Dental Implant Rehabilitation Mitigates the Increased Mortality Risk Associated With Tooth Loss: A Population-Based...

To (i) evaluate the association between posterior masticatory unit (PMU) loss and all-cause mortality, (ii) quantify mediation through dietary intake, nutritional biomarkers, and body mass index (BMI), and (iii) assess whether prosthetic rehabilitation modifies this relationship.

Data from 17 109 adults participating in NHANES 1999-2004 and 2011-2014, with mortality follow-up through 2019, were analyzed. PMUs were classified as ≥ 5 from natural teeth (reference), < 5 without posterior prosthetic rehabilitation, < 5 despite the presence of posterior prosthetic restorations, ≥ 5 achieved through removable or tooth-supported fixed prostheses, and ≥ 5 achieved through implant-supported prostheses. Weighted Cox regression estimated adjusted hazard ratios (aHRs) for all-cause mortality. Causal mediation models quantified indirect effects through diet quality, nutritional markers, and BMI. Hypothetical interventions rehabilitating lost PMUs were emulated using longitudinal modified treatment policies with targeted maximum likelihood estimation.

Compared with participants with ≥ 5 PMUs from natural teeth, mortality risk was higher among those with < 5 PMUs without posterior prosthetic rehabilitation (aHR 1.60; 95% CI 1.22-2.09), < 5 PMUs despite the presence of posterior prosthetic restorations (aHR 1.29; 95% CI 1.08-1.55), and ≥ 5 PMUs achieved through removable or tooth-supported fixed prostheses (aHR 1.27; 95% CI 1.10-1.48). No excess mortality risk was observed for ≥ 5 implant-supported PMUs (aHR 1.00; 95% CI 0.77-1.30). Diet quality indices (Alternative Healthy Eating Index, Dietary Approaches to Stop Hypertension, Dietary Inflammatory Index) mediated 6%-11% of the association, while fruit and fiber intake alone mediated 5%-9%; protein intake, nutritional biomarkers, and BMI contributed smaller proportions. Under causal assumptions, emulated scenarios restoring ≥ 5 PMUs with implant-supported prostheses or maintaining ≥ 5 natural PMUs were associated with 4%-5% higher estimated survival among individuals with < 5 PMUs without posterior prosthetic rehabilitation.

Loss of natural PMUs is associated with increased all-cause mortality, only partially mediated by diet quality. This excess risk appears attenuated by posterior prosthetic rehabilitation and is no longer evident when ≥ 5 PMUs are restored with implant-supported prostheses. When posterior teeth are lost, implant-supported rehabilitation may be considered as an option potentially associated with improved survival.