Dental Implants and Kidney Disease

I have a patient, a 44 year old male, who has an interesting medical and dental history.

This patient has been coming to me for about a year. He has a significant medical history of having some kidney issues but they seemed to be under control at this time. From a dental perspective he has had several dental implants over the years and they are all holding up well. His root canals have not held up very well; they were done in his native country and do not appear to be up to American standards.

Last year he had a front tooth break and it could no longer be saved. The tooth had a root canal and crown that had been done several years ago but did not hold up as well as we would like. The solution was to make a 1-tooth flipper and have the tooth extracted and an implant placed at my specialist. He decided to do this in 2 phases with bone grafting material placed after the extraction.

This patient has had several complications that I have not seen in other patients with little or no significant medical history. The first bone graft did not seem to perform well and was redone. Then an implant was placed and that did not osseointegrate (where the bone and titanium implant fuse together). After placing the second implant into the space the patient had a more dramatic kidney issue requiring daily dialysis. Then the surgeon noticed that the implant failed during this period. As you might guess, both patient and surgeon are frustrated!

With the markers for kidney problems, like high levels of creatinine being reduced with dialysis, the patient physically looks better and will likely try again on the implant. There is not a lot of research on specific guidelines for dental implants with kidney disease. The general rule is if you have a systemic condition, take a very diligent look at ALL of the things that a patient has concerning their medical history. Keep in mind that chances of failure are higher in the compromised population. Then make a good decision on whether or not to proceed from this point. From a dental standpoint, implants, especially single tooth implants, are the best treatment plan to replace a tooth compared to something removable or a fixed dental bridge.

One other point of interest: I have a patient who was on dialysis for many years and on the list to receive a new kidney. After the surgery he was not allowed to have his teeth cleaned for at least 6 months because of the anti-rejection drugs he had to take. In the past he seemed to have greatly inflamed gums, his tissues looking red and swollen. After his new kidney that condition disappeared and his gums look great, even though he had no apparent change in his home care. I’ve witnessed this myself in only one patient…hence I can’t come up with some rule…but this guy looked better!