Dental implants are a safe, proven and popular form of tooth replacement when teeth are lost due to decay, gum disease, trauma or neglect. Most dental offices closed during the initial lockdown phases of the Coronavirus pandemic, but once precautions were understood and PP became available, most outpatient dental procedures resumed in a safe fashion. One fear that has emerged is that patients are wondering if it is safe for elective dental procedures and if they are at risk for failure of procedures like dental implants due to the health concerns associated with the novel Coronavirus SARS-CoV-2.
The COVID-19 pandemic in the United States is part of the worldwide pandemic of coronavirus disease 2019 (COVID-19). More than 24,100,000 confirmed cases have been reported since January 2020, resulting in more than 399,000 deaths, the most of any country and the eleventh-highest on a per capita basis. The U.S. has nearly a quarter of the world’s cases and a fifth of all deaths. COVID-19 became the third leading cause of death in the U.S. in 2020, behind heart disease and cancer.
More than 5 million implants are placed each year by dentists in the United States. Dental implant failure is uncommon, but dental implants can fail for many reasons. However as of now there has been no detailed study showing an increase in failure rate of dental implants directly related to Covid-19 or the SARS-CoV-2 coronavirus. The main reasons for implant failure include early infection or loss of integration due to lack of initial stability at the time of surgical placement. The coronavirus can invade oral tissues, but the lungs are the organs most affected by COVID–19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs.
One of the most important factors in implant success is the overall health of the patient at the time of implant placement. Patients who are smokers or who have diabetes or other significant underlying health problems are at a greater risk for implant failure. It takes a strong immune system to allow for the acceptance of the titanium implant and an immune system that is compromised in any way can put the patient at risk for adverse healing in general. Theoretically a patient who is sick with the coronavirus could present with a diminished immune system, therefore placing the patient at increased risk for early failure, but this would not be directly related to the mechanism of action of the virus itself. There is no strong evidence that the virus itself would “attack” the implant surface or the surgery site as some have questioned, but further studies would be needed to rule this hypothesis out in entirety.
Successful dental implant surgery can be nearly painless, safe and provide a predictable outcome even in today’s pandemic laden landscape. Pre-operative antibacterial rinses like Chlorhexidine Gluconate or dilute hydrogen peroxide have proven effective in reducing oral viral load pre-operatively. Doctors, surgical assistants and the entire staff of qualified periodontal and oral surgery offices are taking the pandemic and all Covid-era related treatment quite seriously, including pre-op screening, imbedded safety protocols and follow up for any and all close contact events. With a well trained team, the risk of dental implant surgery and restoration during a world-wide pandemic can be well mitigated or even virtually eliminated.