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

Introduction: 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. Material 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.