HIV Positive Patient: Are Dental Implants an Option?
Dr. NR, a general dentist, asks:
I have a patient who is HIV+ but is asymptomatic. I would like to treatment plan the patient for implants and crowns. The only significant finding in his medical history is HIV status. His CD4 and neutrophil counts [PMN] are well above levels where antibiotic prophylaxis are recommended. The patient appears healthy overall. With so many developments in drug therapy for HIV positive patients, life expectancy has been increased significantly. The patient wants to be restored as closely as possible to his natural teeth. No removable appliances. What precautions should I take pre-operatively and during the surgical placement of the implants and post-operatively? Have any of you had any negative consequences or complications with dental implants in this kind of situation?
8 Comments on HIV Positive Patient: Are Dental Implants an Option?
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Peter Fairbairn
6/14/2010
I placed 2 implants ,UR 4 and 3 into a patient with full blown Aids at his request 17 years ago and loaded with a cantilever type bridge.
Recently I saw him ( he had responded well to traement) to place another on the UL 2 and he was well, had no issues no bone loss around one of the implants and 1 mm on the other.
Since then we have placed in numerous other HIV pos. cases again with no issue even where GBR was needed.
Just all the best cross infection protocols , and good consent as to the immuno-compromised status.
As with smokers etc , just another risk group but I have not had any long term issues in fact have been pleasantly supprised by the cases.
Peter
Carlos Boudet, DDS
6/14/2010
With current drug therapy, the life expectancy and quality of life has been improved tremendously in these patients, and if no other problems exist that would contraindicate treatment, implants can be planned as part of a comprehensive treatment plan.
Keep strict adherence to the recommended infection control protocols.
Good luck.
Barry B Hoffman, Prosthod
6/14/2010
I suggest reading the book "Inventing the Aids Virus" by Peter Deusberg. It's available on Amazon. Form your own opinion. The disease called "Aids" is the only disease in the history of mankind that does not satisfy Koch's Postulates regarding an infectious disease. Why is that?
I rejected reading the book several times before my partner finally broke me down and to relieve myself of his constant nagging I said, "OK, I'll read it". 1/3 of the book is peer reviewed documentation that would be universally accepted as serious with regard to the professional journal in which it is published.
Bottom line: Treating a patient with AIDS is not a problem as long as they are not a current drug abuser, their immune system is not under the influence of AIDS drugs, and they have a normal healing response.
Richard Hughes, DDS, FAAI
6/15/2010
Dr. Hoffman, From an accademic standpoint you have to include Leprosy. M. leprae does not follow Koch's Postulates.
Cliff Leachman
6/15/2010
I've done >10 patients, including some with Hep C with the similar results as for those without disease. I've been to numerous courses and heard them state that Hep C and HIV are contraindications to implant therapy, but so is smoking in some circles. We know that if Italian Dentists refused to do implants because of smoking there would be much fewer implants in Italy. Not a justification, but I guess its more your comfort level and their HEALTH!
Aslan Gokbuget
6/16/2010
İf patient is currently under control of his or her doctor it is not a problem.I did HIV+ patient years ago and ıt works perfectly..and had a very positive psychological effect on patient.
Barry B Hoffman, Prosthod
6/17/2010
Dr. Hughes,
I stand corrected. However, the fact that M. Leprea can not be grown in pure culture is irrelevant to the concept of disease transmission. This is from Wikipedia:
"Koch's postulates have their limitations and so may not always be the last word. They may not hold if:
•The particular bacteria (such as the one that causes leprosy) cannot be "grown in pure culture" in the laboratory.
•There is no animal model of infection with that particular bacteria"
Thomas Cason MFOS
6/21/2010
I see no reason to exclude an HIV +ve patient from implant therapy as long as they are not in a terminal stage of the disease process, no concommitant habits eg heavy smoking , drug problems and maintain excellent oral health ie as any patient for implants should be. Again as for any patient they should be advised of possible risks with implant therapy. These patients also expect to have a normal quality of life.
I have done a fair number of HIV patients and do not encounter any problems that might otherwise be seen in other patients and frankly don't see what the big deal is?
