Oral Health Risk Factors for Bisphosphonate-Associated Jaw Osteonecrosis

Dental implants in patients treated with antiresorptive medication – a systematic literature review

“…The evaluation of dentures vs. implants. It is suggested to not place immediate implants in patients with antiresorptive therapy, atraumatic surgery with perioperative antibiotics, the necessity of a recall and the avoidance of bone augmentations Grötz 2010 [54]ReviewThe authors provide an algorithm how to proceed with patients receiving BP seeking implant therapy.The authors state the necessity for an individual risk assessment and avoidance of bone augmentations Krimmel 2014 [55]RS50 patients with BP-ONJDMFT of all patients 20.5 ± 4.2disease free interval for patients with DMFT < 20: 39.7 ± 1.1 monthsdisease free interval for patients with DMFT > 20: 14.4 ± 2.8 monthsThe DMFT had no influence on the overall healing rate of BP-ONJ Tsao 2013 [56]CCS63 patients22 BP-ONJ patients41 matched controlsCaries similar between groupsPeriodontal disease associated with BP-ONJ (pocket depth, IgG serum titer against Porphyromonas gingivalis, IL 1ß level in gingival cervical fluid) Thumbigere-Math 2013 [57]CCS73 patients25 BP-ONJ patients 48 matched controlsBP infusions BP-ONJ 38.4 and control 18.8BP-ONJ vs control:missing teeth: 7.8 vs 3.1clinical attachment level: 2.18 vs 1.56radiogic bone loss at teeth > 50%: 20% vs. 6% Martin 2010 [58]CSS8,752 patients with oral BP returned dental survey (62% response rate)589 patients with dental implants16 patients with 26 implant failures8 patients with failure of 12 implants in the maxilla9 had failure with 14 implants in the mandible Shabestari 2009 [59]RS21 female osteoporotic women with oral BP and 46 implantsNo BP-ONJ, no signs of peri-implantitis Zahid 2011 [60]RS362 patients with implants26 BP patients with 51 implants3 implants failedPatients with BP had more thread exposure Memon 2012 [61]RS200 patientsBP: 100 women with 153 implantscontrol: 100 women with 132 implantsSuccess equal for both groups 93.5 (BP) vs. 95.5 (control)crestal bone change from implant insertion to stage two surgery: no difference between the groups Yip 2012 [62]CCS337 patients 114 patients with implant failure223 patients without implant failure% of patients using BPImplant failure group: 9.65%no implant failure: 4.04 Walter 2014 [3]RS504 patients with osteonecrosis227 with BP-ONJ7 out of 227 patients with BP-ONJ implant as trigger factor…”

Effect of different doses of zoledronic acid in establishing of bisphosphonate-related osteonecrosis

“…1 However, experimental models reveal other risk factors that contribute to the development of BRONJ, such as the use of high-strength ABp 28 associated with corticosteroids, 15 local infection, 1 surgical trauma, 29 hyperparathyroidism 30 and periodontal disease. 31 In this study, we chose to evaluate the intensity of BRONJ through isolated use of different concentrations of ZA. Some features (blinded and randomized) minimize the influence of traumatic factors (arising from surgical difficulty) that could generate additional tissue damage and inflammation that can affect the results.…”

Preventive Strategies for Patients at Risk of Medication-related Osteonecrosis of the Jaw

“…The results suggest that the role of periodontitis-associated microbes as a contributing causal agent may have been overestimated. 41 The ADA advisory committee recommends that patients receiving antiresorptive therapy who have active chronic periodontal disease generally should receive appropriate forms of nonsurgical therapy combined with a reevaluation of 4 to 6 weeks. There are no published studies in which investigators have evaluated the risk of MRONJ after periodontal procedures such as guided tissue regeneration or bone grafting.…”