Is it safe to place implants in patients at risk of MRONJ?

Owen, Brandon; Bradley, Hannah

doi:10.1038/s41432-021-0196-9

Cited by 7 publications

(5 citation statements)

References 6 publications

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“…It could not be conclusively determined whether a fixed or a removable prosthetic solution is superior. Literature evidence suggests that wearing ill-fitting dentures is a risk factor for developing MRONJ [65,76]. Therefore, in cases where a removable solution has been preferred, a strict clinical follow-up is highly advisable to readjust the prostheses when needed, to avoid soft tissue injuries.…”

Section: Discussionmentioning

confidence: 99%

Clinical Performance of Implant-Supported Prostheses in the Rehabilitation of Patients Previously Treated for Medication-Related Osteonecrosis of the Jaws (MRONJ): A Systematic Review

Anitua,

Alkhraisat,

Eguia

2024

Cureus

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There is a lack of consensus on managing resultant bone and soft tissue defects or on restoring oral function and aesthetics following medication-related osteonecrosis of the jaws (MRONJ) lesion healing. This clinical challenge presents a dilemma for practitioners. Removable prostheses pose a recurrence risk if poorly fitted and may inadequately restore function or aesthetics in cases of significant bone defect. Dental implant-supported prostheses could enhance function and quality of life, though their risks and indications are not well-defined. This systematic review examines the clinical outcomes and complications associated with implant-supported rehabilitations post-MRONJ surgery. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations and it was pre-registered in the Prospective Register of Systematic Reviews (PROSPERO) (CRD42023492539).

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Section: Discussionmentioning

confidence: 99%

Clinical Performance of Implant-Supported Prostheses in the Rehabilitation of Patients Previously Treated for Medication-Related Osteonecrosis of the Jaws (MRONJ): A Systematic Review

Anitua,

Alkhraisat,

Eguia

2024

Cureus

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“…Literature is lacking of high-quality evidence regarding the safety profiles of implant placement and management in patients under antiresorptive or antiangiogenic medications. Recent reports shows how bisphosphonate and denosumab treatment for osteoporosis do not increase risk of implant failure 34. Nonetheless, risk of implant surgery triggered MRONJ is still present, independent from the administration pattern or underlying condition, and caution should be exercised during surgery planning 35…”

Section: Discussionmentioning

confidence: 99%

Medication-Related Osteonecrosis of the Jaw: 14 Years’ Retrospective Study on Pathogenetic Trigger Events

Marino

Squillacioti

Giudice

et al. 2022

Journal of Craniofacial Surgery

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Although events such as tooth extraction and oral surgery were considered for a while the sole triggering factor for Medication-Related Osteonecrosis of the Jaw (MRONJ), it is still unclear if trigger events may be precipitating factors that accelerate the onset of the disease that would have possibly occurred anyway. Therefore, this research aimed to retrospectively analyze MRONJ cases diagnosed in our tertiary referral hospital during the last 14 years, focusing on the onset of the disease, potential trigger events, and countermeasures to update the knowledge on their From the

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“…In a systematic review, Granate-Marques and coworkers reported an elevated MRONJ risk associated with implants placed in the posterior jaw if the duration of bisphosphonate therapy exceeded 3 years and if the patients were receiving systemic corticosteroids [ 33 ]. More recently, two further systematic reviews concluded that patients with a history of BP treatment are at risk of developing MRONJ following implant placement (“implant-surgery-triggered” MRONJ), while those with a history of denosumab for osteoporosis show a negligible risk [ 56 , 73 ]. However, data were based on case series and low-quality observational studies, making risk estimates very difficult.…”

Section: Focus Questionsmentioning

confidence: 99%

“…Overall, peri-implantitis rather than the surgical procedure for implant placement itself might constitute a main trigger factor for peri-implant MRONJ. However, dental clinicians should consider that there is a general lack of high-quality evidence regarding the safety of placing implants in patients with a history of anti-resorptive or anti-angiogenic medications, and they should use caution when planning dental implants in patients under AR therapy [ 56 , 73 ]. Obtaining an adequate patient-specific informed consent which includes the low risk of MRONJ as well as early and late implant failure is always recommended before implant placement.…”

Section: Focus Questionsmentioning

confidence: 99%

Anti-resorptive therapy in the osteometabolic patient affected by periodontitis. A joint position paper of the Italian Society of Orthopaedics and Traumatology (SIOT) and the Italian Society of Periodontology and Implantology (SIdP)

et al. 2023

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This joint report from the Italian Society of Orthopaedics and Traumatology (SIOT) and the Italian Society of Periodontology and Implantology (SIdP) aims for a consensus around the scientific rationale and clinical strategy for the management of osteoporotic patients affected by periodontitis who are undergoing anti-resorptive (AR) therapy to manage the risk of the occurrence of a medication-related osteonecrosis of the jaws (MRONJ). Osteoporosis and periodontitis are chronic diseases with a high prevalence in aging patients, and they share some of the same pathogenetic mechanisms based upon inflammation. Available evidence shows the relationship among osteoporosis, AR agents, periodontitis and implant therapy in relation to the incidence of MRONJ. Uncontrolled periodontitis may lead to tooth loss and to the need to replace teeth with dental implants. Tooth extraction and surgical dental procedures are recognized as the main risk factors for developing MRONJ in individuals taking AR therapy for osteometabolic conditions. Although the incidence of MRONJ in osteometabolic patients taking AR therapy may be as low as 0.9%, the increasing prevalence of osteoporosis and the high prevalence of periodontitis suggest that this potential complication should not be overlooked. Good clinical practice (GCP) guidelines are proposed that aim at a more integrated approach (prescriber, dentist, periodontist and dental hygienist) in the management of periodontitis patients undergoing AR therapy for osteometabolic disorders to reduce the risk of MRONJ. Dental professional and prescribers should educate patients regarding the potential risk associated with the long-term use of AR therapy and oral health behavior.

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Is it safe to place implants in patients at risk of MRONJ?

Cited by 7 publications

References 6 publications

Clinical Performance of Implant-Supported Prostheses in the Rehabilitation of Patients Previously Treated for Medication-Related Osteonecrosis of the Jaws (MRONJ): A Systematic Review

Clinical Performance of Implant-Supported Prostheses in the Rehabilitation of Patients Previously Treated for Medication-Related Osteonecrosis of the Jaws (MRONJ): A Systematic Review

Medication-Related Osteonecrosis of the Jaw: 14 Years’ Retrospective Study on Pathogenetic Trigger Events

Anti-resorptive therapy in the osteometabolic patient affected by periodontitis. A joint position paper of the Italian Society of Orthopaedics and Traumatology (SIOT) and the Italian Society of Periodontology and Implantology (SIdP)

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