The goal of successful dental implant treatment is for osseointegration of the dental implant. Because osseointegration is dependent on bone metabolism, it has been postulated that patients exhibiting Vitamin D deficiency may have adverse healing on bone formation around dental implants.
Vitamin D
Vitamin D, in its inactive form (vitamin D3 or cholecalciferol), is a steroid hormone that is acquired through diet or from exposure to the sun (synthesized in the skin from cholesterol).1 Because Vitamin D is biologically inert, it must be activated by two hydroxylation’s in the body to become active. The first hydroxylation takes place in the liver and the second hydroxylation occurs in the kidney, resulting in the physiologically active 5-dihydroxyvitamin D [1,25(OH)2D], also known as “calcitriol”.2
Vitamin Deficiency
Vitamin D has been associated with the health of the brain, cardiovascular, respiratory, skin, and immune systems. In addition, Vitamin D increases the production of extracellular matrix proteins by osteoblasts.3 When there exist reduced levels of 1,25 (OH)2D, impaired absorption of calcium and phosphorus will result. This may cause an increased osteoclast activity, resulting in bone resorption and decreased bone mineral density.
Serum 25-hydroxy vitamin D (25- OH) is the most abundant Vitamin D metabolite and primary circulating form of Vitamin D which is considered the best indicator of a patients Vitamin D status.4 According to the National Institutes of Health, the following are associated blood levels:5 .
Deficient: <12 ng/mL Insufficient: 12-20 ng/mL Ideal: ><12 ng/ml
Insufficient: 12-20 ng/ml
Ideal: >20 ng/ml
Vitamin D deficiency is most commonly due to inadequate dietary intake and insufficient exposure to sunlight. It is a worldwide public health concern affecting up to 70% of the United States Population and up to 85 % of the elderly.6 At this time, it is currently believed that daily consumption of Vitamin D should be approximately 2000 IU (50 mcg).
STUDIES OF VITAMIN DEFICIENCY
To date, most documentation showing the relationship between Vitamin D and implant failure in the available literature is with case studies and animal research. There exist very few studies in dental journals evaluating the relationship between Vitamin D deficiency and early implant failure.
Animal Studies:
- Liu et. al reported that Vitamin D increases implant integration in mice with chronic kidney disease.7
- Kelly et. al. placed 1 mm x 2 mm implants in rats and concluded that Vitamin D deficiency results in impaired integration.8
- Xiong et. al. showed that Vitamin D supplements increase implant integration in mice.9
Human Studies:
- Alvim-Pereira et al found no association between vitamin D receptor gene polymorphism and dental implant loss.10
- Schulze-Späte U concluded no relationship between Vitamin D deficiency and bone growth in maxillary sinus augmentations.11
- Mangano F et al found no significant relation with implant failure in 822 patients that were Vitamin D deficient.12
- Mangano F et. al. in a second study with 885 patients, concluded no significant relationship between implant failure and Vitamin D deficiency.13
CONCLUSION
In conclusion, when evaluating studies on Vitamin D deficiency and dental implants, animal studies have shown a correlation with implant failure. However, as of this time, no conclusive human study has shown a relationship. Therefore, much broader, prospective and well-controlled studies are needed. In the interim, the implant clinician should be aware that patients with severe Vitamin D deficiency may possibly have an increased morbidity with respect to dental implant failure, however it is certainly not an absolute contraindication.
1 Gunton JE, Girgis CM. Vitamin D and muscle. Bone Rep. 2018;8:163–167. doi: 10.1016/j.bonr.2018.04.004…
2 Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010.
3 Reid IR, Bolland MJ, Grey A. Effects of vitamin D supplements on bone mineral density: a systematic review and metaanalysis. Lancet. 2014;383(9912):146–155.
4 Rosen CJ. Clinical practice. Vitamin D insufficiency. N Engl J Med. 2011;364(3):248–254.
5 NIH Fact Sheet for Health Professionals, Vitamin D. March 24, 2020. Accessed 8/5/20. pandemic? Am J Clin Nutr. 2016;103:1033–44.
6 Cashman KD, Dowling KG, Škrabáková Z, Gonzalez-Gross M, Valtueña J, De Henauw S, et al. Vitamin D deficiency in Europe:
7 Liu W, Vitamin D supplementation enhances the fixation of titanium implants in chronic kidney disease mice. PLoS One. 2014;9:e95689.
8 Kelly J, Vitamin D and bone physiology: demonstration of vitamin D deficiency in an implant osseointegration rat model. J Prosthodont. 2009;18:473-478.
9 Xiong Y, 1α,25-dihydroxyvitamin D3 increases implant osseointegration in diabetic mice partly through FoxO1 inactivation in osteoblasts. Biochem Biophys Res Commun.2017;494:626-633.
10 Alvim-Pereira F, Montes CC, Thome G, Olandoski M, Trevilatto PC. Analysis of association of clinical aspects and vitamin D receptor gene polymorphism with dental implant loss. Clin Oral Implants Res, 2008;19(8):786–795.
11 Schulze-Späte U,. Systemic vitamin D supplementation and local bone formation after maxillary sinus augmentation—a randomized, double-blind, placebo-controlled clinical investigation. Clin Oral Implants Res. 2016;27(6):701–6.
12 Mangano F, Is low serum vitamin D associated with early dental implant failure? A retrospective evaluation on 1,625 implants placed in 822 patients. Mediators Inflamm. 2016;2016:
13 Mangano FG,. Low serum vitamin D and early dental implant failure: Is there a connection? A retrospective clinical study on 1,740 implants placed in 885 patients. J Dent Res Dent Clin Dent Prospects. 2018;12:174-182.