Dental implants are now a reliable solution for the functional and aesthetic rehabilitation of partially and completely edentulous patients. In order to achieve long term survival, osseointegration of dental implant needs to occur, that is, direct connection between the bone and implant surface without interposition of the fibrous tissue.

        Osseointegration is a complex phenomenon and depends on many factors, some related to the implant (material, macroscopic design and implant surface), some to the surgical prosthetic protocol (surgical technique, loading conditions and time) and others to patient (quantity and quality of bone at the receiving site and the host response)

         In spite of the high survival rate of implant, early failures occur even when optimal materials are used, surgical protocols are strictly followed and the quantity/quality of bone at recipient site is sufficient.

        All these observations would suggest the existence of specific patient related risk factors, this promotes an investigation into regulatory mechanisms controlling bone metabolism, bone remodeling and bone turnover.

        Vitamin D plays a fundamental role in bone metabolism. It is a fat soluble vitamin which promotes the absorption of calcium in the intestine and regulates calcium and phosphate homeostasis in the tissues and fundamental element in mineralization of bones and teeth. It stimulates the activity of osteoclasts and increases the production of extracellular matrix proteins by osteoblasts. It also plays a role in innate and adaptive immune response.  

        Importance of Vitamin D and its effects on bone metabolism is known but very few studies have investigated the effects of its depletion on stability of dental implants. Almost all studies have been done on animal models. Unfortunately very few prospective clinical studies have so far investigated the effects of vitamin D deficiency on osseointegration and stability of implant in humans.

          The purpose of this study is to investigate correlation between levels of Serum Vitamin D and Serum Calcium on stability of implant.

Review of literature      

1. Mangano et al (2016) carried out a retrospective clinical study to investigate if there is a link between low levels of vitamin D in blood and increased implant failures and found an increasing trend in incidence of early implant failure with worsening of Vitamin D deficiency but failed to prove an effective link between low serum levels of vitamin D and increased risk of early implant failure.

2. In orthopaedics, Maier G S et al (2014) founded the risk to develop a peri-prosthetic joint infection has been associated with a low vitamin D level.

3. Kelly et al (2009) demonstrated that vitamin D deficiency could significantly compromise the establishment of osseointegration of Ti6Al4V implants in rats.

4. Dvorak et al (2011) found Vitamin D deficiency has a negative impact on peri-implant bone formation in ovariectomized rats, which can be compensated by Vitamin D supplementation.

5. Zhou et al (2012) concluded that 1,25(OH)2D3 improves implant osseointegration in osteoporotic rats.

6. Bashutski JD et al (2011) concluded that Vitamin D deficiency at the time of periodontal surgery negatively affects periodontal treatment outcomes for up to 1 yr and Vitamin D status may be critical for post-surgical healing.

7. Choukroun J et al (2014) suggested exploration of vitamin D serum level and LDL Cholesterol  in the case of a failure of a bone graft or implant placement.

8. Fretwurst T et al (2016) illustrated two case reports with vitamin D deficiency and early implant failure and further concluded that Prospective, randomized clinical trials must follow to affirm the relationship between vitamin D deficiency, osteoimmunology, and early implant failure.

9. Wagner F et al (2017) stated that there is no contraindication to place dental implants in osteoporotic patients although osteoporosis significantly influence the peri-implant bone remodelling.

10. Salomó‐Coll O et al (2016) concluded that With the limitation of animal studies, topical application of vitamin D on dental implants could reduce crestal bone loss and increase 10% more bone‐to‐implant contact at 12‐week follow‐up period.

11. Trindade R et al (2015) concluded that Osseointegration of implant devices may also be affected potentially by bone cells and mediators that populate the osseous tissue.

12. Swami et al (2016) stated that RFA can be used to evaluate the effect of early and delayed loading, assess stability over a period of time and early diagnosis of implant failure.

13. Sennerby et al (2000)The resonance frequency analysis technique can supply clinically relevant information about the state of the implant–bone interface at any stage of the treatment or at follow-up examinations.

14. Sennerby L et al (2015) stated that implants with low and/or falling ISQ values pose an increased risk for failure compared with implants with high and/or increasing values.

15. Becker W et al (2018) compared two clinical instruments for resonance frequency analysis and found that Penguin RFA was less cumbersome to utilize and the window revealing the readings was very easier to read.