EFFECTS OF CANNABIS ON
DENTAL IMPLANTS
Dr. ChauLong Nguyen, DDS, MAGD
Mr. John WeisAnterior View at Rest and profile
view
● Gender: Male● Age:70● Race: Caucasian● Marital Status: Married● Employment Status: Self Emloyed-
Certified Cannabis grower● Chief Complaint: “I have severe sharp
pain in lower right side. I don’t want any denture.”
Patient Demographics
Mr. Joh
Anterior & Profile View-Smile
BP= 156/78; Pulpse = 66 ASA Physical Status Classification II Patient has hypertension, high
cholesterol, benign prostatic hyperplasia, and depression
Medical History
He is taking these medicines: Dyazide(spironolactone/HCl)= a combined diuretic for HTN, Lotensin(benazipril) = an ACE angiotensin converting enzyme inhibitor for HTN,
Flomax (tamsulosin HCl) for benign prostatic hyperplasiaLipitor(atorvastatin) = an inhibitor of HMG-CoA reductase (3-Hydroxy-3-methylglutaryl- CoenzymeA) a lipid lowering agent for high cholesterol
Marijuana-Cannabis – THC agent for depression and recreation
Patient has smoked marijuana for 45 years.
Medical History Continue
Marijuana Hemp Plant
Head and Neck = within normal limit Facial Asymmetries: symetric TMJ: asymptomatic Lymph Nodes: not palpable.
Extra-Oral Findings
Objectives and Assessment/Diagnosis
Janurary 2012:
Soft Tissues: generalized within normal limit; Localized severe
inflammation with swelling and exudate in teeth#s 8 and 29.
Dental/ hard tissue : pt has several PFM and gold crowns and
amalgam restorations with recurrent caries in teeth #s 2 O, 2D
3D, 4 M, 32 MOB, missing teeth #s 15, 16, 20, 21, 30, 31.
Intra Oral Findings Dental History
Janurary 2012:
Periodontal disease: pt has generalized moderate periodontitis with localized severe aggressive periodontitis in teeth #s 8 and 29 with class III mobility.
Objectives and Assessment/Diagnosis
continue
Intercuspation Views
Maximum intercuspation – Protrusive movement
Maximum intercuspation right side – Right working side
Maximum intercuspation left side – Left working side
Occlusal View –Maxilla & Mandible
Radiographic Presentation
01.25.2012 X-Rays
1 2 3 4
5a 5b 6a 6b
04.06.2015 X-Rays
1 2 3
04.21.2015 X-Rays
1
2 3 4
Bone level-implant platform on 08-22- 2012 and 03-12 2015
Perio Exam
Tomographs :
patient does not want CBCT
or any scan at this time
Radiographic Presentation
Janurary 2012- July 2015Completed txExtraction of #29, no bone graftExtraction of #8, bone and connective tissue graft, implant, provisional
and fractured 3 times for a year, abutment, PFM delivered on May28, 2013. # 8 porcelain fractured obliquely as in photo on February 2nd, 2015. Several composite restorations have been done for the recurrent caries
of other teeth.Pt does not want any more of his crowns replaced.
Objectives and Assessment/Diagnosis
continue
July 2015:Patient feels happy with his upper teeth. Acquired missing teeth #s 20, 21, 28, 29, 30Adequate inter and intra-arch spaces Type III bone quality
Diagnosis
Type III bone qualityBuccal Lingual width = 8mm in edentulous spacesPrognosis: good to excellent for #8 after three years implant was placed and 21 months of functional prosthetic.
Implant Failure of 4% for type I, II, & III Drs. Guillermo Bernal and Charles J. Goodacre.
Diagnosis continue
CBCT is strongly recommendedFace bowl transferDiagnostic wax upSurgical stents
Proposed Treatment: Plan Sequence
Mounted Casts
After mounting and complete diagnostic wax up
Please refer to articulator for mounting
Surgical stent with pins and stent at gingival level
04.06.2015 X-Rays
1 2 3
Implant placement: Nobel Tapered Groovy•#s 20 & 21 size 3.5mm*11.5mm•# 28 size 3.5mm* 11.5mm•#s 29 & 30 size 5mm*11.5mm
Proposed Treatment: Plan Sequence
Wait 4 monthsPlace custom abutmentsDeliver PFM crowns
Proposed Treatment: Plan Sequence
Major constituents of cannabis: THC = Δ9-tetrahydrocannabinol CBD = cannabidiol THC = main psychoactive ingredient of
cannabis. It also has orexigenic (having a stimulating effect on appetite), analgesic, and antiemetic effects.
