Dental Implant Placement in Patients on Bisphosphonate Therapy: a Systematic Review

Abstract

ObjectivesThe review aims to study dental implant placement purposefulness for patients who have been treated or are on treatment with bisphosphonate medication.Material and MethodsStructured search strategy was applied on electronic databases: MEDLINE, PubMed, PubMed Central and ResearchGate. Scientific publications in English between 2006 and 2017 were identified in accordance with inclusion, exclusion criteria. Publication screening, data extraction, and quality assessment were performed. Outcome measures included implant failure or implant-related osteonecrosis of the jaw.ResultsIn total, 32 literature sources were reviewed, and 9 of the most relevant articles that are suitable to the criteria were selected. Heterogeneity between the studies was found and no meta-analysis could be done. Five studies analysed intraoral bisphosphonate medication in relation with implant placement, three studies investigated intravenous bisphosphonate medication in relation with implant placement and one study evaluated both types of medication given in relation with implant placement. Patients with intraoral therapy appeared to have a better implant survival (5 implants failed out of 423) rate at 98.8% vs. patients treated intravenously (6 implants failed out of 68) at 91%; the control group compared with intraoral bisphosphonate group appeared with 97% success implant survival rate (27 implants failed out of 842), showing no significant difference in terms of success in implant placement.ConclusionsPatients treated with intravenous bisphosphonates seemed to have a higher chance of developing implant-related osteonecrosis of the jaw. The intraorally treated patient group appeared to have more successful results. Implant placement in patients treated intraorally could be considered safe with precautions.

Osseointegrated Implants: A Comprehensive Review

“…The intraorally treated group of patients appeared to have more successful results. Implant placement in intraorally treated patients can be considered safe with precautions [24].…”

Minimalinvasive Implantattherapie unter Berücksichtigung der Medikation

“…Um eine bisphosphonatinduzierte Knochennekrose bei Patienten zu vermeiden, die wegen Osteoporose behandelt werden, wird für diese Patienten eine sehr strenge Indikation für Augmentation und Implantattherapie empfohlen [9]. Da der Erfolg der Implantattherapie mit Bisphosphonattherapie umstritten ist, sollte der Umfang der Behandlung je nach Gesundheit und Zahnanamnese des Patienten individuell festgelegt werden [11]. Zur Risikominimierung wird die Anwendung von kurzen Implantaten erwogen [12].…”

Explantation: Indikation, Technik, Folgebehandlung

“…▪ mindere Knochenqualität ▪ mangelndes Knochenangebot ▪ Implantation im Oberkiefer ▪ Implantatposition posterior ▪ bakterielle Kontamination [8] ▪ Periimplantitis [9] mechanisch/funktionell ▪ fehlende Primärstabilität [2] ▪ Sofortimplantation mit Belastung (umstritten) [10] iatrogen ▪ ungünstige Implantatposition/-angulation ▪ Überhitzung des Knochens bei Implantation [2] ▪ organische Kontamination steril verpackter Implantate in Produktion und Verpackung [11] implantatspezifisch ▪ kurze Implantate ▪ großer Durchmesser [12,13] ▪ zylindrische Form ▪ glatte oder maschinell aufbereitete Oberfläche [14] patientenspezifisch ▪ lokal: Rauchen [15], Bruxismus [16], Parodontitis [9] ▪ systemisch: Z. n. Radiotherapie [12], Diabetes mellitus (umstritten), Osteoporose [2] Bisphosphonattherapie [17] Trepanbohrer Der Einsatz von Trepanbohrern zur Explantation ist weit verbreitet [18,22]. Nach Abnahme von Krone und Abutment fräst ein Trepanbohrer einen möglichst kleinen knöchernen Zylinder um das Implantat [22,23].…”