Can HIV Patients Get Dental Implants or Prosthetics?
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Dental Prosthetics in HIV Patients

Published on Oct 06, 2021 and last reviewed on Aug 08, 2023   -  5 min read


Are patients with human immunodeficiency virus infection (HIV) suitable for dental treatment, especially prosthetic and implant treatments? Read the article to know the management strategies adopted by the dental surgeon in an HIV patient.


The advent of HAART (highly active antiretroviral therapy) has emerged as a boon for patients suffering from chronic HIV infection or type 1 HIV infection. Most HAART has 2-3 classes of antiretroviral drugs comprising protease inhibitors, nucleoside, or non-nucleoside analog reverse transcriptase inhibitors. However, when it comes to the use of the highest patient comforting and functional titanium implants for replacing edentulous areas in these individuals or even for normal surgical and prosthetic crown and bridging procedures, the dental surgeon ensures that there are no secondary complications or pre-existing infections before starting or consenting for dental treatment. Also, the viral load and serology parameters vary due to continuous drug therapy for HIV infection.

What Is the Pathophysiology of the Disease in HIV Patients?

HIV patients often refrain from providing necessary information pertaining to their medical history because it may be known or unknown whether their medical condition can affect the dental treatment. In order to help determine the patient's stage in HIV, the past CD4 count medications and medical reports are necessary to be obtained from the patient's health care provider or physician. The dental surgeon should learn about how the infection has affected the patient's life which will tend to establish an honest rapport and communication between the patient and the dentist.

HIV-infected individuals are at an increased risk of other chronic infections like hepatitis, tuberculosis, neurologic diseases, and also allergy can cause adverse drug reactions in individuals where the disease has progressed or advanced. When any of these associated infections exist, it may result in emergence of resistant strains that can further worsen the general prognosis of the patient when elective dental treatment is done, and it should be avoided in high-risk individuals.

The manner of HIV transmission also has implications for dental treatment, such as the need for antibiotic prophylaxis in patients with a history of intravenous drug usage, narcotic usage in substance abuse, and in certain coagulopathies. Specific oral complications, either due to ulceration, dry mouth or xerostomia, progressive periodontal disease, and candidiasis, are associated in these individuals.

Medical history should also be considered in the active HIV infections, including:

Human immunodeficiency virus (HIV) causes progressive immune system failure, weakening the body's defense against pathogens. HIV- positive patients become vulnerable to the development of opportunistic infections. HIV-associated oral lesions, such as oral candidiasis, hairy leukoplakia, HIV-associated gingivitis and periodontitis, Kaposi sarcoma, non-Hodgkin lymphoma, xerostomia, and destructive carious diseases, can be very common. Atypical periodontal necrotic ulceration and an increased incidence of herpetic infections have also been documented.

What Are the Exclusion Criteria for Dental Procedures?

These are the list of criteria that can hamper any dental treatment and hence should be strictly evaluated by the dentist and preferably be excluded from dental treatment as it can create unnecessary or unwanted systemic complications.

  • Severe immunodeficiency with a high recurrence of opportunistic infections.

  • Uncontrolled diabetes.

  • Severe malocclusion.

  • Severe parafunction (bruxism).

  • Inadequate bone volume (division D based on the Misch classification).

  • Disorders for which surgical procedures were contraindicated.

  • Lack of collaboration.

  • Lack of oral hygiene

What Are the Complications Associated With Dental Implants?

The complications are especially severe when these individuals get a dental implant or prosthetic crowns or bridging done, leading to failure in the implant or prosthetic part.

1. Prosthesis Failure: A prosthesis had to be replaced due to implant failure.

2.Implant Failure:

  • Implant removal due to mobility.

  • Progressive marginal bone loss due to peri-implantitis.

  • Any mechanical complications that render the implant not usable (e.g., implant fracture).

Follow-up after six months of implant insertion, and followed by every year. The stability of each individual implant being assessed manually by tightening the abutment screws with the removed prostheses.

3. Biological and Prosthetic Complications: Most common in cases of peri-implantitis (defined as a progressive bone loss with the sign of infection around an osseointegrated implant) also noticed along with patient symptoms like the presence of pain, pus, paraesthesia in the mandible, and implant fracture. Immediately loaded implants using all-on-four treatment in immunocompromised but immunologically stable patients with good oral hygiene have been documented by implantologists. The need for implementation of strict follow-up protocols to prevent the onset and progression of peri-implant diseases in HIV-positive patients had significantly better results. Successful placements of immediate implants into fresh extraction sockets, that is, immediate placement, reduced total treatment time, allowing the preservation of alveolar bone levels during failed healing events.

What Are the Dental Management Strategies for HIV Patients?

The evaluation of an HIV-infected individual is crucial to the success of dental treatment and procedural planning. This depends on four major factors:

  • Hemostasis or cessation of bleeding.

  • Drug actions or intersections (depending on the patient's past and present drug history).

  • Pre-existing illnesses or infections.

  • Co-operation or patient complaints towards dental treatment.

Management strategies by the physician mainly include a step by step assessment of the patient considering the dates and the values for CD4 levels (to know the extent of immune system damage and the progress of the disease), plasma HIV RNA levels (to access the magnitude of viral replication and complete blood count including RBC, hematocrit, platelet count, total neutrophil, lymphocyte, granulocyte, and total white cell count).

