Osseointegration of dental implants in patients with oral bisphosphonate intake: a review

I ntroduction: Bisphosphonates are  widely used  for  various bone  diseases including osteoporosis and bone tumors. One of the complications associated with these pharmaceutical agents is bisphosphonate-related osteonecrosis of the jaw. This condition may be triggered by placement of dental implants. In turn,  osteonecrosis  of  the  jaw  may  cause  failure  in  osseointegration  of implants. Moreover, bisphosphonates can influence osseointegration of dental implants by alteration of bone turnover. The aim of this study was to review the published articles on osseointegration of dental implants in patients taking oral bisphosphonates. M at erial   and   Methods:  PubMed/Medline   database   was   searched   for published articles until 31 January 2014 using “osseointegration” and “bisphosphonate”   as   keywords.   Inclusion   criteria   were   human   studies including case  series,  retrospective studies  and  prospective  studies  on  the subject.  Exclusion  criteria  were  case  reports,  intravenous  bisphosphonate intake, and placement of implants in other parts of the body rather than jaws. Results: A total of 66 articles were evaluated at abstract level. Eventually 4 articles  were  chosen  including  nearly  1470  patients  taking  oral bisphosphonates. Failure in osseointegration of dental implants or its loss was observed in 23 patients. This shows failure in integration between bone and implant in approximately 1 out of 64 patients taking oral bisphosphonates. Accordingly impaired osseointegration was observed in 1.44% of patients with bisphosphonate intake. Conclusion: Although failure in osseointegration of dental implants in patients with bisphosphonate intake is unlikely, the risk of failure should be considered in treatment planning for these patients and utmost care should be employed to prevent possible complications.