Antidepressant Use and Dental Implant Failure: A Critical Review of Clinical Evidence, Biological Mechanisms, and Practical Implications

Abstract

Dental implants have become the standard of care for replacing missing teeth, with survival rates that are generally favourable but not uniform across patient populations. Over the past decade, a growing body of clinical and preclinical literature has raised the possibility that antidepressant medications, and selective serotonin reuptake inhibitors in particular, may compromise osseointegration and increase the risk of implant failure. This critical review synthesises the available evidence on the association between antidepressant use and dental implant failure, drawing on cohort studies, retrospective clinical series, systematic reviews and meta-analyses, and mechanistic work in cell and animal models. The biological plausibility of the association rests on the dual role of serotonin in skeletal homeostasis: peripherally derived serotonin appears to inhibit osteoblast proliferation and bone formation, while centrally derived serotonin favours bone mass accrual. Selective serotonin reuptake inhibitors disturb this balance in ways that may impair bone healing around titanium fixtures. Clinical studies consistently report a roughly two-fold increase in implant failure among users of selective serotonin reuptake inhibitors relative to non-users, although effect sizes vary across populations, drug subclasses and methodological approaches, and most studies are retrospective and susceptible to confounding by indication, polypharmacy, smoking, and the systemic correlates of depression itself. The review also considers the bidirectional relationship between depression, periodontal disease and oral health behaviours, the differential effects of antidepressant subclasses, the contribution of antidepressant-associated bruxism and xerostomia to peri-implant complications, and the methodological limitations that temper causal interpretation of the existing literature. Clinical implications are discussed, including preoperative risk stratification, multidisciplinary communication with prescribing physicians, and individualised rather than categorical decision-making when planning implant therapy in patients receiving antidepressant treatment. The review concludes that, while the weight of evidence supports a measurable association between selective serotonin reuptake inhibitor use and increased implant failure risk, the absolute risk increase is modest in most reported cohorts and should not by itself constitute a contraindication to implant therapy. Prospective, adequately powered studies that account for depression severity, drug dose and duration, and concurrent risk factors are needed before firmer clinical guidance can be issued.