Could vitamin D impact implant success?

Vitamin D and general oral health

The majority of patients receive sufficient vitamin D from sunlight on their skin from late March/early April until the end of September. When there is a smaller chance of sun exposure, however, patients must seek changes in their diet or supplement intake.[ii] Vitamin D insufficiency is sometimes reported as <30 ng/mL, and deficiency as <20 ng/mL.[iii]

When patients are vitamin D deficient, various oral health problems arise. Vitamin D deficiency is documented to result in increased bone resorption and parathyroid hormone levels, and even mild cases of vitamin D inadequacy can signal a predisposition to osteoporosis.[iv] Patients could also experience the development of rachitic tooth, with increased susceptibility to fracture and decay.[v]

The current consensus on the relationship between vitamin D and periodontal diseases is debated. Most current reports find that periodontitis prevalence is associated with lower levels of vitamin D, though there are alternative findings that come to the conclusion they are not related.^v

However, there is evidence that vitamin D plays an effective role in inflammation regulation, with reports noting that increased 25-hydroxyvitamin D reduces gingival inflammation, and that the effect is dose-dependent.[vi] Researchers have also found that in periodontitis patients, vitamin D supplementation was linked with the regulation of CD3+CD8+ cytotoxic T-lymphocytes (CTLs), which can otherwise increase levels of periodontal tissue damage.^vi

Implant application

Osseointegration is an essential step for implant success, and without it, clinicians need to consider an alternative approach to restoring the dentition. Vitamin D has been discussed amongst other micronutrients – magnesium, resveratrol and vitamin C – as having an influence on the jaw and alveolar bones, as well as implant osseointegration.[vii] Low levels of vitamin D may influence the healing process following surgery, due to the impact on bone metabolism.[viii]

The previously noted inflammatory regulation effects of vitamin D are imperative when observing healing at an implant site. Immediately after implant surgery, the micronutrient induces anti-inflammatory cytokines and reduces the levels of proinflammatory cytokines, subduing the body’s response to surgery.[ix] With an effect on the resistance against bacterial infections at the peri-implant sulcus, vitamin D plays an important role in soft tissue healing and marginal seals.[x]

Next steps necessary

Despite an understanding of vitamin D’s functional capabilities within oral health and surgical healing, the clinical evidence is not yet at a point where sweeping judgements can be made. One 2018 study of 885 patients observed 35 early dental implant failures (EDIFs), and recorded the vitamin D serum levels of each individual. 20 patients with EDIFs recorded vitamin D serum levels of 10-30 ng/ml, and another three with levels <10 ng/ml.[xi] Whilst a greater proportion of EDIFs were recorded in the latter group, compared to patients with 10-30 mg/ml and >30 ng/ml (11.1% of patients in the most severely vitamin D deficient group recorded failures, improving to 4.4% and 2.9% respectively), the study is hampered by a limited sample size in the low serum levels group.^xi

It’s important to remain abreast of the current clinical findings surrounding a variety of factors that influence implant placement success, and just as essential to develop excellent surgical skills. The team at One to One Implant Education are leading the education of clinicians from all across the country, with opportunities to develop implant placement techniques and knowledge with the Postgraduate Diploma in Implant Dentistry. The course is ideal for clinicians looking to take their first steps in the field, and provides insights that help to optimise treatment results.

Vitamin D deficiency is just one component of a patient’s health that can compromise dental implant treatment recovery. Encouraging individuals to consider vitamin supplements is fruitful in many situations. Further research is still to come, and with it, clinicians will be able to better provide support to patients, optimising implant placement success at every given opportunity.

To reserve your place or to find out more, please visit
https://121implanteducation.co.uk or call 020 7486 0000.

Dr Fazeela Khan-Osborne is the founding clinician of the FACE dental implant multi-disciplinary team for the One To One Dental Clinic based on Harley Street, London. She has always had a passion and special interest in implant dentistry, particularly in surgical and restorative full arch rehabilitation of the maxilla. She has been involved in developing treatment modalities for peri-implantitis within clinical practice. Dr Khan-Osborne is also the Founding Course Lead for the One To One Education Programme, now in its 20^th year. As a former Lead Tutor on the Diploma in Implant Dentistry course at the Royal College of Surgeons (England), she lectures worldwide on implant dentistry and is an active full member of the Association of Dental Implantology, the British Academy of Aesthetic Dentistry and the International Congress of Oral Implantologists.

