Putative role of prosthetic dental implants in the development of cardiac sarcoidosis: A case-control study

Main Article Content

Muthiah Subramanian
Debabrata Bera
Jospeh Theodore
Jugal Kishore
Akula Srinivas
Daljeet Saggu
Sachin Yalagudri
Calambur Narasimhan


Cardiac Sarcoidosis, Prosthetic Implants, Dental Procedures


Background: Etiopathogenesis of cardiac sarcoidosis is poorly understood. The objective of this study is to examine a putative role of previous dental procedures on the development of cardiac sarcoidosis(CS).

Methods: Clinical details of 73 patients with CS from the Granulomatous Myocarditis Registry were analyzed. Data regarding clinical presentation, comorbidities, baseline electrocardiogram, echocardiogram and 18fluorodeoxyglucose(FDG) PET-CT was extracted from the registry database. A comprehensive history of dental procedures for all patients was recorded by the dental surgeon. The two control groups comprised of 79 patients with idiopathic ventricular tachycardia and/or complete heart block(with similar clinical presentation) and 145 healthy age and sex matched patients, respectively.

Results:  Dental evaluation revealed that patients of CS had undergone a previous prosthetic dental implant (PI,p<0.001) or root canal treatment(RCT,p=0.025) more often than the controls. Among patients with CS, those who had previous dental procedures had higher18FDG uptake, with regards to maximum standardized uptake values(SUV) in the LV myocardium(8·6+3·3vs.5·5 +1·8, p<0·001) and mediastinal lymph nodes(9·3+4·6vs.5·4+1·7, p<0·001) as compared to patients who did not undergo a dental procedure. The subset of CS patients with a previous PI or RCT had higher uptake levels in the myocardium(max SUV 9·4+3·1vs.6·7+2·0,p=0·011,number of abnormal LV Segments 10·3+3·1vs.6·5+2·8,p=0·008) and mediastinal lymph nodes(max SUV 10·5+4·8vs. 7·2+1·8,p=0·002) compared to those who underwent crowning or extraction. In addition,CS was diagnosed after a shorter latency(47·3+21·0vs.81·6+25·3 months<0·001) following PI or RCT compared to crowning or extraction.

Conclusions:  We observed a significant association between PI and RCT and the occurrence of CS. This group of patients also appear to have a more severe form of the disease.



