Selective Serotonin Reuptake Inhibitors and Dental Implant Osseointegration

Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants that are utilized to treat major depressive disorders and anxiety disorders; SSRIs are the most widely used antidepressants worldwide.³ Past literature on SSRIs have documented that use of SSRIs reduce bone formation thus increasing the risk of bone fracture. Inhibiting the reuptake of 5-HTs results in increased osteoclast differentiation and inhibition of osteoblast proliferation, leading to an overall decrease in bone mass and bone mineral density.¹Recent studies have suggested that use of SSRIs is associated with increased risk of dental implant failure, although other studies involving bone loss and remodeling have reported conflicting results. In addition to SSRIs, proton-proton inhibitors and anti-epileptic drugs have also been implicated in impaired bone remodeling.

We conducted a retrospective study on patients who completed dental implant therapy from December 2007 to January 2016 at a single institution. A total of 510 dental implants (167 implants placed in 29 patients using SSRIs) placed in 108 male patients were used to assess the risk associated with the use of SSRI. The data was analyzed with a multivariate analysis and linear regression model. Osseointegration is defined as a direct structural and functional connection between ordered living bone and the surface of a load-carrying implant, that is critical for implant stability.²In order for implants to be considered successful, they must be fully osseointegrated with the bone and provide function. Implant failure is defined as presenting with one or more of the following: clinical signs of mobility, pain, infection, total loss of implant, radiographic bone loss and/or periapical pathology.

The results of our study show that in patients taking an SSRI at the time of dental implant therapy, 10 implants failed and 157 were successful (5.99% failure rate), while in those who were not taking an SSRI, 20 implants failed and 323 were successful (5.83% failure rate). We found no association between SSRI and dental implant failure risk (RR = 1.03; 95% confidence interval, 0.4918-2.1443; p = 0.9436). A secondary outcome that was associated with increased failure rate was smoking habits (p = 0.03), which is in agreement with previous studies. Additionally, we did not find a dose-dependent risk of dental implant failure in patients who were taking a low-moderate vs. moderate-high dose of SSRIs (RR = 1.91, 95% confidence interval, 0.4201 -8.6981; p = 0.40) The study assessed the use of proton-pump inhibitors and anti-epileptic drugs in the above patients, demonstrating that there was no associated risk of implant failure (p =0.93; p = 0.84, respectively). Our results conclude that treatment with SSRIs is not associated with an increased failure rate of osseointegration of dental implants, which is not in agreement with previously reported studies. ⁴ References:

1. Diem SJ, Blackwell TL, Stone KL, Yaffe K, Haney EM, Bliziotes MM, et al: Use of antidepressants and rates of hip bone loss in older women: the study of osteoporotic fractures. Arch Intern Med 167:1240- 1245, 2007.

2. Parithimarkalaignan S, Padmanabhan TV. Osseointegration: An Update. The Journal of the Indian Prosthodontic Society, 13(1):2-6, 2013.

3. Tsapakis E, Gamie Z, Tran G, Adshead S, Lampard A, Mantalaris A, et al: The adverse skeletal effects of selective serotonin reuptake inhibitors. Eur Psychiatry 27:156-169, 2012

4. Wu, X, K Al-Abedalla, E. Rastikerdar, S Abi Nader, N G Daniel, B Nicolau, and F Tamimi: "Selective Serotonin Reuptake Inhibitors and the Risk of Osseointegrated Implant Failure: A Cohort Study." Journal of Dental Research 93.11 (2014): 1054-061.