Bisphosphonates and Implants

The posterior portion of the maxilla has been described as the most difficult part of the mouth for the implant practitioner, and it requires great ability to achieve successful results. Anatomical considerations include reduced bone quantity, especially in patients who have had alveolar resorption in the wake of tooth loss. So, it may be necessary to perform a bone augmentation procedure before placing the implant. However, one disadvantage of using autogenous bone is the unpredictable bone resorption, which might be reduced by the use of bisphosphonates, perhaps locally. Bisphosphonates have been tested for treating osteoporosis and they are in clinical use. These drugs can also be used to reduce peri-implant resorption thereby allowing orthopedic implants to achieve a stronger primary fixation. Once released from the surface of a coated implant, bisphosphonates reduce osteoclast activity, thereby changing the balance of bone turnover, leading to a net increase in local bone density. Clinically, this idea has been tested in orthopedics but not in dentistry. For dental implants, improved fixation would enable surgeons to push the limits regarding the quality of bone (in a surgical sense) in which implants can be inserted.