Effects of different antidepressant classes on dental implant failure: A retrospective clinical study

Abstract

Background Previous studies have suggested an association between taking antidepressants and dental implant failure. This study aimed to investigate the association of different antidepressant classes with dental implant failure. Methods This retrospective study included patients that received dental implants at the University of Florida from 2011 to 2016. The variables of implant failure, antidepressant use and classes (selective serotonin reuptake inhibitors [SSRI], serotonin‐norepinephrine reuptake inhibitors [SNRI], tricyclic antidepressants [TCA], atypical antidepressants [AA], and monoamine oxidase inhibitors [MAOI]), age, sex, smoking, mild systemic diseases, and implant location were obtained from patients’ records. Odds ratio (OR) and confidence interval (CI) of implant failure in patients taking different antidepressant classes, in relationship to non‐antidepressant users, were estimated, and the influence of multiple variables on implant failure were investigated. Results A total of 771 patients and 1,820 implants were evaluated. The statistically significant predictors for implant failure included smoking (OR = 5.221), use of antidepressants (OR = 4.285), posterior maxilla location (OR = 2.911), mild systemic disease (OR = 2.648), and age (OR = 1.037) (P <0.05). The frequency of implant failure was 33.3% in TCA users, 31.3% in SNRI users, 6.3% in SSRI users, 5.2% in Atypical antidepressant users, and 3.9% in non‐users. Significant associations were observed between the use of SNRI (OR: 11.07; 95% CI: 3.265 to 33.82) and TCA (OR: 12.16; 95% CI: 1.503 to 71.58) and implant failure (P <0.05). Conclusions Users of antidepressants were at higher risk of implant failure than non‐users. Patients taking SNRI and TCA were at the highest risk of implant loss, when compared with non‐users. Conclusions about TCA, however, are based on a limited number of cases.

Association of different antidepressant classes with clinical attachment level and alveolar bone loss in patients with periodontitis: A retrospective study

“…Contrary to the current findings on the positive effects of antidepressants on the periodontium, our group recently reported that the SNRI and TCA antidepressant classes were associated with higher dental implant failure 43 . The usage of antidepressants has also been associated with increased risk of dental implant failure in studies from other research groups 27,30,44 .…”

“…Contrary to the current findings on the positive effects of antidepressants on the periodontium, our group recently reported that the SNRI and TCA antidepressant classes were associated with higher dental implant failure. 43 The usage of antidepressants has also been associated with increased risk of dental implant failure in studies from other research groups. 27,30,44 In addition, investigations in the area of orthopedics have revealed that antidepressants, such as SSRIs, can inhibit bone mineralization and impede bone cell activity by inducing bone cell apoptosis 45,46 The differing responses of antidepressants in the periodontium, peri-implant tissues and other body bones may be due to the different mechanisms of pathological processes involved in such disorders, such as attachment anatomy, bacterial challenge, inflammatory and healing responses, and mechanical stress level.…”

Mental health and periodontal and peri‐implant diseases

“…Associations between antidepressant medications and implant failure have been found 20 . In particular, associations between selective serotonin reuptake inhibitors and implant failure have been shown in numerous studies 21 .…”

“…15 Associations between antidepressant medications and implant failure have been found. 20 In particular, associations between selective serotonin reuptake inhibitors and implant failure have been shown in numerous studies. 21 A common side effect of antidepressants is xerostomia, where increased discomfort on brushing may result in increased plaque accumulation and the development of peri-implant mucositis.…”

“…Little research has evaluated the relationship between the oral microflora, their interactions with the brain, and mental health disorders. Increasingly, mental health disorders and some of their pharmacotherapies have been linked to higher rates of implant failure 18–21 . Possible mechanisms involve inconsistent compliance with dental visits, a lack of adherence to oral hygiene regimes, and use of antidepressants.…”