Outside of a car or a house, Dental Implants can be one of the biggest investments a person will make in the latter half of their lives. It is for this reason that you will want to optimize your chances of having a successful implant procedure. Statistics on the rate of implant failure are hard to come by, but somewhere between one in ten and one in fifty implants fail. Dental implant success is related to operator skill, quality and quantity of bone available at the site, and also to the person’s oral hygiene. Various studies have found the five year success rate to be between 75-95%.[1] What we mean by failure, is that the body does not rebuild bone around the new implant sufficiently to hold it in place. Osteoporosis is an obvious risk factor, since we know that bone loss occurs first in the jaw before the other larger femur or vertebral bones are affected.

     Risk factors for implant failure include poor general health, prior use of the bisphosphonate osteoporosis drugs, and ongoing use of steroid medications for conditions like asthma or rheumatoid arthritis, and smoking.

     From a dental point of view, the longer the procedure takes and the more the electrocautery tool is used the higher the rate of potential failure. Having an implant on the same day as a tooth or prior implant is extracted has a higher intitial rate of failure.[1] It is probably best to begin with a referral from your own dentist who will have ongoing experience with the results of the persons he or she refers you to. Prior use of the bisphosphonates Fosamax, Actonel, Boniva, Didronel, and Aredia should be discussed within the clinical context of each individual.

     There are a number of things you can do to encourage bone growth in the jaw.

     Many of these things sound like a basic preventive program for preventing bone loss, but each will be discussed so that you know why each is important.

  • Good quality and variety of protein
  • Calcium, 1200-1500 mg/day
  • Magnesium,  250-600 mg/day
  • Vitamin D3, 1400-4000 i.u./day, enough to produce a Vitamin D 25-OH level of 50pg/ml
  • Vitamin C, 1000-5000 mg/day
  • DHEA, 10-50 mg/day
  • Vitamin K, 2-10 mg/day
  • Boron, 2 mg/day
  • Manganese, 2-5 mg/day
  • Silica, 20-30 mg/day[2]

     To build cancellous bone, first a protein scaffold has to be laid down. Then, the scaffold is calcified. This mineralization process is Vitamin K dependant. Calcium is the most common mineral in bone. A lot can be obtained from foods. The balance should be taken as calcium citrate, which is absorbed by the gut more easily. Magnesium is the third most common mineral in bone, and complements calcium.

     Vitamin D3 is necessary for optimal calcium absorbtion from the gut, but it plays an equally important role in bone remodeling and repair. A serum vitamin D 25-OH should be obtained ideally before and certainly after starting a supplement, along with a calcium level. For people with irritable bowel, celiac or other absorbtion problems, doses of vitamin D3 of two to ten thousand international units may be necessary to raise the serum level up above 40. Sunlight is the old fashioned way of making Vitamin D, so persons who are outside a lot may not need supplements.

     Vitamin C is an essential vitamin that plays a number of roles in connective tissue repair. The RDA of 60 mg/day is enough to prevent scurvy, but it is not by any means an optimal amount. 250-500 mg/day can reasonably by obtained from food sources with attention to diet.

     Vitamin K comes from dark green leafy vegetables. It is sold as a drug in Japan at doses of 10 mg. It is a critical activator of the calcification process for new bone, and should be optimally ingested to enhance new bone development. Persons on coumadin will not be able to optimize this system, but a recent article found that even persons on coumadin with unstable anticoagulant control benefited by supplementation with Vitamin K.[3]

     DHEA is an adrenal prehormone. As a rule, men make more than women, and younger people make less as they grow older. It is a precursor for testosterone and estrogens. Anabolic hormones play a part in muscle and bone building and maintenence. Moving DHEA Sulfate levels up into the upper half of the normal range through supplementation will help to optimize bone formation.

     Boron, Manganese and Silica are micronutrients that when absent prevent optimal bone growth. They can be obtained from unprocessed foods, and many bone support supplement formulas will contain small amounts of these micronutrients.

     For persons with congestive heart failure, chronic renal insufficiency, parkinsons disease or emphysema, Coenzyme Q-10 in liberal dosages may improve organ efficiency enough to improve systemic body repair processes.

     Is it necessary to take all these things? –No. If you are relatively healthy with no risk factors you have a good chance of success no matter what you do. This program is designed to optimize implant success, and can be retired after six months when the implant has taken; some may wish to continue, but the purpose of the protocol will have been achieved.

     This protocol alone does not constitute medical advice, and it would be wise to discuss this either with your physician or dentist prior to beginning it.

John H Juhl, D.O.
New York City

[1] Chuang SK, Wei LJ, Douglass CW, Dodson TB, Risk factors for dental implant failure: a strategy for the analysis of clustered failure-time observations, J Dent Res, 81(8):2002; p572-77.

[2] Shils ME, Olsen JA, Shike M, Modern Nutrition in health and disease 8th Ed., Vol 1, Lea & Febiger, Philadelphia, 1994, p 282.

[3] Sconce E, Avery P, et al, Vitamin K supplementation can improve stability of anticoagulation for patients with unexplained variability in response to warfarin, Blood, 2006 Nov 16, (Epub ahead of print).