Previously successful dental implants can fail when patients commence anti-resorptive therapy—a case series

Pogrel, M. Anthony; Ruggiero, Salvatore L.

doi:10.1016/j.ijom.2017.07.012

Cited by 34 publications

(37 citation statements)

References 11 publications

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“…Early diagnosis and treatment of this condition is very important. This case adds to the previous reports of exfoliation of dental implants with oral BP …”

Section: Resultssupporting

confidence: 73%

“…There are many reports of BRONJ with intravenous use of BP but few with oral use . A case series has reported removal of some implants with bony sequestrum still attached . The patients were on alendronate, zolendronate and denosumab treatments.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9][10][11] A case series has reported removal of some implants with bony sequestrum still attached. 9 The patients were on alendronate, zolendronate and denosumab treatments. Another case series reported failure of osseointegration or subsequent loss of integration when oral BP was started after successful implant placement.…”

Section: Discussionmentioning

confidence: 99%

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Osteonecrosis and spontaneous exfoliation of dental implants associated with oral bisphosphonate therapy: a case report

Rawal

Hilal

2019

Australian Dental Journal

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Bisphosphonates (BPs) have long been used for the treatment of osteoporosis and diseases like bone malignancies, active Paget's disease of bone, severe osteogenesis imperfecta and fibrous dysplasia among others. They bond highly to the bone surface and inhibit bone resorption. As BPs have a long half‐life in bone because of their irreversible binding to bone, patients retain their risk profile even after drug cessation. This property also explains the complications wherein the cessation of bone resorption leads to halt in bone turnover. Usually with alendronate the risk of bisphosphonate‐related osteonecrosis of jaw (BRONJ) wears off after 12 months. Reporting of the development of BRONJ is commonly associated with the intravenous BPs. Invasive surgical procedure associated with the placement of implants has been shown to be a major reason for the occurrence or initiation of BRONJ in susceptible patients. The prognosis of implants placed in the jaws of patients under or past BP medication is still uncertain. The present case report describes a patient on long‐term oral BP therapy with spontaneous exfoliation of implant supported bone due to osteonecrosis.

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“…Early diagnosis and treatment of this condition is very important. This case adds to the previous reports of exfoliation of dental implants with oral BP …”

Section: Resultssupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

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Osteonecrosis and spontaneous exfoliation of dental implants associated with oral bisphosphonate therapy: a case report

Rawal

Hilal

2019

Australian Dental Journal

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“…The MRONJ lesion was located in the mandible in 84 patients and in 34 patients in the maxilla, and somehow more often in posterior regions of the jaws. BP intake was iv in 61 patients and orally in 44 patients, while one study (Pogrel & Ruggiero, 2017) did not specify administration pathway. Further, in 11 patients, an obvious reason could not be identified, while three studies (Holzinger et al, 2014;Jacobsen et al, 2013;Troeltzsch et al, 2016) did not report on any possible triggering factor.…”

Section: Studies On Mronj Associated With Implantsmentioning

confidence: 99%

“…tailed single-patient data on ARD type and indication for intake, as well as the duration of intake until MRONJ, were possible to extract from four studies (68 patients)(Giovannacci et al, 2016;Holzinger et al, 2014;Jacobsen et al, 2013;Kwon et al, 2014;Lazarovici et al, 2010;Pogrel & Ruggiero, 2017;Troeltzsch et al, 2016).…”

mentioning

confidence: 99%

The effect of antiresorptive drugs on implant therapy: Systematic review and meta‐analysis

Stavropoulos

Bertl

Pietschmann

et al. 2018

Clinical Oral Implants Res

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Objectives: A considerable portion of the adult population has received and/or is receiving treatment with antiresorptive drugs (ARDs). It is thus relevant to assess possible side effects of ARD intake in connection to various aspects of implant therapy. The aim of this study was to answer the focused question "In patients with systemic intake of ARDs, what is the outcome and complication rate of implant therapy including associated bone grafting procedures comparing to patients without systemic intake of ARDs?" Materials and Methods:Original studies fulfilled predefined inclusion criteria (e.g., case series, cohort studies, case-control studies, and controlled and/or randomized controlled clinical trials; retro-or prospective design; and ≥10 patients with systemic intake of ARDs). Various patient-, medication-, and intervention-related parameters [i.e., implant loss, grafting procedure complication/failure, peri-implant marginal bone levels/loss, medication-related osteonecrosis of the jaws (MRONJ), and periimplantitis] were extracted, and meta-analyses and quality assessment were performed. Results:Twenty-four studies with bisphosphonate (BP) intake (mainly low dose for osteoporosis treatment) and seven studies on hormone replacement therapy (HRT), including ≥10 patients, and controls not taking the medication were identified.Furthermore, seven studies on MRONJ associated with implants were included.Meta-analyses based on four studies reporting on patient level and eight studies reporting on implant level showed no significant differences in terms of implant loss between patients on BPs (mainly low dose for osteoporosis treatment) and controls.Furthermore, low-dose BP intake did not compromise peri-implant marginal bone levels. Based on two studies, no negative effect of HRT was observed on the implant level, while HRT appeared to exert a marginally significant negative effect regarding implant survival on the patient level and regarding peri-implant marginal bone levels.Based on six studies reporting single-patient data, MRONJ in patients on BP for osteoporosis appeared in 70% of the cases >36 months after start of drug intake, while in patients with cancer, MRONJ appeared in 64% of the cases ≤36 months after first BP intake.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. | 55STAVROPOULOS eT AL. | 57 STAVROPOULOS eT AL.Random-effects meta-analyses, separately for each ARD type, were implemented to calculate from the included cohort and casecontrol studies pooled estimates at the patient and/or implant level.All statistical analyses were performed using Stata (StataCorp LLC, USA).

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Dental Implants

Freilich¹,

Shafer²,

Halepas³

2019

Evidence-Based Oral Surgery

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Previously successful dental implants can fail when patients commence anti-resorptive therapy—a case series

Cited by 34 publications

References 11 publications

Osteonecrosis and spontaneous exfoliation of dental implants associated with oral bisphosphonate therapy: a case report

Osteonecrosis and spontaneous exfoliation of dental implants associated with oral bisphosphonate therapy: a case report

The effect of antiresorptive drugs on implant therapy: Systematic review and meta‐analysis

Dental Implants

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