Journal of Oral Implantology August 2013 - (Page 510)

LITERATURE REVIEW Osseointegration of Dental Implants and Osteonecrosis of the Jaw in Patients Treated With Bisphosphonate Therapy: A Systematic Review Gurpreet K. Chadha, BDS Azadeh Ahmadieh, DDS, MS Satish Kumar, DDS, MDSc Parish P. Sedghizadeh, DDS, MS* 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 bisphosphonaterelated 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. Key Words: bisphosphonates, diphosphonates, osteonecrosis, jaw, oral, dental implants INTRODUCTION B isphosphonate (BP) drugs are a group of medications with many therapeutic applications in the treatment of bonerelated disorders such as osteoporosis, multiple myeloma, or cancer metastasis to bone because of their ability to affect bone remodeling and increase bone mineral density.1 BP drugs promote osteoclast apoptosis and can also impair osseous blood supply.2 BP drugs exert their actions by selective deposition in bones due to their high affinity for hydroxyapatite crystals.3 As very small amounts are released into the circulation during bone turnover, BP half-life is estimated in Division of Periodontology, Diagnostic Sciences and Dental Hygiene, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, Calif. * Corresponding author, e-mail: sedghiza@usc.edu DOI: 10.1563/AAID-JOI-D-11-00234 510 Vol. XXXIX /No. Four /2013 years.4 There are 2 main classifications of BP drugs in the literature based according to mode of use (oral vs intravenous) or chemical composition (nitrogen vs non–nitrogen-containing). Common oral BP drugs such as alendronate, risedronate, ibandronate, or etidronate are used to treat osteoporosis. Common intravenous forms such as pamidronate and zoledronic acid are utilized for treatment of oncologic patients where these drugs may help prevent progressive bone resorption, reduce the extension of bony metastasis and tumor burden, and decrease pain.5 A significant adverse effect observed in patients using either oral or intravenous BP is osteonecrosis of the jaw, termed bisphosphonate-related osteonecrosis of the jaw (BRONJ). The frequency of BRONJ for patients on intravenous BP is estimated to range from 0.8%–12.0% as compared to patients taking oral BP which is estimated to be extremely low.6–9 Most cases of BRONJ occur after invasive

Table of Contents for the Digital Edition of Journal of Oral Implantology August 2013

Literary Responsibility—Everyone Has a Role to Play
Rehabilitation of Surgically Relocated Integrated Dental Implants With and Without Bone Morphogenesis Protein-2
Erratum
Marginal Fit of Implant-Supported All-Ceramic Zirconia Frameworks
Influence of the Implant Diameter With Different Sizes of Hexagon: Analysis by 3-Dimensional Finite Element Method
Autologous Dental Pulp Stem Cells in Regeneration of Defect Created in Canine Periodontal Tissue
Histologic and Biomechanical Evaluation of 2 Resorbable-Blasting Media Implant Surfaces at Early Implantation Times
Efficacy of Guided Bone Regeneration Using Composite Bone Graft and Resorbable Collagen Membrane in Seibert’s Class I Ridge Defects: Radiological Evaluation
Minimal Iliac Bone Harvesting in Sinus Lift Surgery
Functional Load in Oblique Bicortical Implants: Parasinusal Implants and Palatine Implants
Ultrasonic Oscillations for Conservative Retrieval of a Rare Fracture of Implant Healing Abutment
Craniofacial Implant-Retained Auricular Prosthesis: A Case Report
Gingival Conditioning in an Implant-Supported Prosthesis: A Clinical Report
An Early Loaded Implant-Supported Mandibular Complete Arch Fixed Prosthesis in a Young Completely Edentulous Patient: A Case Report
Computer Guided Surgery for Implant Placement and Dental Rehabilitation in a Patient Undergoing Sub-Total Mandibulectomy and Microvascular Free Flap Reconstruction
Guided Bone Regeneration for Socket Preservation in Molar Extraction Sites: Histomorphometric and 3D Computerized Tomography Analysis
Osseointegration of Dental Implants and Osteonecrosis of the Jaw in Patients Treated With Bisphosphonate Therapy: A Systematic Review
Review of Current Literature

Journal of Oral Implantology August 2013