Effects of systematic bisphosphonate use in patients under orthodontic treatment: a systematic review

Abstract

Summary Background Bisphosphonates are a class of drugs prescribed for several osseous related disorders owing to their ability to regulate bone turnover, which could in turn affect orthodontic treatment outcomes. Objective To examine the effect of bisphosphonate (BP) use on orthodontic patients through clinical and radiographic measurements. Search methods Systematic and unrestricted search of 17 databases complemented with additional hand-searches were performed up to March 2019. Selection criteria Articles reporting on human patients with a history of BPs administration that received orthodontic treatment were eligible for inclusion. Data collection and analysis Data regarding the medical profile of the patients, the specific type of malocclusion and the performed treatment plan, as well as the clinical and radiographic outcomes were extracted. Quality assessment was performed by the ROBINS-I tool for the cohort studies and by a slightly modified checklist from the original one proposed by Agbabiaka et al. for the case reports. Results 7 articles (1 retrospective cohort study and 6 case reports) were eventually included in the present review including 122 subjects (29 patients and 93 controls) reporting on the clinical and radiographic changes following orthodontic treatment of patients during or after BPs use. BPs seem to have a controversial effect on the clinical and patient-reported variables, even though the majority of the included patients presented with compromised treatment results and a rather slow rate of tooth movement. Most radiographic findings revealed mild root resorption, widened periodontal ligament spaces and sclerotic changes on the surrounding alveolar bone. However, these results should be interpreted with caution, due to the limited number of the eligible articles and their limitations. Limitations The included studies were of rather low quality due to study design and incomplete reporting. Conclusions and implications BP administration seems to be associated with compromised clinical outcomes, prolonged treatment time, and moderate changes on the roots and surrounding tissues of orthodontic patients. Registration Non-registered. Funding None.

Effectiveness of Low-Level Laser Therapy during Tooth Movement: A Randomized Clinical Trial

“…The initial tooth displacement due to orthodontic force determines, especially in the early stages of OTM [2,4], the increase of stress in the periodontal ligament which determines the osteogenic response of the alveolar bone responsible for the subsequent tissue remodeling [7,8,9]. This could result in a significant reduction in the speed of OTM and in related phenomena such as in gingivitis, dental ankyloses, and root resorption [10,11,12].…”

Could medications and biologic factors affect post‐orthodontic tooth movement changes? A systematic review of animal studies

“…These drugs prevent bone resorption through osteoclastic control 60,61 . A recent systematic review contended that bisphosphonate administration is associated with a slower rate of tooth movement, prolonged treatment time and compromised results 25 . Relapse was also found to decrease in the identified studies.…”

“…As orthodontic tooth movement can be modulated by any substance administered that can have effects on the molecular pathways involved, 18,19 the potential impact of different medications on the rate of orthodontic tooth movement has been systematically reviewed previously, and various effects have been shown in animals 20‐23 . Effects in human subjects have also been documented 24,25 . To the best of our knowledge, there has not been any systematic review comprehensively elaborating the potential effect of medications and other biologic factors on the rate of relapse following active orthodontic tooth movement, as the available studies have not managed to identify and appraise all the pertinent information 26…”

“…[20][21][22][23] Effects in human subjects have also been documented. 24,25 To the best of our knowledge, there has not been any systematic review comprehensively elaborating the potential effect of medications and other biologic factors on the rate of relapse following active orthodontic tooth movement, as the available studies have not managed to identify and appraise all the pertinent information. 26…”

Pharmaka, Noxen und die Ernährung – welche anamnestische Relevanz haben sie für die kieferorthopädische Therapie?

“…Eine weitere große Stoffgruppe von Medikamenten, von denen bekannt ist, dass sie einen Einfluss auf die kieferorthopädische Therapie nehmen können, ist die Stoffgruppe der Antiresorptiva, die meist in der Therapie der postmenopausalen Osteoporose eingesetzt werden, zu denen u. a. Bisphosphonate, Strontiumranelat und Vitamin D gehören und welche die kieferorthopädische Zahnbewegung durch eine verminderte Osteoklastenaktivität und -differenzierung und die damit einhergehende Reduktion des Knochenabbaus verlangsamen oder sogar gänzlich (bei intravenöser Gabe) inhibieren können. Insbesondere Bisphosphonate können sich aufgrund ihrer Struktur mit hoher Affinität an die dihydroxyapatithaltige Knochenmatrix heften und dort jahrzehntelang ihre Wirkung entfalten (Langzeitwirkung) [15]. Strontiumranelat stellt eine Ersatzmedikation für Bisphosphonate dar, weist hinsichtlich der Umbauprozesse des Knochens sowohl antikatabolische als auch anabolische Eigenschaften auf und verursacht nach bisherigem Kenntnisstand keine Kiefernekrosen (BRONJ), welche als Nebenwirkung bei Bisphosphonat-Medikation auftreten können.…”