Evaluation of the Relationship Between Intake of Proton Pump Inhibitors and Peri-implant Bone Microstructure by Using Fractal Analysis: A Retrospective Case-Control Study

Objective: The use of proton pump inhibitors (PPIs) may be associated with implant failure, as they have the potential to influence bone metabolism and the osteointegration process. This study aimed to evaluate the long-term impact of PPI usage on bone metabolism by employing fractal analysis on periapical radiographs.

Materials-Methods: We adopted a retrospective, matched case-control design and conducted this study. We retrospectively analyzed a database of 27 PPI users (87 dental implants) and then established a control group comprising 27 matching nonusers (88 dental implants) based on age, sex, implant-specific details including brand, macro design, location, and diameter, follow-up period, the presence of augmentation, and the smoking status of participants, thereby resulting in 54 patients (175 dental implants) in all. The primary predictor variable was PPI use. Outcome variables were the incidence of implant failure, fractal dimensions (FD), and crestal bone loss (CBL) on periapical radiographs.

Results: Among the 27 PPI users, three patients experienced implant failure, while there were no failures among nonusers after a mean follow-up of 76.9 months (p > 0.05). The mean ± SD FD values at the final follow-up visits were 1.14 ± 0.07 for PPI users and 1.19 ± 0.05 for nonusers (p < 0.01). No significant differences in CBL values between the two groups (p > 0.05).

Conclusion: Based on this study, PPI intake may negatively affect bone metabolism around dental implants. Clinicians should be careful about osteoporotic changes in the jaws when examining PPI users.

Keywords: dental implant, fractal analysis, proton pump inhibitor