Evaluation of the Relationship Between Intake of Proton Pump Inhibitors and Peri‐Implant Bone Microstructure by Using Fractal Analysis: A Retrospective Case–Control Study

ABSTRACT Objectives Proton pump inhibitors (PPIs) have been suggested to influence bone metabolism and osseointegration. This study aimed to assess the long‐term effects of PPI usage on trabecular bone patterns around dental implants through fractal analysis of periapical radiographs. Material and Methods This retrospective, matched case–control study analyzed a database of 27 PPI users (87 dental implants) and established a control group of 27 nonusers (88 dental implants), matching them by age, sex, smoking status, total follow‐up duration, and history of augmentation procedures. The final study population included 54 patients with a total of 175 dental implants, all of which were from the same brand and identical in composition and surface treatment. The primary predictor variable was PPI use, while the outcome measures included implant survival rate, crestal bone loss (CBL), and fractal dimension (FD) values assessed on periapical radiographs. Results Three PPI users experienced implant failure during a mean follow‐up period of 76.9 months, whereas no failures occurred in the nonuser group ( p > 0.05). Similarly, no significant differences were observed in CBL values between the two groups ( p > 0.05). However, the mean (standard deviation) FD values at the final follow‐up were 1.14 (0.07) for PPI users and 1.19 (0.05) for nonusers, showing a significant difference ( p < 0.01). Conclusions The findings of this study suggest that PPI use may have a detrimental impact on bone metabolism surrounding dental implants. Clinicians should be vigilant regarding possible trabecular alterations in the jawbones of patients undergoing PPI therapy.