Does the use of proton pump inhibitors lead to an increased risk of dental implant failure? A systematic review and meta-analysis.

Background: Proton-pump inhibitors (PPI) are one of the commonly used medications for a variety of gastrointestinal disorders. Given the large population using PPI and the increased use of dental implants in recent times, it is pertinent to examine if PPI impacts implant outcomes. This systematic review examined the risk of implant failure amongst PPI users vs non-users.

Material and methods: PubMed, Embase, Scopus, and Web of Science literature databases were scouted for cohort or case-control studies comparing implant survival between PPI users vs non-users. Last date of the literature search was 30th October 2024.

Results: We identified eight studies for inclusion. Both crude and adjusted data were pooled separately. Meta-analysis of crude data demonstrated that there was a statistically significant risk of implant failure in PPI users as compared to non-users (OR: 2.71 95% CI: 1.72, 4.29 I2 = 63%). These results failed to change on sensitivity analysis. Pooled analysis of adjusted data showed that PPI use may not independently predict implant failure (OR: 1.44 95% CI: 0.92, 2.24 I2 = 73%). Exclusion of one outlier study showed a significantly increased risk of implant failure with PPI use (OR: 1.71 95% CI: 1.17, 2.50 I2 = 42%).

Conclusions: There may be a tendency for higher implant failure in patients using PPI. The lack of stability of the results on sensitivity analysis and non-significant associations noted with adjusted data preclude strong conclusions. There is a need for further high-quality studies to strengthen the available evidence.