Implants in a Coeliac Patient?

I have a 27 year old female patient suffering from Coeliac Disease.  She has a mobile #7 [maxillary right lateral incisor; 12]  (grade 3 mobility). She is currently take  Osteocare.  I have taken a DPT and a periapical radiograph to see the bone levels only to find huge bone loss. Obviously dentures are not welcome as a permanent solution. I am thinking that once her coeliac condition is under control I would do a scaling and root planing through perio open flap surgery. Then I would provisionalize  #6 [maxillary right canine; 13] and #7 with a partial denture, remove the impacted canine(if close to the future implant site) and eventually place 2 implants with a bone graft. The lower incisors are also mobile. I suggested electively extracting them and placing 2 implants with a bone graft followed by a 4-unit bridge four months later. Provide a good maintenance programme and review remaining dentition. Would you go ahead with implants? How would you tackle this patient? My main concern is that the implants do not take. Does anyone have any experience with this?


![]](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/10/dch_000.jpg)


![]](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/10/dch_001-e1350478891239.jpg)

15 Comments on Implants in a Coeliac Patient?

New comments are currently closed for this post.
CRS
10/17/2012
Celiac disease is a lifelong condition which severely affects the patients nutrition and ability to absorb nutrients. Treatment sometimes consists of steroid therapy. This patient is not a good candidate for implants. I suggest removing the hopeless teeth, defer the impacted canine for now, it may not heal, and make partial denture for the maxilla. Scale and root plane the mandibular teeth. Can you refer this to a periodontist? The best one could hope for is locator retained maxillary denture, the implants probably won't integrate. With this case you need to see how the patient will respond to conservative therapy first. The physician managing the celiac needs to advise. Good luck.
Leal
10/17/2012
If the patient is taking Osteocare she has deficient mineral absorption (due to her disease). Most of these patients present with time bone issues (osteoporosis etc.). These kind of diseases tend to get better and worse at times so you never know how her mineral levels are unless she does tests 4 / 6 / 8 times a year. By the time you place the implants she can have good mineral levels to integrate the implant, but probably months later the levels fall and the continuous bone resorption / apposition gets compromised over time. Also the patient most likely did not go to a dentist years ago because that bone loss issue did not start yesterday (patient cooperation won't be as you would like). I'm sure O.H. isn't good either but I would probably not place implants in this patient unless I see continuous good blood mineral concentration (and supervised all the time) and perfect O.H. (very difficult). The 2 or 3 inferior incisors are lost. That upper lateral is lost. And she is only 27 y.o. Struggle to maintain the other teeth with subgingival scaling, periochips, possible gingivectomy, etc etc., struggle with O.H. and place some provisionals (removable). Don't place implants to have sleep disorders. Place implants to sleep better.
Leal
10/17/2012
Sorry; correction: the "(very difficult)" stands for the blood mineral / vitamin, etc concentration and not for the O.H.
John Kong, DDS
10/19/2012
I never heard of implants being contraindicated in pts with coeliac disease.
CRS
10/20/2012
All contraindications in implant or any surgery are relative there are very few absolutes.Now as a doctor with judgement one has to weigh the patients health risks. Most text books on implant therapy list metabolic disease and the general health of the patient as contraindications. You have to proceed very cautiously with this case requiring close medical management. Not sure even how the patient will respond to conservative therapy with healing.We have to remember that one can perform the most perfect surgery but what makes it work is the patient's ability to HEAL!. We are not just technicians we use our knowledge,judgement and experience to treat patients.I agree with Leal good advice. I think you can help this patients dental condition and quality of life, but anything invasive is subject to the patients general health. You will never get any practioner to give you an absolute contraindications but what would a reasonable oral surgeon do in this case is what you'll hear in a court of law.
John Kong, DDS
10/20/2012
Have you ever placed a dental implant in a patient who is diabetic? How about HIV? Lupus pt. on steroids? These conditions can all potentially affect healing. It's been done and will continue to be done by implant surgeons in the future. The key is are the conditions under control or managed enough to undergo implant surgery. There are many people living with Celiac disease and is often managed with proper gluten-free diet. You shouldn't make a blanket statement that people with Celiac Disease shouldn't get implants because they can't "Heal" or even assume that most with the disease can't "Heal." Any person who is malnourished (regardeless of what disease you have) will have compromised healing, but just because you have Celiac disease doesn't at all mean you are malnourished. There are plenty of healthy people who manage Celiac disease very well. Hence, I see no contraindications to placing implants in patients with Celiac disease so long as their condition is under control and managed.
Richard Hughes, DDS, FAAI
10/20/2012
