Impact of Adrenal Gland Dysfunction on Dental Implant Therapy and Osseointegration: A Narrative Review

REVIEW
Bylbyl Reçica, Vjosa Hamiti Krasniqi, Jehona Ahmedi, Besir Salihu

 

For citation: Reçica B, Krasniqi VH, Ahmedi J, Salihu B. Impact of Adrenal Gland Dysfunction on Dental Implant Therapy and Osseointegration: A Narrative Review. International Journal of Biomedicine. 2026;16(3):320-326. doi:10.21103/Article16(3)_RA4

Originally published September 5, 2026

Abstract: 

Background: Dental implant therapy is widely used for oral rehabilitation, with success largely dependent on bone metabolism and effective osseointegration. Systemic conditions, particularly endocrine disorders such as adrenal gland dysfunction, may influence these biological processes. However, the impact of adrenal disorders on dental implant outcomes remains insufficiently explored in current clinical guidelines.

Methods: A narrative review was conducted. An electronic search was performed in PubMed/MEDLINE, Scopus, and Web of Science databases for studies published through December 2024. Relevant studies addressing adrenal gland dysfunction, corticosteroid therapy, bone metabolism, and dental implant therapy were included. A total of 24 publications were selected based on their clinical relevance and contribution to evidence-based recommendations.

Results: Current evidence suggests that adrenal gland dysfunction should not be considered an absolute contraindication for dental implant therapy. Patients with well-controlled adrenal insufficiency may achieve favorable outcomes with appropriate medical management and perioperative corticosteroid supplementation protocols. In contrast, uncontrolled hypercortisolism and prolonged corticosteroid therapy may negatively affect bone metabolism, impair wound healing, and increase the risk of peri-implant complications. Risk stratification protocols enable clinicians to optimize outcomes through individualized treatment planning.

Conclusion: Adrenal gland dysfunction represents a relative risk factor rather than a contraindication to dental implant therapy. Careful patient evaluation, interdisciplinary collaboration with endocrinologists, and individualized treatment planning incorporating stress-reduction protocols and appropriate corticosteroid supplementation are essential to optimize clinical outcomes and ensure long-term implant success. Future prospective studies with standardized protocols are needed to establish comprehensive evidence-based guidelines for perioperative management and long-term implant outcomes in patients with adrenal dysfunction.(International Journal of Biomedicine. 2026;16(3):320-326.)

