The use of certain antiresorptive drugs to treat osteoporosis can increase the risk of medication-related osteonecrosis of the jaw (MRONJ) among patients with dental implants, according to researchers from the National and Kapodistrian University of Athens.
Healthy bone breaks down and is replaced with new bone. However, conditions such as osteoporosis can cause an imbalance in this process and result in weak bones. Antiresorptive drugs increase bone strength by slowing bone turnover.
Previous research has shown that these drugs can increase the risk of MRONJ, which interferes with the normal turnover of the jawbone and impedes a patient’s quality of life, among dental implant patients.
However, the researchers noted that there is little understanding of MRONJ risk factors in these patients and whether they contribute to dental implant loss among patients on antiresorptive drugs.
The researchers conducted a systematic review of scientific articles in PubMed/Medline using set search terms. Their search resulted in 32 articles covering 5,221 patients, 12,751 implants, 618 cases of implant loss, and 136 cases of MRONJ.
The first group of articles included studies on dental implant success rates in patients with a history of taking antiresorptive drugs and did not present with MRONJ. Most studies, 18 out of 22, reported that resorptive therapy use is safe in patients undergoing dental implant surgery because dental implant failure was low and MRONJ cases were absent.
However, the researchers noted limitations of these studies that make their conclusion problematic, including missing control groups, limited patient samples, short follow-up periods, and a lack of clinical and radiographic follow-up, which is the only way to diagnose MRONJ.
Also, the researchers said, some studies presented evidence that oral bisphosphonates, the most common antiresorptive drugs, may increase bone loss and, thus, increase the risk of implant failure.
The second group of articles included studies of patients with dental implants, a history of taking antiresorptive drugs, and presentation of MRONJ. Some studies did not provide a conclusion, whereas others concluded that MRONJ is a complication of dental implants.
Also, several studies suggested that MRONJ can develop many months or years after dental surgery, even when antiresorptive treatment begins after implant placement. But this group had limitations similar to the first that prevented the researchers from stating that MRONJ is a late complication in these cases.
The researchers said that clinicians can conduct successful dental implant surgery in patients taking antiresorptive therapies by informing the patient about the importance of oral hygiene to prevent MRONJ, the use of antibiotics, drug holidays, and frequent follow-up exams.
Also, because MRONJ occurred mostly in the posterior locations of the jaw in the second group of studies, the researchers said that clinicians should be careful when planning implants in this area.
Given the few studies on this topic and the low quality of the available studies, the researchers said they couldn’t state whether antiresorptive drug use is a risk factor for increased dental implant failure and/or if MRONJ is a late complication.
Resorptive medication use is widespread and dental implant procedures are increasing, the researchers said, so researchers and clinicians need to gain a better understanding of the intricacies involving dental implant success rates, antiresorptive therapy, and MRONJ.
The study, “Success Rate and Safety of Dental Implantology in Patients Treated With Antiresorptive Medication: A Systematic Review,” was published by the Journal of Oral Implantology.
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