Impact of rheumatoid arthritis in oral surgery and implantology treatment based on literature

Abstract

Rheumatoid arthritis (RA) is an autoimmune disease that results in a chronic, systemic inflammatory disorder that principally
attacks synovial joints. The pathology of the disease process often leads to the destruction of articular cartilage and
the bone. Normal bone remodeling cycle requires the balance between bone resorption and bone deposition which is
determined by the activities of two principle cell types, namely, osteoclasts and osteoblasts. Osteoblasts and osteoclasts,
coupled together via cytokine mediated cell signaling. The dominance of pro-inflammatory cytokines in bone homeostasis
leads to osteolysis. Many articles have been published about the pathobiochemical similarity between rheumatoid arthritis
and periodontitis, whereas the role of the disease in bone regeneration and osseointegration is less proven. According
to the international literature in rheumatoid arthritis, due to frequent periodontitis, decreased salivary secretion, medication,
as well as a decrease in bone regenerative potential, rheumatoid arthritis is considered as relative contraindication
in implantology. In daily practice, we face more frequently with rheumatoid arthritis which makes the topic so important
in oral surgery and implantology. It can be said that adequate preoperative preparation (healthy periodontal status, antibiotic
protection, consultation with the rheumatologist to modify medication) interventions can be done more safely. The
risk of failure is higher in patients suffering from rheumatoid arthritis of the underlying disease which fact is important to
be communicated before surgical intervention.