Osseointegration of Dental Implants and Osteonecrosis of the Jaw in Patients Treated With Bisphosphonate Therapy: A Systematic Review

Abstract

Bisphosphonate (BP) drugs are a commonly prescribed group of medications used in the treatment of metabolic and oncologic bone disorders. The aim of this study was to conduct a systematic review in order to evaluate whether patients on BP therapy are appropriate candidates for dental implants as compared to patients not taking BP drugs with respect to successful implant osseointegration and the risk of developing bisphosphonate-related osteonecrosis of the jaw. Based on the current literature, a history of oral or intravenous BP use is not an absolute contraindication for dental implant placement, and dental implants can osseointegrate successfully in this patient population. Importantly, the studies currently available on this topic are of moderate to weak strength of evidence with inherent bias and limitations, and hence results must be interpreted in this context. Well-controlled studies with higher strength of evidence and larger population sizes are required to address this topic more accurately in the future.

Effect of advanced age and/or systemic medical conditions on dental implant survival: A systematic review and meta‐analysis

“…Osteoporosis patients, on the other hand, receive ART at much lower doses. As their risk of MRONJ is much lower, implants are increasingly utilized in these patients (Chadha, Ahmadieh, Kumar & Sedghizadeh, ). The risk of MRONJ in osteoporosis patients on low‐dose bisphosphonates is estimated to be 0.7 per 100,000 person‐years of exposure, and fewer than 100 cases of MRONJ after implant therapy in this group of patients have been reported (Ata‐Ali, Ata‐Ali, Penarrocha‐Oltra & Galindo‐Moreno, ).…”

Dental implants in patients treated with antiresorptive medication – a systematic literature review

“…However, there are cases of successful implant insertion in patients with malignant primary diseases and cases of BP-ONJ in patients with osteoporosis [9, 10]. Reviews mention that there are only very few retrospective studies with moderate strength of evidence addressing this topic [11] so that no final recommendation can be given [12]. Oral and intravenous BP are not seen as absolute contraindications for dental implant therapy and that dental implants can osseointegrate successfully.…”

“…Oral and intravenous BP are not seen as absolute contraindications for dental implant therapy and that dental implants can osseointegrate successfully. It is recommended to do a risk assessment and to inform the patient about the potential risk of BP-ONJ development [11–13]. …”

The effects of zoledronic acid and dexamethasone on osseointegration of endosseous implants: histological and histomorphometrical evaluation in rats

“…(Madrid & Sanz ; Javed & Almas ; Chadha et al. ) A history of oral BP use does therefore not seem to be an absolute contraindication for dental implant placement. Yet, all reviews emphasize the necessity for more robust studies, as only weak to moderate strength of evidence is available.…”