Bisphophonate jaw osteonecrosis and the risk of implant loss: a literature review

The use of dental implants has increased in the general population with controversies on its use for patients under bisphosphonate therapy (BF). Objectives: to analyze possible indications and implications of dental implant placement in patients under oral BFs. Material and Methods: a literature search was made with the terms “dental implant”, “bisphosphonate”, and “osteonecrosis” at PubMed/MEDLINE and Scielo electronic records. Portuguese, English, and Spanish literatures were screened from 2003 to 2012. Articles not relating BFs to dental implants were excluded. Results: 21 articles were identified, including letters to the editor, monographs, practical guidelines, literature reviews, and research articles, being the latter received more attention and divided into: randomized clinical trials (3), non-randomized trials (1), cohort (1), observational (3), and case report studies. In the animal model, BFs did not interfere with bone remodeling. However, nine dental implants were lost in human beings (7 in transversal studies, 2 in a case report). Conclusion: 1) BF osteonecrosis occurs do its cumulative effect in the organism, time of use, associated dental disease, and invasive procedures; 2) oral BFs present less complications than IV BFs; 3) implant placement must consider cost-benefit ratio, oral BF time period, and clinical conditions; and 4) recommended protocols of certified associations must be followed.