Dental implants in heart transplant patients?
Has anyone done dental implants in heart transplant patient or any transplant patient? I have a heart transplant patient being evaluated for full mouth teeth extraction and full mouth dental implants and is taking Prograf (tacrolimus) and Cellcept (mycophenolate). He had his heart transplant 6 years ago and is otherwise in good health, except for periodontal disease. I have not been able to find any guidelines in the peer reviewed literature on how to evaluate or treatment plan this patient or if I should be taking special precautions. Has anybody had experience with this?
5 Comments on Dental implants in heart transplant patients?
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CRS
10/4/2013
I haven't done this personally but I would recommend referral to a university setting. The patient is on major immunosuppressive drugs is at risk due to the perio disease. You may not want to go it alone on this one. The perio involved teeth need to go I would not be concerned about implants at the get go. Also why did the patient require a transplant? Iv drugs, bacterial or viral cardio myopathy? That's an important factor in this otherwise " healthy patient" with a heart transplant. Good luck.
Richard Hughes, DDS, FAAI
10/5/2013
CRS, you make a good point. Ask yourself what could go wrong?
If you elect to do this case, then stage it accordingly and treat in a hospital setting. Get the physicians involved.
CRS
10/5/2013
Thanks Richard. As dentists it is valid to take the lead on the dental issues I.e. oral sepsis affecting an immunocompromised patient. I think that immunocompromised patients are an absolute contraindications for dental implants which are elective but the source of periodontal disease needs to be removed. I also would take it in steps.
Dean Licenblat
10/8/2013
I agree with CRS, huge risk and sometimes its not worth the stomach lining and heart tissue, in fact I was once told you sometimes make more money on the cases you turn away. This could very well be one of those cases. Just my opinion, leave that one to the specialists in a hospital setting with all the medical specialists at their fingertips
Dime
10/8/2013
Patients with transplanted heart according to the new guidelines from 2007 from the AHA are not candidates for antibiotic prophylaxis during dental procedures so I do not see any reason why these patient with stable condition won't be a good candidate as long as he is classified in the group 2 according to ASA-PS classification.
So I do not see any reason why not to extract wait to heal than do something simple no bone augmentation something removable easy to make, easy to clean and long to last.
Good luck!
