DENTAL IMPLANT THERAPY IN PATIENTS WITH CHRONIC KIDNEY DISEASE: CLINICAL CONSIDERATIONS, TIMING, AND SAFETY

Vollständiger Abstract

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Background: Chronic kidney disease (CKD) is associated with systemic alterations that may affect bone metabolism, wound healing, bleeding risk, and susceptibility to infection. These factors may influence the biological and clinical outcomes of dental implant therapy, particularly in patients with advanced disease or receiving renal replacement therapy. Objective: This critical narrative review aimed to analyze the current evidence regarding dental implant therapy in patients with CKD, with emphasis on biological mechanisms, implant outcomes, clinical timing, dialysis, kidney transplantation, and individualized treatment planning. Methods: A structured literature search was conducted in PubMed, Scopus, and Web of Science. Priority was given to systematic reviews, clinical studies, clinical guidelines, and publications addressing dental implants, osseointegration, renal replacement therapy, and kidney transplantation. The selected evidence was critically appraised and narratively synthesized according to its clinical applicability. Results: Current evidence does not support considering CKD an absolute contraindication to dental implant therapy. Implant placement has been reported as technically feasible in selected patients with advanced CKD, dialysis dependence, and stable kidney transplantation. However, the available evidence is limited and heterogeneous, and recent evidence in patients with end-stage renal disease indicates that early implant loss and marginal bone changes may occur despite technically feasible implant placement. CKD-related mineral and bone abnormalities, anemia, bleeding risk, systemic instability, immunosuppressive therapy, and treatment-related factors may modify clinical outcomes. Evidence is particularly limited for peritoneal dialysis and for defining standardized timing around kidney transplantation. Conclusion: Dental implant therapy may be feasible in carefully selected and medically stable patients with CKD, although the certainty of evidence regarding long-term safety and predictability remains limited. Treatment decisions should integrate systemic stability, renal treatment modality, CKD-related mineral and bone abnormalities, hematological and pharmacological factors, oral health, surgical complexity, and the patient's ability to maintain long-term peri-implant care.