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Title Impact Of Bisphosphonates On Implant Failure Is Unclear
Clinical Question Do bisphosphonstes prescribed for osteoporosis increase the likelihood of implant failure in older adults?
Clinical Bottom Line Based on a literature review of case reports and retrospective studies, there is no definitive risk of implant failure in bisphosphonate users, though several studies suggest there may be. Given lack of RCTs and heterogeneity among retrospective studies, further investigation is required.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20594057Zahid / 2011362 consecutive human adultsRetrospective Chart Review
Key resultsThere was no difference in implant failure between patients treated with bisphosphonates and those that were not (OR 2.32 (0.64-8.36)). However, there was more thread exposure in the bisphosphonate treated group (OR 3.25 (1.58-6.72)). The patients were taking bisphosphonates for osteoporosis.
#2) 20367090Javed / 2010287 human adultsLiterature Review of retrospective trials and case reports.
Key resultsNo difference was reported on implant viability as this was a literature review. Only reported that studies had mixed results and the impact on implant survival between patients being treated with bisphosphonates was unclear. No p values or CI were reported given lack of statistical analysis.
Evidence Search Bisphosphonates AND Dental Implant Failure
Comments on
The Evidence
These studies were heterogeneous with respect to patient population, and neither study investigated dissimilarities between treatment and control groups. Nevertheless, there was sufficient followup as well as exposure prior to onset of outcome.
Applicability These results are applicable to adult patients with osteoporosis taking bisphosphonates who are considering implant therapy.
Specialty/Discipline (General Dentistry) (Periodontics) (Prosthodontics)
Keywords Bisphosphonates, Dental Implants, Implant Failure
ID# 2103
Date of submission: 09/16/2011spacer
E-mail MaldonadoAlf@livemail.uthscsa.edu
Author Katherine Maldonado Alfandari
Co-author(s) e-mail
Faculty mentor/Co-author Yong-Hee Patricia Chun, DDS, MS, PhD
Faculty mentor/Co-author e-mail ChunY@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Hohyun Ryan Ryou, Matthew Gesell (San Antonio, TX) on 12/08/2017
A PubMed search conducted in November 2017 found a limited amount of related evidence that does not change the conclusion of the CAT. At about the same time the CAT was written, a systematic review (Madrid, 2009, PMID 19663954) and a retrospective study (Shabestari, 2010, PMID 19438964) were published. New research has been done since then in the forms of retrospective study (Al-Sabbagh, 2015, PMID 25764480), case control study (Famili, 2015, PMID 24945991) and meta-analysis (Chen, 2013, PMID 23940794). As mentioned in the CAT, the general consensus amongst the studies is that further research will need to be performed. Only a few thousand implants have been evaluated, which limits the validity and clinical applicability of the research already done.

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