Download data is not yet available.
Abstract 183 | PDF Downloads 120


[1] Moller DR, Rybicki BA, Hamzeh NY, Montgomery CG, Chen ES, Drake W, et al. Genetic, Immunologic, and Environmental Basis of Sarcoidosis. Annals of the American Thoracic Society. 2017;14:S429-S36.
[2] Laney AS, Cragin LA, Blevins LZ, Sumner AD, Cox-Ganser JM, Kreiss K, et al. Sarcoidosis, asthma, and asthma-like symptoms among occupants of a historically water-damaged office building. Indoor air. 2009;19:83-90.
[3] Jordan HT, Stellman SD, Prezant D, Teirstein A, Osahan SS, Cone JE. Sarcoidosis diagnosed after September 11, 2001, among adults exposed to the World Trade Center disaster. Journal of occupational and environmental medicine. 2011;53:966-74.
[4] Newman KL, Newman LS. Occupational causes of sarcoidosis. Current opinion in allergy and clinical immunology. 2012;12:145-50.
[5] Kern DG, Neill MA, Wrenn DS, Varone JC. Investigation of a unique time-space cluster of sarcoidosis in firefighters. The American review of respiratory disease. 1993;148:974-80.
[6] Gundelfinger BF, Britten SA. Sarcoidosis in the United States Navy. The American review of respiratory disease. 1961;84(5)Pt 2:109-15.
[7] Duraccio D MF, Faga M. Biomaterials for dental implants: current and future trends. J Mater Sci. 2015;50:4779-812.
[8] Ananth H, Kundapur V, Mohammed HS, Anand M, Amarnath GS, Mankar S. A Review on Biomaterials in Dental Implantology. International journal of biomedical science : IJBS. 2015;11:113-20.
[9] Yalagudri S, Zin Thu N, Devidutta S, Saggu D, Thachil A, Chennapragada S, et al. Tailored approach for management of ventricular tachycardia in cardiac sarcoidosis. J Cardiovasc Electrophysiol. 2017;28:893-902.
[10] Terasaki F YK. New guidelines for diagnosis of cardiac sarcoidosis in Japan. Ann Nucl Cardiol. 2017;3:42-5.
[11] Chareonthaitawee P, Beanlands RS, Chen W, Dorbala S, Miller EJ, Murthy VL, et al. Joint SNMMI-ASNC expert consensus document on the role of (18)F-FDG PET/CT in cardiac sarcoid detection and therapy monitoring. Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology. 2017;24:1741-58.
[12] Dilsizian V, Bacharach SL, Beanlands RS, Bergmann SR, Delbeke D, Dorbala S, et al. ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. J Nucl Cardiol. 2016;23:1187-226.
[13] Saini M, Singh Y, Arora P, Arora V, Jain K. Implant biomaterials: A comprehensive review. World journal of clinical cases. 2015;3:52-7.
[14] Newman LS. Beryllium disease and sarcoidosis: clinical and laboratory links. Sarcoidosis. 1995;12:7-19.
[15] Skelton HG, 3rd, Smith KJ, Johnson FB, Cooper CR, Tyler WF, Lupton GP. Zirconium granuloma resulting from an aluminum zirconium complex: a previously unrecognized agent in the development of hypersensitivity granulomas. Journal of the American Academy of Dermatology. 1993;28:874-6.
[16] Redline S, Barna BP, Tomashefski JF, Jr., Abraham JL. Granulomatous disease associated with pulmonary deposition of titanium. British journal of industrial medicine. 1986;43:652-6.
[17] Pimentel JC. [Systemic granulomatous disease, of the sarcoid type, caused by inhalation of titanium dioxide. Anatomo-clinical and experimental study]. Acta medica portuguesa. 1992;5:307-13.
[18] Triplett RG, Frohberg U, Sykaras N, Woody RD. Implant materials, design, and surface topographies: their influence on osseointegration of dental implants. Journal of long-term effects of medical implants. 2003;13:485-501.
[19] Saravanakumar P, Thallam Veeravalli P, Kumar VA, Mohamed K, Mani U, Grover M, et al. Effect of Different Crown Materials on the InterLeukin-One Beta Content of Gingival Crevicular Fluid in Endodontically Treated Molars: An Original Research. Cureus. 2017;9:e1361.
[20] Balaguer-Marti JC, Penarrocha-Oltra D, Balaguer-Martinez J, Penarrocha-Diago M. Immediate bleeding complications in dental implants: a systematic review. Medicina oral, patologia oral y cirugia bucal. 2015;20:e231-8.
[21] Nair RP. Non-microbial etiology: foreign body reaction maintaining posttreatment apical periodontitis. Endodontic Topics. 2003;6:114-334.
[22] Sjogren U, Sundqvist G, Nair PN. Tissue reaction to gutta-percha particles of various sizes when implanted subcutaneously in guinea pigs. European journal of oral sciences. 1995;103:313-21.
[23] Pascon EA, Spangberg LS. In vitro cytotoxicity of root canal filling materials: 1. Gutta-percha. Journal of endodontics. 1990;16:429-33.
[24] Lechner J BV. Impact of Endodontically Treated Teeth on Systemic Diseases. Dentistry. 2018;8.
[25] Fireman E, Kramer MR, Priel I, Lerman Y. Chronic beryllium disease among dental technicians in Israel. Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG. 2006;23:215-21.
[26] Muller-Quernheim J, Gaede KI, Fireman E, Zissel G. Diagnoses of chronic beryllium disease within cohorts of sarcoidosis patients. The European respiratory journal. 2006;27:1190-5.
[27] Rybicki BA, Iannuzzi MC, Frederick MM, Thompson BW, Rossman MD, Bresnitz EA, et al. Familial aggregation of sarcoidosis. A case-control etiologic study of sarcoidosis (ACCESS). American journal of respiratory and critical care medicine. 2001;164:2085-91.
[28] Lucas RM, McMichael AJ. Association or causation: evaluating links between "environment and disease". Bulletin of the World Health Organization. 2005;83:792-5.
[29] Fedak KM, Bernal A, Capshaw ZA, Gross S. Applying the Bradford Hill criteria in the 21st century: how data integration has changed causal inference in molecular epidemiology. Emerging themes in epidemiology. 2015;12:14.