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Nikolas Vourakis is a Senior Implant and Restorative Surgeon in private clinics in London and Edinburgh. His special interest and main qualifications are in Oral Surgery and Oral Implantology, while he has vast experience in all areas of Aesthetic Dentistry. He has been a practising Dental Surgeon since 2005 after graduating from the prestigious Military Academy Medical School at the University of Thessaloniki, Greece. Nikolas started his training in the Oral and Maxillofacial Surgery Department of the 401 Military Hospital in Athens, Greece. As a military officer, he then went on to serve as a team leader in a field hospital in Kabul, Afghanistan – an experience, which shaped his commitment and dedication to his chosen field. On returning to Greece, he furthered his training completing a Postgraduate Diploma in Oral Implantology from the University of Athens, Greece and a Master of Science Degree in Oral Surgery/Implantology from Göethe University of Frankfurt, Germany. He recently obtained an Advanced Surgical Master Curriculum in Regenerative Implant Dentistry next to Dr Istvan Urban in Budapest, Hungary. Nikolas is lecturing about Dental Implants and Regenerative Dentistry, and he is holding a program for introducing and mentoring dentists in Implant Dentistry. He is a Member of the Association of Dental Implantology and the International Team for Implantology.

[i] Royal Museums Greenwich, (N.D.). When is the winter solstice? (Online) Available at: https://www.rmg.co.uk/stories/topics/when-winter-solstice-shortest-day [Accessed September 2024]

[ii] NHS, (2020). Vitamin D. (Online) Available at: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ [Accessed September 2024]

[iii] Kennel, K. A., Drake, M. T., & Hurley, D. L. (2010, August). Vitamin D deficiency in adults: when to test and how to treat. In mayo clinic proceedings (Vol. 85, No. 8, pp. 752-758). Elsevier.

[iv] International Osteoporosis Foundation, (N.D.). Vitamin D. (Online) Available at: https://www.osteoporosis.foundation/health-professionals/prevention/nutrition/vitamin-d [Accessed September 2024]

[v] Botelho, J., Machado, V., Proença, L., Delgado, A. S., & Mendes, J. J. (2020). Vitamin D deficiency and oral health: a comprehensive review. Nutrients, 12(5), 1471.

[vi] Meghil, M. M., Hutchens, L., Raed, A., Multani, N. A., Rajendran, M., Zhu, H., … & Cutler, C. W. (2019). The influence of vitamin D supplementation on local and systemic inflammatory markers in periodontitis patients: A pilot study. Oral diseases, 25(5), 1403-1413.

[vii] Alsulaimani, L., Alqarni, A., Almarghlani, A., & Hassoubah, M. (2022). The relationship between low serum vitamin D level and early dental implant failure: a systematic review. Cureus, 14(1).

[viii] Karaoglu, A., Pekcetin, Z. S., Koray, E., Soyer, H. Y., & Koray, M. (2019). The Role of Vitamin D in Implant Success. Open Journal of Stomatology, 9(11), 260.

[ix] Trybek, G., Wlodarczyk, M. A., Kwiatek, J., Preuss, O., Brodkiewicz, A., Sinicyn, A., & Grzywacz, A. (2018). The effect of vitamin D3 on the osteointegration of dental implants. Baltic Journal of Health and Physical Activity, 10(4), 2.

[x] Nastri, L., Moretti, A., Migliaccio, S., Paoletta, M., Annunziata, M., Liguori, S., … & Iolascon, G. (2020). Do dietary supplements and nutraceuticals have effects on dental implant osseointegration? A scoping review. Nutrients, 12(1), 268.

[xi] Makke, A. (2022). Vitamin D supplementation for prevention of dental implant failure: A systematic review. International Journal of Dentistry, 2022(1), 2845902.