Implants in a Coeliac Patient?

Celiac disease is a lifelong condition which severely affects the patients nutrition and ability to absorb nutrients. Treatment sometimes consists of steroid therapy. This patient is not a good candidate for implants. I suggest removing the hopeless teeth, defer the impacted canine for now, it may not heal, and make partial denture for the maxilla. Scale and root plane the mandibular teeth. Can you refer this to a periodontist? The best one could hope for is locator retained maxillary denture, the implants probably won't integrate. With this case you need to see how the patient will respond to conservative therapy first. The physician managing the celiac needs to advise. Good luck.

If the patient is taking Osteocare she has deficient mineral absorption (due to her disease). Most of these patients present with time bone issues (osteoporosis etc.). These kind of diseases tend to get better and worse at times so you never know how her mineral levels are unless she does tests 4 / 6 / 8 times a year. By the time you place the implants she can have good mineral levels to integrate the implant, but probably months later the levels fall and the continuous bone resorption / apposition gets compromised over time. Also the patient most likely did not go to a dentist years ago because that bone loss issue did not start yesterday (patient cooperation won't be as you would like). I'm sure O.H. isn't good either but I would probably not place implants in this patient unless I see continuous good blood mineral concentration (and supervised all the time) and perfect O.H. (very difficult). The 2 or 3 inferior incisors are lost. That upper lateral is lost. And she is only 27 y.o. Struggle to maintain the other teeth with subgingival scaling, periochips, possible gingivectomy, etc etc., struggle with O.H. and place some provisionals (removable). Don't place implants to have sleep disorders. Place implants to sleep better.

I never heard of implants being contraindicated in pts with coeliac disease.

All contraindications in implant or any surgery are relative there are very few absolutes.Now as a doctor with judgement one has to weigh the patients health risks. Most text books on implant therapy list metabolic disease and the general health of the patient as contraindications. You have to proceed very cautiously with this case requiring close medical management. Not sure even how the patient will respond to conservative therapy with healing.We have to remember that one can perform the most perfect surgery but what makes it work is the patient's ability to HEAL!. We are not just technicians we use our knowledge,judgement and experience to treat patients.I agree with Leal good advice. I think you can help this patients dental condition and quality of life, but anything invasive is subject to the patients general health. You will never get any practioner to give you an absolute contraindications but what would a reasonable oral surgeon do in this case is what you'll hear in a court of law.

Coeliac disease is man autoimmune disease that affects the small intestines ability to absorb fts, carbohydrates, calcium, B12 and nicotinic acid. If one would place implants, go slow. Place one then evaluate, keep their physicians in the loop. That said, I probably would treat with conventional non implant dentistry.

Yes Dr Kong I have placed implants in patients in patients with health problems I'm not sure where you are getting A "blanket statement" sounds kinda defensive to me. Read the other posts. I hope with time and maturity you will develop judgement, I agree with the other posters. I said that this needs to be approached cautiously Each patient is an individual.. I think the fact that you are not in control of the healing may be troublesome to you. I don't think anyone in private practice wants to manage failing implants and cause harm to the patient. Judgement and discretion are key, not comparing apples and oranges(. You have mentioned three different medical issues) This is a 27yo patient with significant bone loss and unknown medical status, proceed with judgement and caution I would not try to predict the future.

Crs, im simply responding to your previous statement "this patient is not a good candidate for dental implants...the implants probably won't integrate.". Why? b/c this patient has celiac disease? The doctor made no mention of this condition being out of control. I do agree that each person should be treated individually; and fyi im quite comfotable with my judgement.. This patient has boneloss is due to primary etiology for all periodontitis, which is plaque in a susceptible host. I'm merely saying if the patient's celiac disease is under control there is no contraindications for dental implants. And you can plan for more than a rpd or an implant overdenture should the dentist and patient choose to do so.

Many thanks to all your helpful comments. I feel that this is a tricky case and requires utmost attention. I am of the same opinion that this patient requires excellent control and maintenance of her condition before any implants are even planned. She also has to stop smoking as combined with her health status and periodontal condition right now she is a no-go for implants. I do wish to help this young lady out to the best of my knowledge and hence your advice is very helpful. Should you have any other advice please post it. Best wishes to all from Malta!

All of the above discussion about Celiac Disease is very interesting but it is beside the point in this case. These teeth have lost over 75% of their alveolar bone. Even in a healthy patient, these teeth have an extremely questionable periodontal prognosis. What do you expect to accomplish with open flap curettage? Yes, you might have cleaner roots but you will still have teeth which have lost 75% of their bony support. There is NO way that you are going to regenerate any bone in a case such as this where the bone loss is primarily horizontal. In addition, in a patient who has active aggressive periodontitis, even in one who is healthy systemically, implants are totally contraindicated. This is all basic DIAGNOSIS. Please, please put the Titanium away and try to restore health to the teeth as best you can. DrT

Well, despite all the haggling about whether implants shoudl be done in a patient with Coeliac disease, I think the one thing we can all agree on is that someone who has severe periodontal disease AND is a smoker is likely to have some serious issues with healing. I know everyone has their own different take on perio and smoking and implants, but given the amount of bone loss she has, combined with smoking, her young age and her medical conditions, I would not offer her implants at this time.

The literature is clear: a history of severe periodontal disease and smoking translates to a higher rate of implant complications and implant failures. She has a significant systemic disease which will affect her bone metabolism and overall healing. What systemic disease doesn't affect healing? A periodontist should be involved with her care and implants shouldn't be a consideration at this point. She has generalized severe periodontal disease which has to be addressed before any restorative plans are made. The bacteria don't differentiate between transgingival tooth structure or implants...both are colonized and both can develop inflammation and bone loss. So far, bone loss around implants is less easily and less predictably managed than is bone loss around teeth. Placing implants in this kind of oral/systemic environment is simply the wrong thing to do.

Well said periodoc!