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.