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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dc.contributor.author Stavropoulos, Andreas en_US
dc.contributor.author Bertl, Kristina en_US
dc.contributor.author Pietschmann, Peter en_US
dc.contributor.author Pandis, Nikolaos en_US
dc.contributor.author Schiødt, Morten en_US
dc.contributor.author Klinge, Björn en_US
dc.date.accessioned 2018-11-05T15:45:12Z
dc.date.available 2018-11-05T15:45:12Z
dc.date.issued 2018 en_US
dc.identifier.issn 1600-0501 en_US
dc.identifier.other 30306695
dc.identifier.uri http://hdl.handle.net/2043/26734
dc.description.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. en_US
dc.format.extent 39
dc.language.iso eng en_US
dc.publisher Wiley en_US
dc.subject antiresorptive drugs en_US
dc.subject bisphosphonates en_US
dc.subject dental implants en_US
dc.subject hormone replacement therapy en_US
dc.subject medication-related osteonecrosis of the jaws en_US
dc.subject systematic review en_US
dc.subject.classification Medicine en_US
dc.title The effect of antiresorptive drugs on implant therapy : Systematic review and meta-analysis en_US
dc.type Article, review peer-reviewed scientific en_US
dc.contributor.department Malmö University. Faculty of Odontology en_US
dc.identifier.doi 10.1111/clr.13282 en_US
dc.subject.srsc Research Subject Categories::ODONTOLOGY en_US
dc.relation.ispartofpublication Clinical Oral Implants Research;S18
dc.relation.ispartofpublicationvolume 29 en_US
dc.description.authorversion No en_US
dc.identifier.pmid 30306695
dcterms.identifier.OAurl https://doi.org/10.1111/clr.13282 en_US
dc.format.ePage 92
dc.format.sPage 54
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