Prognosis of dental implants in patients with low bone density: A systematic review and meta-analysis

Abstract Statement of problem Osteoporosis is a risk factor for implant success. Evidence for the prognosis of dental implants in patients with osteoporosis is still unclear. Purpose The purpose of this systematic review was to compare implant success in patients with low versus normal bone density and to evaluate special techniques used to enhance implant success in these patients. Material and methods Searches were performed electronically in 4 databases (PubMed, LILACS, Cochrane, and Grey Literature) through July 2017 and manually to identify studies addressing the subject. Randomized and nonrandomized clinical trials and cohort studies were included. Results Eleven studies met the eligibility criteria, with a total of 1071 participants. Seven studies compared implant success in low and normal bone density, and 4 compared implant success in special and conventional techniques of implant placement. The risk of bias in the assessment of cohort studies was critical; of nonrandomized clinical trials, serious; and of randomized clinical trials, high. The meta-analysis showed no significant difference between implant survival in patients with low and normal bone density 5 years after implant placement. Conclusions Implant survival in patients with low bone density seems to be feasible with special precautions. Implant placement using special adopted techniques might provide equivalent implant stability, survival, and marginal bone loss to normal bone. The quality of evidence is still unclear.