The Risk of Osseointegration in the Coronavirus Disease 19 Pandemic

Abstract

Coronavirus disease 19 (COVID-19) is associated with respiratory complications but also with alterations on bone metabolism. Coronavirus disease 19, therefore, might be a risk factor for osseointegration. Recent studies suggest that severe acute respiratory syndrome coronavirus 2 is related with bone abnormalities mainly for act via renin-angiotensin system. This report aims to list the bone alterations caused by coronavirus disease 19 and the possible consequences on the peri-implant bone healing. The current data add to the accumulating knowledge that coronavirus disease 19 may negatively impact the osseointegration and it requires further research.

What factors predict craniomandibular disorders in severe COVID-19 survivors after prolonged intubation?

“…We added serum CRP to be a predictor variable because of inflammatory effects of SARS-CoV-2 on the musculoskeletal system via, for example, 1) angiotensin-converting enzyme 2 (ACE2) receptors used to enter host cells, including osteoblasts and osteoclasts, and blocks its receptor functions, including bone resorption, and maintaining bone structure, and 2) the nuclear factor κ B (RANK)/RANK-Ligand (RANKL) system and the tryptophan-kynurenine (Trp-Kyn) pathway activated by cytokine storm, causing inflammatory arthritis, muscle fibrosis, weakness, fatigue, and atrophy, sarcopenia, tendinopathy, and increased bone fragility [9] , [10] , [11] , [12] . The cut-off CRP ≥ 40 mg/l was used because of its association with disease severity at admission and mortality in COVID-19 patients [13] .…”

Association of Peri-Implant Health Status With COVID-19

“…Dental implants are fixed appliances that are often used to restore mastication and orofacial esthetics. 8 , 9 Presence of pathogenic bacteria in subgingival oral biofilm (OB) is often linked with the etiopathogenesis of peri-implant diseases; 10 however, studies 11 , 12 , 13 have shown that subgingival viral load can also play a role in this regard. There is dearth of clinical investigations that have assessed the influence of COVID-19 on peri-implant tissues; however, it has been proposed that COVID-19 may negatively affect osseointegration by depleting angiotensin-converting-enzyme-2 (ACE2) expressed in osteoblasts, osteoclasts and epithelial cells of respiratory system.…”

“…There is dearth of clinical investigations that have assessed the influence of COVID-19 on peri-implant tissues; however, it has been proposed that COVID-19 may negatively affect osseointegration by depleting angiotensin-converting-enzyme-2 (ACE2) expressed in osteoblasts, osteoclasts and epithelial cells of respiratory system. 12 , 14 , 15 According to Block MS 15 implant failures are more often manifested in patients with COVID-19 than their corresponding controls. Between March and December 2022, the author encountered implant failures after placement in five patients and 80% of these were in patients with COVID-19.…”

COVID‐19 as a factor associated with early dental implant failures: A retrospective analysis

“…5 It has been suggested that the effects of COVID-19 on bone metabolism may negatively affect the osteointegration of dental implants. 2,3 Dental implant failures are classified as late or early failures based on the time of occurrence. Failure after loading with prosthetic restoration is called late failure.…”

“…1 These effects can be explained by the angiotensinconverting enzyme-2 (ACE-2) pathway changes and the inflammatory cytokine storm that causes bone resorption by stimulating osteoclast activity. [1][2][3] ACE-2 is a receptor for coronavirus and is expressed in respiratory epithelial cells and bone tissue. Expressed by osteoblasts and osteoclasts in bone tissue, ACE-2 plays a role in bone apposition/resorption balance.…”