Relationship between vitamin D deficiency and early implant failure and osseointegration

This systematic review investigated the relationship between pre-operative vitamin D levels and implant osseointegration and implant-related outcomes. It also assessed studies involving vitamin D supplementation before implant placement. In vivo experimental and clinical studies published up to May 15, 2025, were reviewed. Out of 151 initially identified publications, 43 met the inclusion criteria. In total, 16 animal and 27 human studies were included. Most animal studies investigated vitamin D supplementation before implant placement (nine studies), whereas six studies explored vitamin D coatings on implant surfaces. Animal models included osteoporosis, diabetes mellitus, ultraviolet (UV) light deficiency, chronic kidney disease-induced uremia, and orchiectomy. A positive effect was found for vitamin D on implant osseointegration in 13 of the 16 studies. The human studies comprised three case reports, 10 retrospective studies, three prospective case series, eight prospective controlled trials (2-4 cohorts), and three randomized clinical trials (RCTs). Collectively, 22 of the 27 human studies supported a beneficial association between adequate vitamin D levels and improved implant osseointegration or reduced early implant failure. Vitamin D deficiency was associated with up to a fourfold increase in early implant failures. Pre-surgical supplementation with vitamin D3 enhanced implant osseointegration, improved bone-implant-contact (BIC), promoted peri-implant bone preservation, and reduced early implant failures, even among high-risk populations (i.e., diabetics). When implant-related parameters such as pocket depths, radiographic marginal bone levels, or implant stability were measured, significantly poorer outcomes were consistently observed in vitamin D-deficient groups. Evidence from both animal and human studies strongly indicates that vitamin D deficiency impairs both new bone formation and BIC. Supplementation, particularly in patients with systemic conditions, may improve implant osseointegration outcomes. Pre-operative screening and correction of vitamin D deficiency are recommended to optimize implant success. Additional well-designed prospective clinical trials and RCTs are needed to further elucidate the extent of the correlation between serum vitamin D deficiency and the risk of implant failure.