Evaluation of dental implants as a risk factor for the development of bisphosphonate-related osteonecrosis of the jaw in breast cancer patients

Abstract

It remains unclear whether dental implants are a risk factor for the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). We retrospectively evaluated the status of dental implants in patients given intravenous bisphosphonates (BPs) in a breast cancer cohort to elucidate the risk for BRONJ at the implant site. We established a BRONJ oral monitoring program for 247 breast cancer patients given intravenous BP in our institution. The 3-year cumulative incidence rate was determined. The systemic and local risk factors of 44 patients who completed comprehensive oral examinations were evaluated by logistic regression analysis. The 3-year cumulative incidence rate of the 247 patients was 0.074 % (8/247, 95 % CI 0.0081-0.014). In the 44 orally examined patients, 6 (13.6 %: 6/44) had dental implants. Of these 6 patients, 1 developed BRONJ at the implant site. There were no significant differences in the age, total BP treatment period, number of residual teeth, time of regular oral monitoring, oral hygiene level, or dental implant insertion. Although a case of ONJ was identified, dental implants which were inserted before intravenous BP administration were not a risk factor for the development of ONJ in breast cancer patients.

Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw

“…Recent reports suggest that implants inserted before patients with cancer or osteoporosis are treated with BPs are unlikely associated with subsequent occurrence of BRONJ if oral health is appropriately managed [25,26]. However, dental implantation performed during or after BP treatment is a potential risk factor for BRONJ.…”

Risk of Dental Implant Failure Associated With Medication Use

“…The systematic review by Guazzo et al 16 similarly stated that, because of study heterogeneity and the high risk of bias, insufficient data quality did not allow estimates of risk to be determined. Matsuo et al 17 and Tallarico et al 18 reported no increased risk in failure associated with IV or oral bisphosphonate use, respectively. The association between oral bisphosphonate use and dental implant failure was investigated in a case-control study involving 337 female patients (age ࣙ40 years).…”

The effect of antiresorptive drugs on implant therapy: Systematic review and meta‐analysis

“…Reason for exclusion Stvrtecky, Kaufman, and Borgetti, (1995) Only 9 patients Marx, Sawatari, Fortin, and Broumand (2005) Only 4 Famili and Zavoral (2015) Only 3 patients with relevant medication intake Nisi et al (2015) Only 9 patients with MRONJ associated with implants Rugani, Kirnbauer, Acham, Truschnegg, and Jakse (2015) Single case report Matsuo et al (2016) Only 6 patients Gurgel et al (2017) Patients with BP and/or HRT intake not reported separately Wagner et al (2017) Only 5 patients with BP intake…”