Patient-related risk factors for implant therapy. A critique of pertinent literature

Background: Treatment planning for dental implants involves the assessment of patient‐related risk factors prior to formulation of a treatment plan. The aim of this review was to assess relevant literature and provide evidence‐based information on the successful surgical placement of dental implants. Methods: An electronic search of Medline, PubMed and the Cochrane Databases of Systematic Reviews was undertaken using a combination of MeSH terms and keywords. A handsearch was also performed and cross‐referenced with articles cited in papers selected. The primary study parameter was implant failure. Results: Forty‐three studies were selected based on specific inclusion criteria. Many studies contain confounding variables, numbers in subcategories are often too small for meaningful statistical analysis, and follow‐up times vary and are often short‐term. Conclusions: There are many risk factors which the clinician is required to know and understand to advise patients, and consider in planning and treatment provision. Consistent evidence exists to show an increased failure rate with smokers, a history of radiotherapy and local bone quality and quantity. Weaker evidence exists to show a higher incidence of peri‐implant disease in patients with a history of periodontitis‐related tooth loss. Lack of evidence precludes definitive guidelines for patients with autoimmune disorders where expert opinion recommends caution. Osteoporotic patients show acceptable survival rates; however patients on oral bisphosphonates show a small incidence but high morbidity from osteonecrosis of the jaw. Emerging evidence suggests that there is a correlation between genetic traits and disruption of osseointegration.