Bisphosphonates as Supplement to Dental Treatment: A Network Meta-Analysis

Abstract

The objective of this study was to assess clinical measurements related to the effectiveness of bisphosphonate (BP) administration as a supplement to conventional dental treatment in patients free of bone-related diseases using a network meta-analysis. Only randomized controlled trials (RCTs) were included that provided dental clinical measurements on human patients treated with BPs with or without similar untreated controls or treated with placebo. Information sources included a systematic search of 17 electronic databases up to August 2020, complemented by manual searches. Risk of bias assessment was performed with the revised Cochrane risk of bias tool for randomized trials (RoB 2.0). Extracted measurements were pooled according to time of evaluation. The random-effects model by DerSimonian and Laird was used to calculate mean differences (MDs) and the respective 95% confidence intervals (CIs). Seven RCTs were included in the network meta-analysis, assessing 391 subjects reporting on periodontal treatment effects after 2 to 12 mo of BP administration. BP treatment was associated with significant improvement of most clinical measurements, compared with BP-naive controls. According to the network ranking, alendronate was more efficient in improvement of probing depth and clinical attachment gain when compared to zoledronate or alendronate/risedronate. Similarly, the local application of alendronate as a gel was more effective than the oral administration. A long-term analysis of the pharmaceutical effects was not possible due to insufficient data. The current review, performed according to existing guidelines, included only RCTs and, through appropriate statistical analyses, provided precise estimates for most assessed outcomes. However, no adverse effects or long-term treatment results were analyzed due to inadequate pertinent data. BP administration seems to be beneficial in the short term for the treatment of periodontal diseases, mainly through controlling periodontal inflammation.

Influence of risedronate on orthodontic tooth movement in rodents: a systematic review and case report

“… 42 Although there was impairment of tooth movement, a slight amount of root resorption was exhibited after the treatment. These results contrast with those of Zymperdikas et al, 21 , 43 who verified a reduction in the prevalence of root resorption after the administration of bisphosphonates. Katz et al 11 also revealed a reduced predominance of periapical lesions in osteoporotic patients, particularly among those who took risedronate.…”

Zoledronic acid affects the process of Porphyromonas gingivalis infecting oral mucosal epithelial barrier: An in-vivo and in-vitro study

“…The main manifestations of periodontal diseases are periodontal soft tissue inflammation, probing bleeding, alveolar bone resorption and loss of attachment ( Kinane, 2001 ; Kinane et al., 2017 ). BPs has a strong anti-resorption effect so that BPs not only are used to treat diseases related to bone metabolism ( Barbosa et al., 2021 ), but also had a therapeutic potential in periodontal diseases ( Kc et al., 2021 ; Zymperdikas et al., 2021 ; Arena et al., 2022 ). Application of BPs in periodontal disease can inhibit osteoclast recruitment and induce osteoclasts apoptosis, thereby reducing alveolar bone resorption caused by periodontal tissue inflammation.…”

“…ZA can significantly prevent symptomatic periodontal diseases and reduce teeth loss in patients with osteoporosis, on the condition that they have maintained good oral hygiene ( Taguchi et al., 2019 ). In addition, local administration is thought to be more acceptable than systemic administration because it causes fewer adverse effects ( Needleman et al., 1995 ; Position Paper: The Role of Controlled Drug Delivery for Periodontitis, 2000 ; Zymperdikas et al., 2021 ). Compared to placebo, 1% alendronate gel for local delivery could significantly improve CAL and reduce PD after treating periodontal diseases by scaling and root planning (SRP) ( Pradeep et al., 2012 ; Sharma and Pradeep, 2012a ; Sharma and Pradeep, 2012b ; Pradeep et al., 2013 ).…”

Multiple Idiopathic Cervical Root Resorption: A Challenge for a Transdisciplinary Medical-Dental Team

“…Due to their antiresorptive effects on alveolar bone, systemic bisphosphonate use has been suggested to prevent progression of root resorption (37), and local delivery of bisphosphonates have been explored as potential approach for preventing root resorption of replanted teeth (38). While local use of bisphosphonates appears likely to serve as an effective interventional strategy in these contexts, caution should be taken due to the recent association of systemic anti-resorptives with MICRR, as well as the more established links with medication-related osteonecrosis of the jaw (MRONJ) (78)(79)(80)(81).…”