Coeliac disease is man autoimmune disease that affects the small intestines ability to absorb fts, carbohydrates, calcium, B12 and nicotinic acid. If one would place implants, go slow. Place one then evaluate, keep their physicians in the loop. That said, I probably would treat with conventional non implant dentistry.
CRS
10/20/2012
Yes Dr Kong I have placed implants in patients in patients with health problems I'm not sure where you are getting A "blanket statement" sounds kinda defensive to me. Read the other posts. I hope with time and maturity you will develop judgement, I agree with the other posters. I said that this needs to be approached cautiously Each patient is an individual.. I think the fact that you are not in control of the healing may be troublesome to you. I don't think anyone in private practice wants to manage failing implants and cause harm to the patient. Judgement and discretion are key, not comparing apples and oranges(. You have mentioned three different medical issues) This is a 27yo patient with significant bone loss and unknown medical status, proceed with judgement and caution I would not try to predict the future.
John Kong, DDS
10/20/2012
Crs, im simply responding to your previous statement "this patient is not a good candidate for dental implants...the implants probably won't integrate.". Why? b/c this patient has celiac disease? The doctor made no mention of this condition being out of control. I do agree that each person should be treated individually; and fyi im quite comfotable with my judgement.. This patient has boneloss is due to primary etiology for all periodontitis, which is plaque in a susceptible host. I'm merely saying if the patient's celiac disease is under control there is no contraindications for dental implants. And you can plan for more than a rpd or an implant overdenture should the dentist and patient choose to do so.
CRS
10/20/2012
Every single tooth has severe bone loss. Do you think this patient based on the two xrays alone and a history of Celiac disease on a calcium supplement is a good candidate for dental implants? Be realistic and read the other posts. If you just want to argue the case for Celiac disease I have treated this patient population with oral surgery procedures including dental implants with success. But they did not have this severe periodontal disease. Don't you agree that periodontal health is related to overall systemic health and vice versa? Now lump in an auto-immune disease. I would proceed with caution, one miracle at a time! Frankly I'm not that good!
Jean Paul Demajo
10/23/2012
Many thanks to all your helpful comments. I feel that this is a tricky case and requires utmost attention. I am of the same opinion that this patient requires excellent control and maintenance of her condition before any implants are even planned. She also has to stop smoking as combined with her health status and periodontal condition right now she is a no-go for implants. I do wish to help this young lady out to the best of my knowledge and hence your advice is very helpful. Should you have any other advice please post it. Best wishes to all from Malta!
DrT
10/23/2012
All of the above discussion about Celiac Disease is very interesting but it is beside the point in this case. These teeth have lost over 75% of their alveolar bone. Even in a healthy patient, these teeth have an extremely questionable periodontal prognosis. What do you expect to accomplish with open flap curettage? Yes, you might have cleaner roots but you will still have teeth which have lost 75% of their bony support. There is NO way that you are going to regenerate any bone in a case such as this where the bone loss is primarily horizontal. In addition, in a patient who has active aggressive periodontitis, even in one who is healthy systemically, implants are totally contraindicated. This is all basic DIAGNOSIS. Please, please put the Titanium away and try to restore health to the teeth as best you can. DrT
DES
10/23/2012
Well, despite all the haggling about whether implants shoudl be done in a patient with Coeliac disease, I think the one thing we can all agree on is that someone who has severe periodontal disease AND is a smoker is likely to have some serious issues with healing. I know everyone has their own different take on perio and smoking and implants, but given the amount of bone loss she has, combined with smoking, her young age and her medical conditions, I would not offer her implants at this time.
Periodoc
10/23/2012
The literature is clear: a history of severe periodontal disease and smoking translates to a higher rate of implant complications and implant failures. She has a significant systemic disease which will affect her bone metabolism and overall healing. What systemic disease doesn't affect healing? A periodontist should be involved with her care and implants shouldn't be a consideration at this point. She has generalized severe periodontal disease which has to be addressed before any restorative plans are made. The bacteria don't differentiate between transgingival tooth structure or implants...both are colonized and both can develop inflammation and bone loss. So far, bone loss around implants is less easily and less predictably managed than is bone loss around teeth. Placing implants in this kind of oral/systemic environment is simply the wrong thing to do.
CRS
10/25/2012
Well said periodoc!

Featured Products

OsteoGen Bone Grafting Plug
Combines bone graft with a collagen plug to yield the easiest and most affordable way to clinically deliver bone graft for socket preservation.
CevOss Bovine Bone Graft
Make the switch to a better xenograft! High volume of interconnected pores promotes new bone. Substantially equivalent to BioOss and NuOss.