Dental Implantology in Acromegaly: Pathophysiological Challenges, Biomaterial Interactions, and Future Directions-A Narrative Review.

INTRODUCTION: Acromegaly is a chronic endocrine disorder caused by excessive secretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). Acromegaly leads to a wide range of systemic alterations, including metabolic disturbances, abnormalities in bone microarchitecture, soft tissue overgrowth, and morphological changes in the maxilla and mandible. All these factors may significantly complicate the planning and success of implant therapy. STUDY AIM: This narrative review aimed to critically analyze the impact of acromegaly on bone healing and osseointegration, with particular emphasis on the stability of implant biomaterials, and to assess whether the disease constitutes a contraindication to implant prosthetic treatment. METHODS: A narrative literature review was conducted using the PubMed, Scopus, and Web of Science databases, covering publications from 2000 to August 2025. Manual screening of reference lists from key articles was also performed. Peer-reviewed publications in English, including experimental and preclinical studies, case reports, biomaterials research, and conceptual reviews, were included based on their relevance to acromegaly, bone metabolism, stomatognathic alterations, and implant therapy outcomes. No formal inclusion or exclusion criteria were applied, and methodological quality was not formally assessed, reflecting the exploratory and conceptual nature of this review. RESULTS: Patients with acromegaly exhibit persistent structural bone deficits, such as reduced trabecular number, irregular trabecular distribution, and increased cortical porosity, despite normal or even elevated bone mineral density. In parallel, profound changes in soft tissues and dentition are observed, including macroglossia, diastemas, gingival overgrowth, and mandibular prognathism, which further complicate prosthetic rehabilitation. Animal studies suggest that GH and IGF-1 may support early osseointegration, although the long-term effects of their excess remain inconclusive. Clinical data, although limited, indicate that implant placement in patients with acromegaly is feasible when treatment is meticulously planned and carried out within an interdisciplinary setting. Standard biomaterials, such as titanium and its alloys, may undergo degradation under conditions of chronic inflammation and oxidative stress, underscoring the need for innovative solutions integrating bioactive and immunomodulatory materials, as well as patient-specific implants manufactured using 3D printing technologies. CONCLUSIONS: Acromegaly should not be regarded as an absolute contraindication to implant therapy; however, the current evidence is limited. Implant placement requires individualized planning, endocrine control, and interdisciplinary coordination. Further clinical and preclinical studies are needed to establish reliable treatment protocols for this population.