Keywords: 
adrenal insufficiency • hypercortisolism • Cushing syndrome • corticosteroid therapy • dental implants • bone metabolism
References: 
  1. Mombelli A, Cionca N. Systemic diseases affecting osseointegration therapy. Clin Oral Implants Res. 2006 Oct;17 Suppl 2:97-103. doi: 10.1111/j.1600-0501.2006.01354.x. Erratum in: Clin Oral Implants Res. 2006 Dec;17(6):746. PMID: 16968386.
  2. Albrektsson T, Johansson C. Osteoinduction, osteoconduction and osseointegration. Eur Spine J. 2001 Oct;10 Suppl 2(Suppl 2):S96-101. doi: 10.1007/s005860100282. PMID: 11716023; PMCID: PMC3611551.
  3. Brånemark PI. Osseointegration and its experimental background. J Prosthet Dent. 1983 Sep;50(3):399-410. doi: 10.1016/s0022-3913(83)80101-2. PMID: 6352924.
  4. D’Ambrosio F, Amato A, Chiacchio A, Sisalli L, Giordano F. Do Systemic Diseases and Medications Influence Dental Implant Osseointegration and Dental Implant Health? An Umbrella Review. Dent J (Basel). 2023 Jun 5;11(6):146. doi: 10.3390/dj11060146. PMID: 37366669; PMCID: PMC10296829.
  5. Sakka S, Baroudi K, Nassani MZ. Factors associated with early and late failure of dental implants. J Investig Clin Dent. 2012 Nov;3(4):258-61. doi: 10.1111/j.2041-1626.2012.00162.x. Epub 2012 Aug 27. PMID: 22927130.
  6. Torrejon-Moya A, Izquierdo-Gómez K, Pérez-Sayáns M, Jané-Salas E, Marí Roig A, López-López J. Patients with Thyroid Disorder, a Contraindication for Dental Implants? A Systematic Review. J Clin Med. 2022 Apr 25;11(9):2399. doi: 10.3390/jcm11092399. PMID: 35566524; PMCID: PMC9102443.
  7. Guyton AC, Hall JE. Textbook of Medical Physiology. 14th ed. Philadelphia: Elsevier; 2021.
  8. Chan MH. Update on Management of the Oral and Maxillofacial Surgery Patient on Corticosteroids. Oral Maxillofac Surg Clin North Am. 2022 Feb;34(1):115-126. doi: 10.1016/j.coms.2021.08.011. Epub 2021 Oct 25. PMID: 34711466.
  9. Carmona D, Ouanounou A. Adrenal Insufficiency and Its Implications on Dental Treatment. Compend Contin Educ Dent. 2021 Sep;42(8):422-428; quiz 429. PMID: 34449238.
  10. Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hahner S, et al. Diagnosis and treatment of primary adrenal insufficiency: Endocrine Society Clinical Practice Guideline. Lancet Diabetes Endocrinol. 2016 Mar;4(3):216-26.
  11. Compston J. Glucocorticoid-induced osteoporosis. Lancet. 2018 Jun 9;391(10137):2345-2357.
  12. Canalis E. Mechanisms of glucocorticoid action in bone. Endocrine. 2015;49:13-19.
  13. Miller CS, Little JW, Falace DA. Supplemental corticosteroids for dental patients with adrenal insufficiency: reconsideration of the problem. J Am Dent Assoc. 2001 Nov;132(11):1570-9; quiz 1596-7. doi: 10.14219/jada.archive.2001.0092. PMID: 11806072.
  14. Khalaf MW, Khader R, Cobetto G, Yepes JF, Karounos DG, Miller CS. Risk of adrenal crisis in dental patients: results of a systematic search of the literature. J Am Dent Assoc. 2013 Feb;144(2):152-60. doi: 10.14219/jada.archive.2013.0094. PMID: 23372131.
  15. Salem M, Tainsh RE Jr, Bromberg J, Loriaux DL, Chernow B. Perioperative glucocorticoid coverage. A reassessment 42 years after emergence of a problem. Ann Surg. 1994 Apr;219(4):416-25. doi: 10.1097/00000658-199404000-00013. PMID: 8161268; PMCID: PMC1243159.
  16. Hahner S, Loeffler M, Fassnacht M, Weismann D, Koschker AC, Quinkler M, Decker O, Arlt W, Allolio B. Impaired subjective health status in 256 patients with adrenal insufficiency on standard therapy based on cross-sectional analysis. J Clin Endocrinol Metab. 2007 Oct;92(10):3912-22. doi: 10.1210/jc.2007-0685. Epub 2007 Aug 7. PMID: 17684047.
  17. Arlt W, Baldeweg SE, Pearce SHS, Simpson HL. Endocrine management of severe illness in intensive care units: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2022 Feb 1;107(2):494-520.
  18. Osella G, Terzolo M, Borretta G, Magro G, Conti M, Angeli A. Bone mineral density and bone metabolism in Cushing syndrome. J Clin Endocrinol Metab. 1994 Aug;79(2):487-493.
  19. Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing’s syndrome. Lancet. 2006 May 13;367(9522):1605-17. doi: 10.1016/S0140-6736(06)68699-6. PMID: 16698415.
  20. van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology (Oxford). 2000 Dec;39(12):1383-9. doi: 10.1093/rheumatology/39.12.1383. PMID: 11136882.
  21. Compston JE. Corticosteroid-induced bone loss. Endocr Rev. 2017;38:347-372.
  22. Thygeson B. Systemic factors affecting wound healing in the oral cavity. J Oral Maxillofac Surg. 2020;78(2):217-228.
  23. Moy PK, Medina D, Shetty V, Aghaloo TL. Dental implant failure rates and associated risk factors. Int J Oral Maxillofac Implants. 2005 Jul-Aug;20(4):569-77. PMID: 16161741.

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Received May 28, 2026.
Accepted July 17, 2026.
© 2026 The Author(s). International Journal of Biomedicine is published by IMRDC. This is an open access article under the CC BY-NC-ND 4.0 license.