Serological parameters (CD4 cell count, CD4 or CD8 ratio, and HIV RNA) need to be measured to identify any variations in patients' immune statuses and to verify patient compliance and response to antiretroviral treatment. This is because the viral load is changed or altered in response to certain medications in the immune system in HIV- positive patients. But it is not the same as in HIV-negative patients, and the primary stability is not impacted, and postoperative complications such as non-healing wounds or risk of infection occur in low percentages if there is an adequate level of CD4+ and there is no neutropenia. Similarly, the dental surgeon should obtain a list of all prescription medications taken currently, along with an INR assessment (for analyzing the coagulation status) so that the timing of dental procedures can be scheduled accordingly, especially during the administration of local anesthesia.

What Are Post-Surgical Instructions to Be Followed?

After surgery, mouth rinsing with a chlorhexidine digluconate containing solution (0.12 % or 0.2 %), twice per day for ten days, in addition to the recommended standard post-surgical medication, that is, 1 g Amoxicillin and Clavulanic acid two times per day for seven days after surgery, and non-steroidal anti-inflammatory drugs are taken post-surgery. All patients are usually instructed to avoid rough brushing and any trauma to the surgical site and recommended to follow a soft diet.


HIV candidates in the current times have become candidates for dental surgery and prosthetic treatment like crowns, bridges, and implants. However, the mandatory or elective procedures are done by considering the exclusion criteria to prevent oro-systemic complications in those patients and after careful systemic assessment by the physician and also considering the dental surgeon's consent and evaluation.

Frequently Asked Questions


Can HIV-Positive Patients Get Dental Implants?

Yes, people with HIV (human immunodeficiency virus) can get dental implants. According to studies, HIV-positive patients who receive dental implants do not experience a higher failure rate. This is especially noticeable in the presence of HAART (highly active antiretroviral therapy) controlled CD4+ T cell counts (a type of white blood cell that fights infections), and prophylactic antimicrobial therapy.


Is HIV Transmission Possible Through Surgical Instruments?

Yes, HIV infection can spread through surgical instruments if they are contaminated with HIV. The HIV can stay in a used syringe for up to 42 days depending on temperature and other conditions. However, the chances of spread are very less because all the instruments are properly sterilized after treating an HIV patient. 


What Effect Does HIV Have on the Teeth?

When an individual has HIV, their mouth could be the first area of the body to experience symptoms. One will be more prone to infections and other diseases since HIV infection will impair the immune system. This may result in tooth loss and discomfort in the mouth. HIV leads to dry mouth, ulcers, and gum diseases which increases the risk of cavities and loosening of the tooth.


Who Cannot Undergo Dental Implants?

Patients with systemic illnesses like diabetes, Parkinson's disease (a brain disease that causes tremors) and specific autoimmune diseases are more likely to experience implant problems or infections. Osteoporosis (a bone disease that leads to weak bones), the drugs used to treat osteoporosis and other bone degradation illnesses, play a significant role in implant failures.


Can Implants Be Placed When There Are No Teeth?

Yes, it is possible to place implants when there are no teeth in the jaw. The conditions that are required for the placement of the implants are good jaw bone volume and density and the absence of any medical condition that affects bone like diabetes, osteoporosis, etc.


Is It Possible to Get Dental Implants Without Gums?

No, if gums are unhealthy and receded, the success rate of implants will decline drastically. A person may not be a candidate for dental implants if they have extensive gum recession or bone loss. Dental implants are designed to operate like natural tooth roots because they are fixed directly into the jawbone and gingival tissue. The likelihood of an implant failing can increase if there is insufficient gum tissue.


Are Dentures Considered Better Than Implants?

Dentures and implants both have their pros and cons. Which is better among them depends upon the individual’s condition. For example, if a person is having uncontrolled diabetes, implants will fail. In this case, dentures would be the better option. However, if a patient has a good bone and wants a long-term and fixed prosthesis, an implant would be better than a denture. Dentures cost less than implants but their longevity is low compared to implants. Because dentures cannot prevent bone loss in the jaw but implants do.


Who Can Get Dental Implants?

Candidates should have healthy gums and be of sufficient age that their jawbone has ceased developing. There should be adequate bone to support and secure the implants as well. Even if the jawbone has deteriorated, people may still be a candidate for implants. Dental implants may even be suggested to stop additional bone loss. In these circumstances, implant surgery actually entails bone grafting techniques that can rebuild the bone. Additionally, it is needed that candidates should be physically fit with no underlying medical conditions that can negatively affect implant placement.


How Long Do Dental Implants Last?

Dental implants can really last longer, in fact, they can last for at least ten to 15 years to a lifetime if they are taken care of well like a natural tooth. The maintenance measures include proper brushing and flossing, taking good care of overall health, and a visit to a dentist after every six months.


Does the Absence of Teeth Affect How the Face Looks?

Yes, the absence of teeth affects the looks and can change the shape of the shape. The teeth provide height to the lower third of the face and provide support to the facial muscles. In the absence of teeth, the muscles around lips and cheeks will sag and the height of the face will get reduced.


Is It Possible to Get Permanent Dentures?

Traditional dentures are removable prostheses. However, these dentures can be fixed with implants, called implant-supported dentures. In this procedure, implants are placed inside the jaw, and the denture is fixed to the implants so that they become fixed.

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Last reviewed at:
08 Aug 2023  -  5 min read




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