Bisphosphonates and Their Influence on the Implant Failure: A Systematic Review

Abstract

Objective: The goal of this systematic review was to study the relationship between the use of bisphosphonates (oral or intravenous) and its effect on implant osseointegration. Methods: The focused question was “In patients medicated with bisphosphonates and who underwent surgery to place dental implants, what is the influence of that medication (of different generations) on the failure of dental implants (O)?” Following specific eligibility criteria, four databases (PubMed/MEDLINE, Scopus, Web of Science, DOAJ) were electronically screened to search the articles. Specific MeSH terms were used in combinations with Boolean Operators “AND” and “OR” for the research. In addition, a manual search was done. The data extracted were the (i) author, (ii) year of publication, (iii) country, (iv) research question, (v) study design, (vi) patient information, (vii) the number of patients included, (viii) patient/implant status, (ix) the number of implants evaluated, (x) type of implant, (xi) risk factors, and (xii) findings obtained. Moreover, the following were also registered: the (i) type, generation, duration, and route for BP administrated; (ii) the presence of any systemic condition and drug treatment; (iii) follow-up (months); and (iv) implant failure rate (%). The quality assessment of the included studies was carried out using the Modified Newcastle–Ottawa scale. Results: A total of 491 articles were found (183 in PubMed/MEDLINE, 171 in Scopus, 65 in Web of Science, and 72 articles in DOAJ), and 17 articles were considered for full-text reading. After the exclusion of 3 articles, 14 were included in this systematic review (11 case reports, 2 retrospective, and 1 prospective study). The reasons for the bisphosphonates intaking included osteoporosis, multiple myeloma, breast cancer, knee cancer, and osteogenesis imperfecta. The oral administration involved Alendronato (eight studies), Risedronate (three studies), and Ibandronate (three studies); whereas the intravenous administrations were Zoledronate (seven studies), Clodronato (one study), and Pamidronato (three studies). The duration of use of bisphosphonates at the time of implant placement was diverse; it ranged from no interruption of bisphosphonate intaking up to its discontinuation for 2, 3, or 6 months before surgery, with respective use being resumed 1, 3, or 8 months after surgery. Antibiotic treatment (amoxicillin + clavulanic acid) was performed before the intervention in two cases and after the intervention in three cases. Finally, the percent of implant failure rate when intaking BPs had an average of 49.96%. Conclusions: Within the limitation of this systematic review, it was possible to conclude that a high mean failure rate of implant osseointegration (49.96%) was found, regardless of the generation of bisphosphonates used. Moreover, the failure rate was lower in patients using second generation bisphosphonates (Alendronate and Pamidronate) and was higher with the IV administration compared to the oral administration of bisphosphonates.

Use of Local Melatonin with Xenogeneic Bone Graft to Treat Critical-Size Bone Defects in Rats with Osteoporosis: A Randomized Study

“…It is common to find patients with osteoporosis taking medications, such as bisphosphonates. Within this aspect, Rebelo et al [28] demonstrated the influence of bisphosphonates on implant failure; the authors concluded a high mean failure rate of implant osseointegration (49.96%) was found to be associated…”

“…It is common to find patients with osteoporosis taking medications, such as bisphosphonates. Within this aspect, Rebelo et al [28] demonstrated the influence of bisphosphonates on implant failure; the authors concluded a high mean failure rate of implant osseointegration (49.96%) was found to be associated with the medication, regardless of the bisphosphonates' generation; therefore, the failure rate was lower in patients using second-generation bisphosphonates (Alendronate and Pamidronate) and higher with the IV administration compared to the oral administration. Then, strategies were studied in order to improve the development of functional biomaterials for delivering multiple growth factors, which are effective strategies for bone repair in a temporally controllable carrier and, thus, improve the therapeutic effect [29].…”

Dental implant considerations in patients with systemic diseases: An updated comprehensive review

“…Additionally, the failure rate was higher with IV administration of bisphosphonates compared to oral administration, and it was lower in patients utilizing secondgeneration bisphosphonates (alendronate and pamidronate). 175 There are controversies regarding discontinuing bisphosphonate therapy before and/or after dental implant surgery. In a study by Tripodakis et al, 176 a 3-month drug holiday (second-and thirdgeneration bisphosphonates; alendronate and risedronate) before and after implant placement + postoperative antibiotic therapy resulted in a successful implant treatment during a 2-year follow-up.…”

Changes in the biomechanical properties of the bone during implant placement

“…[47]. Both early and late implant failure may be affected by patient characteristics (i.e., non-modifiable risk factors such as age, sex, immune status, chronic conditions or diseases, oral status and inadequate oral hygiene, periodontal disease, bruxism, medication intake, smoking) and adherence to treatment guidelines [48]. Pre-surgical implant planning and bone preparation are some of the critical aspects to ensure a successful intervention and a pleasing outcome of implant-supported prostheses.…”

“…Implant bed preparation should be performed as effectively and gently as possible, to ensure the primary healing and the long-term success of the implants [48]. The conventional drilling is a commoly used technique to prepare implant nests [49]; first, a gradual drilling of the osteotomy site occurs, which is later enlarged to the desired diameter.…”