that the article state only an osteosarcoma associated with a dental implant. It also states that the association is rare and is only a potential complication. Nowhere it seems that the article says that dental implants and its associated materials caused the osteosarcoma. I agree with Gerald and Mehdi’s caution not to pooh pooh it and discount the possibility out of hand…….however remote. As well trained scientists…….we can never really discount or guarantee anything. We can only talk in terms of percentages and statistics and the likelihood or unlikelihood of anything…….because the fact is that we only know very little of anything. If we do succeed in anything, it is because we know enough of a little to achieve a little success which unless we see it in perspective, we might deceive ourselves into thinking that it is a lot. Our success in implantology has revolutionised virtually every area of dentistry…….virtually only but in reality a pathetic imitation of the real thing. Keep a sober abutment …. I mean head on your fixture…..I mean shoulders!

    Cheers.

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  15. h tailor says:

    I must admit that I was shocked when I read the initial article. Reading further comments on the topic tells me that we are concerned about the issue and hope that further research will give us better direction.
    I often wonder the same about composite resins and their long term effects.

    yours truly

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  16. Darick Nordstrom says:

    It was disappointing to read some of these posts and realize they were from doctors (dentists), who should be welcoming this information and using it as a stimulus to search more. I remember reading back in the ’80s implantology journals about the titanium ‘cloud’ extending from implants, and of studies linking titanium compounds with neoplastic changes. Now it is over 20 years later, and where are the studies evaluating the Ti corrosive process and the presence of other dental metals, or exploring differences between patients who have DNA markers for metabolic deficiency in clearing heavy metals?
    Doctors carry the responsibility to make more global decisions in behalf of the patient (vs. nurses, technicians, etc.), recognizing that few treatments carry no risk. Publishing this article was a confirmation of this role.
    I remember the ‘inflammation’ caused by a JADA article about severe chronic dermatologic conditions ultimately found to be caused by the use of ‘dental sealants’ (Dycal, Life) containing sulfonamides, in sensitized individuals. The backlash ultimately lead to the canning of the ADA’s first woman editor, who probably assumed that the unique information could have helped a few other undiagnosed cases, and sounded the clarion bell to step up materials compatability research and dissemination.

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  17. Joao Palmieri says:

    Relate of Case is classified as type D evidence. Other confounding variables , as excessive exposure to X-rays, may be the real factor of risk. We should remember that in 70´s cafeine was postulated as carcinogenous and it was true only if there was association with tobacco. It was a spourious associatin. Anyway, osseointegration has more than 40 years now and we have enough time to make another type of study: case-control p. ex. that will give us more accurate information.

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  18. BD says:

    Has anybody looked into the evidence base.
    What is the incidence of osteosarcoma of the maxilla or mandible in the general population ?
    Compare this with the occurence in patients who have undergone implant placement.
    Implants have been around for long enough now that, if there was an incresed risk, we would surely be starting to see it in the population.

    (0)

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