Is implanto-prosthodontic treatment available for haemodialysis patients?

Sir, Dental problems and complications in renal patients are infrequently discussed in nephrological journals. In this context, the appearance of two publications (Original Article and Editorial Comment) dedicated to this underestimated, but very important problem in NDT seems a very positive exception [ 1 , 2 ]. Underdiagnosed and untreated periodontitis and other gingival changes may in consequence lead to odontogenic bacteriemic episodes and the development of potentially serious infections, e.g. infective endocarditis. One must remember that ESRD patients are immunodeficient, a condition caused by disturbances of the cellular and humoral immunological response [ 3 ]. On the other hand, patients after renal transplantation may develop a very specific type of gingival hyperplasia and subsequent periodontitis caused by cyclosporine. We recently published our experience with this subject, taking into account treatment performed on patients after successful renal transplantation [ 4 , 5 ]. In the second paper, we proposed a diagnostic and therapeutic algorithm based on our experience and literature search. We wish to draw attention to another important issue related to the availability of modern dental implantology in ESRD patients. In their comments, Craig et al . [ 1 ] suggested that ‘osseous periodontal surgical procedures such as bone grafting or dental implants may be contraindicated in patients with significant renal osteodystrophy’. This suggestion was based on the results of studies performed several years ago. Unfortunately, this type of opinion is quite common both in dental and nephrological literature [ 6 ]. In the last 5 years, we have performed several studies in patients treated with maintenance haemodialysis and afte successful renal transplantation leading to opposite conclusions, showing that this type of treatment is applicable to ESRD patients [ 7–9 ]. In Table 1 , the availability of implants in 100 haemodialysis patients is shown. Results were compared with a control group of 50 healthy persons, with similar age and gender. Studies included radiometric analysis in digital dental panoramic tomography (DPT) using implantological template by Nobel Biocare. Multivariance analysis consists of: radiometric, mathematical Fourier's and densitometric analysis of the jaw bones; Nobel Direct implants simulation, using implantological template and digital pantomography system Planmeca, Vix Win 2000; histological and histomorphometrical analysis of jaws bone tissue samples jaws mineral bone qualitative analysis using EPR (electron paramagnetic resonance methodology) evaluation of biochemical markers of bone metabolism (calcium, phosphate, PTH, alkaline phosphatase). Analysis of the obtained results performed using multiple regression and correlation tests (Statistica 7,0, StatSoft, Tulsa, USA) Evaluation of the degree of jaw bones decline in place of dental implants installation in reference to the status of renal osteodystrophy: frequency and duration of the haemodialysis period was also performed. Comparison of the availability of implant installation at maxilla or mandible between control group and HD patients Comparison of the availability of implant installation at maxilla or mandible between control group and HD patients Detailed data showing the results of consecutive steps of examination performed in ESRD patients were published elsewhere [ 7–9 ]. The analysis shows a decreased quantity and quality of bone tissue of the maxilla and mandible in renal osteodystrophy. Nevertheless, according to internationally recognized standards, these changes were not a contraindication to implantological treatment. This thesis was confirmed in clinical practice because we observed normal function of the implants in patients suffering from renal osteodystrophy, who had received implants many years previously. In general, these patients need more frequent professional advice on oral hygiene and microbiological control using RT-PCR (unpublished data). Only four patients were potentially excluded from this procedure dependent on the time of haemodialysis therapy, due to the inappropriate state of their mandible (low bone density and considerable bone decrease). No exclusions were noted on potential implant installation in the maxilla. In conclusion, the results of our studies clearly show that in the large majority of patients on renal replacement therapy, implantological treatment is possible. Nevertheless, taking into account all specific circumstances (potential use of immunosuppression, higher risk of infection, etc.) it is necessary to establish a special diagnostic and therapeutical algorithm regulating implantological procedures in these patients [ 10 ]. Conflict of interest statement . None declared.