By : Dr. ChauLong Nguyen, DDS, MAGD

1. EFFECTS OF
CANNABIS ON
DENTAL IMPLANTS
Dr. ChauLong Nguyen, DDS,
MAGD

2. Mr. JohnWeis
AnteriorView at Rest and profile view

3. ● 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

4. Mr. Joh

5.  BP= 156/78; Pulpse = 66
 ASA Physical Status Classification II
 Patient has hypertension, high cholesterol, benign
prostatic hyperplasia, and depression
Medical History

6. 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 hyperplasia
Lipitor(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

7. Marijuana Hemp Plant

8.  Head and Neck = within normal limit
 FacialAsymmetries: symetric
 TMJ: asymptomatic
 Lymph Nodes: not palpable.
Extra-Oral Findings

9. Objectives and Assessment/Diagnosis
Janurary 2012:
SoftTissues: 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

10. 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

11. Intercuspation Views
Maximum intercuspation – Protrusive movement

12. Maximum intercuspation right side – Right
working side

13. Maximum intercuspation left side – Left
working side

15. Radiographic Presentation

16. 01.25.2012 X-Rays
1 2 3 4
5a 5b 6a 6b

17. 04.06.2015 X-Rays
1 2 3

18. 04.21.2015 X-Rays
1
2 3 4

19. Bone level-implant platform on 08-22- 2012 and
03-12 2015

20. Perio Exam

21. Tomographs :
patient does not want CBCT
or any scan at this time
Radiographic Presentation

22. Janurary 2012- July 2015
Completed tx
Extraction of #29, no bone graft
Extraction 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

23. July 2015:
Patient feels happy with his upper teeth.
 Acquired missing teeth #s 20, 21, 28, 29, 30
Adequate inter and intra-arch spaces
Type III bone quality
Diagnosis

24. Type III bone quality
Buccal Lingual width = 8mm in edentulous spaces
Prognosis: 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

25. CBCT is strongly recommended
Face bowl transfer
Diagnostic wax up
Surgical stents
ProposedTreatment: Plan Sequence

26. Mounted Casts

27. After mounting and complete diagnostic wax up
Please refer to articulator for mounting

28. Surgical stent with pins and stent at gingival
level

29. 04.06.2015 X-Rays
1 2 3

30. Implant placement: NobelTaperedGroovy
•#s 20 & 21 size 3.5mm*11.5mm
•# 28 size 3.5mm* 11.5mm
•#s 29 & 30 size 5mm*11.5mm
ProposedTreatment: Plan Sequence

31. Wait 4 months
Place custom abutments
Deliver PFM crowns
ProposedTreatment: Plan Sequence

32. 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

33. 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

34. The United Kingdom, Canada, and several European countries
have approved nabiximols (Sativex®), a mouth spray
containingTHC 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?

35. 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

36. 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

37. ASBMR (American Society of Bone
and Mineral Research)
Cochrane Review
Pubmed
Effects of Cannabis on Bone Healing and/or
Bone Loss on Dental Implants

38. 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

39. 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

40. 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

41. Effect of cannabidiol on human gingival fibroblast extracellular
matrix metabolism: MMP production and activity, and production of
fibronectin and transforming growth factor β
By 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

42. Effects of Cannabis on bone Compare bone
levels from August 2012-April 2015

43. Maximum intercuspation left side – Left
working side

44. Maximum intercuspation right side – Right
working side

45. 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

46. ThankYou for your attention & advice.