Clinical context: Nutrition, an emerging systemic risk factor

Although implant survival rates now exceed 90%, therapeutic success relies on a complex biological cascade — inflammation, angiogenesis, osteogenesis — that is highly demanding of metabolic resources. While protein deficiencies and micronutrient deficits (Vitamin D, Calcium, Magnesium) are known obstacles to osseointegration, the rise of specific diets that profoundly alter metabolism poses new clinical challenges. Practitioners are facing a patient population increasingly adopting the ketogenic diet (KD), intermittent fasting (IF) or low-calorie diets (LCD), often without appreciating their potential impact on peri-implant bone healing.

Objective and hypotheses of the study

This systematic literature review (2010-2025) aims to synthesise the scientific evidence regarding the effects of these three types of diets on bone biology and clinical outcomes in oral implantology. The authors seek to determine whether these nutritional patterns, by modulating systemic inflammation and bone remodelling, can favourably or unfavourably influence osseointegration. The central hypothesis is based on the capacity of these diets to alter bone formation markers and pro-inflammatory cytokine levels (such as IL-6 and TNF-α), thereby directly impacting the long-term stability of titanium implants.

Methodology: a rigorous synthesis of the literature (2010-2025)

To evaluate the impact of ketogenic diets, intermittent fasting and hypocaloric diets on osseointegration, the authors structured this systematic review around a comprehensive analysis of the scientific literature published between 2010 and 2025. The search was conducted on the PubMed, Scopus and Web of Science databases, specifically targeting the interactions between nutritional patterns and bone biology.

The selection included a diverse range of studies to ensure a comprehensive overview of the subject:

• Human clinical studies and experimental animal models.
• Mechanistic research on bone remodelling.
• Previous systematic reviews and meta-analyses.

Data extraction focused on key biological parameters, including bone mineral density, biochemical markers of formation and resorption, as well as levels of inflammatory mediators. The authors systematically prioritised studies documenting the mechanisms of angiogenesis and osteogenesis, fundamental processes for the long-term stability of dental implants. This methodology allows the identification of current trends while highlighting critical gaps in clinical research specific to implantology.

Synthesis of nutritional and metabolic determinants

This systematic review, covering the period 2010-2025, highlights that while implant survival rates exceed 90%, systemic nutrition directly modulates the biological processes of osseointegration. The authors report that protein and micronutrient deficiencies significantly impair primary and secondary stability.

Impact of specific diets: KD, IF and LCD

The analysis of modern diets reveals various influences on implant success factors:

• Ketogenic Diet (KD): Despite having anti-inflammatory properties, this diet raises concerns regarding its actual impact on bone metabolism.
• Intermittent Fasting (IF): Data indicate that moderate intermittent fasting does not appear to adversely affect systemic bone markers in the short term.
• Low-Calorie Diet (LCD): Associated with risks of essential nutrient deficiencies and negative effects on bone remodelling and clinical healing.

The authors note that angiogenesis and osteogenesis, pillars of osseointegration, are particularly sensitive to the host's metabolic reserves. However, the lack of randomised clinical trials specific to implantology still limits the establishment of definitive dietary recommendations.

Conclusion

The study emphasises that nutrition is no longer a secondary factor but a silent determinant of implant success. Although specific human data on KD or IF diets still lack long-term follow-up, the influence of micronutrients and proteins is firmly established.

Clinical analysis: the plate, a hidden variable of osseointegration

The data compiled in this systematic review (2010-2025) reveal that nutrition must no longer be considered merely as a general health parameter, but as a direct driver of implant success. The authors report that osseointegration is a metabolically demanding process where protein intake is crucial for the synthesis of the collagen matrix. The synthesis notably indicates that a magnesium or vitamin D deficiency directly impairs bone formation and the initial mechanical stability of titanium implants.

The value of this work lies in the analysis of "trendy" diets. While moderate intermittent fasting appears neutral in the short term on systemic bone markers, the ketogenic diet presents a notable ambivalence: an interesting anti-inflammatory potential counterbalanced by genuine concerns regarding bone metabolism. Conversely, low-calorie diets (LCD) are identified as risk factors due to possible nutritional deficiencies hindering peri-implant bone remodelling.

Limitations and implications for practice

However, the scope of these conclusions is tempered by a major limitation: the absence of prospective human clinical data specific to oral implantology. The majority of the mechanisms described are based on animal models or general mechanistic studies. As it stands, the authors of the review consider it premature to establish rigid dietary guidelines. Nevertheless, for the implantologist, these results require heightened vigilance during the anamnesis: a patient following a severe or highly specific restrictive diet during the critical healing phase could present a suboptimal biological response.

Study summary

This systematic review (2010-2025) establishes that ketogenic, hypocaloric diets and intermittent fasting directly modulate bone remodelling and angiogenesis. The authors report that protein-energy malnutrition compromises the mechanical fixation of titanium, whereas vitamin D levels remain a key factor in implant success.

In practical terms, for the practitioner:

• Integrate nutrition into the anamnesis: Systematically identify patients on a ketogenic diet or strict intermittent fasting, as these metabolic profiles influence the peri-implant inflammatory response.
• Caution regarding restrictive diets: Severe caloric restriction can induce protein and magnesium deficiencies; it is recommended to advise against starting an aggressive weight-loss diet during the initial healing phase.
• Optimise the biological terrain: Ensure nutritional stability and adequate vitamin D levels prior to surgery to support the high metabolic demand of osseointegration.

Technical glossary of the study

Osseointegration: Multifactorial biological process involving a cascade of inflammation, angiogenesis, osteogenesis and remodelling, determining the long-term stability and success of the dental implant.

Ketogenic diet (KD): Diet characterised by a high fat and low carbohydrate intake. The study notes anti-inflammatory effects but highlights uncertainties regarding its actual impact on peri-implant bone metabolism.

Intermittent fasting (IF): Dietary pattern alternating cycles of food intake and fasting. Compiled data indicate that moderate fasting does not appear to alter systemic bone markers in the short term.

Low-calorie diets (LCD): Calorie restriction protocols that may induce nutritional deficiencies. In this review, they are associated with negative effects on bone turnover and clinical healing.

Protein-energy malnutrition: Nutritional status directly linked, according to the authors, to an alteration in bone formation and a compromise of the mechanical fixation of titanium implants.

Cytokines (IL-6 and TNF-α): Circulating inflammatory markers whose elevation, favoured by diets rich in refined sugars, can disrupt the balance between bone resorption and formation necessary for implant integration.

Bone remodelling: Physiological balance between bone formation and resorption, identified here as a demanding metabolic process whose integrity depends on the host's metabolic reserves.

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