CBD has no psychoactivity, it primarily reduces pain and inflammation, and do many other things.
Effects of Cannabis on Bone Healing and/or Bone Loss on Dental
Implants
http://www.drugabuse.go/publications/ drugfacts/marijuana-medicine
“What medications contain cannabinoids?
Two FDA-approved drugs, dronabinol and nabilone, contain THC. They treat nausea caused by chemotherapy and increase appetite in patients with extreme weight loss caused by AIDS.
Facts about medicinal Marijuana at
The United Kingdom, Canada, and several European countries
have approved nabiximols (Sativex®), a mouth spray containing THC and CBD. It treats muscle control problems caused by MS. The United States is conducting clinical trials for its safe use in treating cancer pain.Although it has not yet undergone clinical trials, scientists
have recently created Epidiolex, a CBD-based liquid drug to treat certain forms of childhood epilepsy”.
What medications contain cannabinoids?
My literature research focuses on the effect of cannabis on human bone from studies of over five years for a large control group of people
who do not smoke or use any form of cannabis beginning to smoke marijuana and receiving prosthetic implants include dental implants on this same group of people.
Effects of Cannabis on Bone Healing and/or Bone Loss on Dental
Implants
I can not find studies of cannabis on human bone.
Cannabis has only been given to rats and in vitro experiments in my literature researches.
Effects of Cannabis on Bone Healing and/or Bone Loss on Dental
Implants
ASBMR (American Society of Bone and Mineral Research)Cochrane Review Pubmed
Effects of Cannabis on Bone Healing and/or Bone Loss on Dental Implants
Many recent studies reported Marijuana, Cannabis sativa, has positive impact on bone healing and bone regeneration.
These are some examples of full text/abstract studies.
Effects of Cannabis on Bone Healing and/or Bone Loss on Dental
Implants
Cannabidiol, a Major Non-Psychotropic Cannabis Constituent Enhances Fracture Healing and Stimulates Lysyl Hydroxylase Activity in Osteoblasts by Natalya M Kogan1, Eitan Melamed1, Elad
“.. Taken together, these data show that CBD leads to improvement in fracture healing and demonstrate the critical mechanical role of collagen crosslinking enzymes. © May 10, 2015 American Society for Bone and Mineral Research.”
Effects of Cannabis on Bone Healing and/or Bone Loss on Dental
Implants
Increase of mesenchymal stem cell migration by cannabidiol via activation of p42/44 MAPK(mitogen-activated protein kinase).By Schmuhl E1, Ramer R2, Salamon A3, Peters K3, Hinz B4. PubMed-Biochem Pharmacol. Epub 2013 Dec 1.
“Collectively, this study demonstrates CBD to promote the migration of MSCs via activation of the CB₂ receptor and inhibition of GPR55 and to induce osteoblastic differentiation. CBD may therefore recruit MSCs to sites of calcifying tissue regeneration and subsequently support bone regeneration via an osteoanabolic action on MSCs.”
Effects of Cannabis on Bone Healing and/or Bone Loss on Dental Implants
Effect of cannabidiol on human gingival fibroblast extracellular matrix metabolism: MMP production and activity, and production of fibronectin and transforming growth factor βBy S. Y. Rawal1,2, M. Kh. Dabbous1,3,4,5 and D. A. Tipton1,3 first published online: 17 NOV 2011-Journal of Periodontal Research Volume 47, Issue 3, pages 320–329, June 2012
“The data suggest that the CBD may promote fibrotic gingival enlargement by increasing gingival fibroblast production of transforming growth factor β and fibronectin, while decreasing MMP production and activity.”
Effects of Cannabis on Bone Healing and/or Bone Loss on Dental
Implants
Effects of Cannabis on bone Compare bone levels from August
2012-April 2015
Maximum intercuspation left side – Left working side
Maximum intercuspation right side – Right working side
Patient is happy with the result of healing from his first implant in # 8.
He is motivated to be in the study and to have five more implants in teeth #s 20, 21, 28, 29, 30.
Bone around #8 heals very well More studies on human with longer oberservation should be done for strong support of Cannabidiol usage in bone healing and or bone loss.
Summary of treatment plan and research
Thank You for your attention & advice.
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