Impact of Antihypertensive Drugs on Implant Osseointegration

Dr. Faleh Tamimi, Assistant Professor in the Faculty of Dentistry at McGill University, spoke with Dr. Chiraz Guessaier about the research he conducted and the articles he co-authored on the impact of proton pump inhibitors on implant osseointegration.

Highlights

• Propranolol, a non-selective b-blocker widely used to treat cardiovascular conditions, favours bone accrual. Accordingly, we hypothesized that propranolol could be useful for improving bone healing and osseointegration. This in vivo study was designed to investigate the effect of propranolol on bone healing and osseointegration in rats’ tibiae.
• On 24 Sprague–Dawley rats, a unicortical defect was created in the right tibial metaphysis of each rat and a custom-made titanium implant was placed in the left tibia. Animals were then assigned into two groups (n = 12, each group) and treated daily with either propranolol (5 mg/kg: subcutaneous) or saline, for 2 weeks. Then, after killing, the volume of the cortical defects (mm³) and the percentages of newly formed bone in the defects, were assessed with micro-computed tomography; bone-implant contact percentage and peri-implant bone volume/tissue volume were assessed by histomorphometry.
• Propranolol-treated rats presented smaller cortical defects (1.56 ± 0.28 mm³ versus 2.04 ± 0.29 mm³, p < 0.001) with more bone volume/tissue volume (60.6 ± 7.9% versus 41.1 ± 10.2%, p < 0.001) compared to saline- treated rats. Propranolol also enhanced osseointegration as propranolol-treated rats presented higher bone-implant-contact (65.0 ± 13.1% versus 42.5 ± 8.8%, p < 0.001) and peri-implant bone volume/Tissue volume (73.8 ± 10.1% versus 56.9 ± 5.7%, p = 0.007) than saline-treated rats.
• Propranolol enhanced bone healing and implant osseointegration.

Antihypertensive Medications and the Survival Rate of Osseointegrated Dental Implants: A Cohort Study

• Antihypertensive drugs in general are beneficial for bone formation and remodeling, and are associated with lower risk of bone fractures. As osseointegration is influenced by bone metabolism, this study aimed to investigate the association between antihypertensive drugs and the survival rate of osseointegrated implants.
• This retrospective cohort study included a total of 1,499 dental implants in 728 patients (327 implants in 142 antihypertensive-drugs-users and 1,172 in 586 nonusers). Multilevel mixed effects parametric survival analyses were used to test the association between antihypertensive drugs use and implant failure adjusting for potential confounders.
• Only 0.6% of the implants failed in patients using antihypertensive drugs while 4.1% failed in nonusers. A higher survival rate of dental implants was observed among users of antihypertensive drugs [HR (95% CI): 0.12 (0.03–0.49)] compared to nonusers.
• Our findings suggest that treatment with antihypertensive drugs may be associated with an increased survival rate of osseointegrated implants. To our knowledge, this could be the first study showing that the systemic use of a medication could be associated with higher survival rate of dental implants.

Articles Cited in the Interview

• Wu X, Al-Abedalla K, Eimar H, Arekunnath Madathil S, Abi-Nader S, Daniel NG, Nicolau B, Tamimi F. Antihypertensive Medications and the Survival Rate of Osseointegrated Dental Implants: A Cohort Study. Clin Implant Dent Relat Res. 2016 Mar 3. doi: 10.1111/cid.12414. [Epub ahead of print]
• Al-Subaie AE, Laurenti M, Abdallah MN, Tamimi I, Yaghoubi F, Eimar H, Makhoul N, Tamimi F. Propranolol enhances bone healing and implant osseointegration in rats tibiae. J Clin Periodontol. 2016 Oct 5. doi: 10.1111/jcpe.12632. [Epub ahead of print]