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

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

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Publication Article, review peer-reviewed scientific
Title The effect of antiresorptive drugs on implant therapy : Systematic review and meta-analysis
Author Stavropoulos, Andreas ; Bertl, Kristina ; Pietschmann, Peter ; Pandis, Nikolaos ; Schiødt, Morten ; Klinge, Björn
Date 2018
English abstract
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 ther‐ apy. The aim of this study was to answer the focused question “In patients with sys‐ temic intake of ARDs, what is the outcome and complication rate of implant therapy including associated bone grafting procedures comparing to patients without sys‐ temic 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 peri‐ implantitis] 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 re‐ porting 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 os‐ teoporosis 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. Conclusion: Low‐dose oral BP intake for osteoporosis treatment, in general, does not compromise implant therapy, that is, patients on ARDs do not lose more implants nor get more implant‐related complications/failures comparing to implant patients with‐ out BP intake. There is almost no information available on the possible effect on im‐ plant therapy of high‐dose BPs or other widely used ARDs (e.g., denosumab), or on the success or safety of bone grafting procedures. Patients with high‐dose ARD in‐ take for management of malignancies, patients on oral BP over a longer period of time, and patients with comorbidities should be considered as high‐risk patients for MRONJ.
DOI https://doi.org/10.1111/clr.13282 (link to publisher's fulltext.)
Link https://doi.org/10.1111/clr.13282 .Icon
Publisher Wiley
Host/Issue Clinical Oral Implants Research;S18
Volume 29
ISSN 1600-0501
Language eng (iso)
Subject antiresorptive drugs
bisphosphonates
dental implants
hormone replacement therapy
medication-related osteonecrosis of the jaws
systematic review
Medicine
Research Subject Categories::ODONTOLOGY
Handle http://hdl.handle.net/2043/26734 Permalink to this page
Link to publication in DiVA Find this research publication in DiVA.
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