Failure rate and treatment plan options of dental implants in patients with fibro-osseous lesions: a systematic review

Abstract

Dental implant placement requires prerequisites, such as the quality and quantity of the available bone. Oral and maxillofacial fibro-osseous lesions (FOLs) are a group of intraosseous benign lesions, consisting of cemento-osseous dysplasia (COD), fibrous dysplasia (FD), and cemento-ossifying fibroma (COF), characterized by progressive replacement of normal bone tissue by fibrous connective tissue comprising varying amounts of mineralized substances, and consequently, the quality of the bone tissue. The aim of this study is to provide information for clinicians on the risks of implant insertion into these types of lesions. The ISI Web of Science, PubMed, and Scopus databases were searched based on the following PICO: The PICO question of the present study is as follows: What are the failure rates and treatment plan options (O) of implant placement (I) in patients with a fibro-osseous lesion who need an implant treatment at the site of the lesion (P)? Of the 301 identified studies, 39 eligible studies (16 on COD, 14 on FD, and nine on COF) were included in the present systematic review. Overall, 40 and 56 implants were placed in healthy areas near the lesions, in the grafted tissues placed in the location of the removed lesions, or within the COD and FD lesions, respectively. All of the 29 implants in the group of COF lesions were placed in the healed or grafted tissue, replacing the resected COF-affected areas. The failure rate of implants placed in the studies investigating COD, FD, and COF lesions were 22.50%, 7.14%, and 10.34%, respectively. Treatment options for implant placement in COD and FD lesions were reported as removing the lesion and waiting for the bone to be healed (with or without grafting), placing implant in the healthy bone near the lesion, or placing the implant embedded in the lesion. However, all of COF lesions were removed (mostly with resection) and dental implants were placed in the grafted tissue. Considering the limitations of the present study, it can be concluded that it would be more appropriate to avoid placing dental implants into the COD and FD lesions and inserting the implants in the surrounding healthy bone, healed, or grafted bone tissues are preferred. However, due to the neoplastic nature of COF removing the lesions prior to the implant insertion is crucial.