ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title A Patient Undergoing Oral Bisphosphonate Therapy For Less Than Five Years Can Receive Dental Implant Therapy
Clinical Question In a patient who is taking oral bisphosphonates, what is the likelihood of osteonecrosis when a dental implant is placed as compared to a patient not treated with this drug?
Clinical Bottom Line A patient undergoing oral bisphosphonate therapy for less than five years can receive dental implant therapy.
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) 19663954Madrid/2009217 adult humans on Bisphosphonates <5 yearsSystematic Review
Key resultsAuthors were able to find one prospective RCT and three retrospective studies. No cases of BRONJ were reported in the selected patient population. All of the patients were followed for a period of 1-4 years. Implant survival rates were between 95-100%.
Evidence Search (("mouth"[MeSH Terms] OR "mouth"[All Fields] OR "oral"[All Fields]) AND ("diphosphonates"[MeSH Terms] OR "diphosphonates"[All Fields] OR "bisphosphonates"[All Fields])) AND ("dental implants"[MeSH Terms] OR ("dental"[All Fields] AND "implants"[All Fields]) OR "dental implants"[All Fields]) AND (English[lang] AND systematic[sb])
Comments on
The Evidence
This systematic review provides the best available evidence to date supporting placement of implants in a patient who has been treated with oral bisphosphonates for less than 5 years. Due to the scarcity of peer reviewed literature, validity testing was limited. Short case series and Case Reports were excluded. This systematic review shows no cases of osteonecrosis in 217 patients over three studies. Limiting this systematic review is the incidence of the disease which was quoted in the article to range from .7 cases per 100,000 (manufacturer of alendronate) to as low as 1 in 296 (patients receiving tooth extractions; Mavrokokki et. al., 2007). The study population of 217, although large, is overshadowed by the very small incidence of the disease. This article presents the best evidence to begin a discussion between provider and patient for obtaining adequate informed consent in the placement of dental implants on a patient taking oral bisphosphonates.
Applicability This systematic review provides dentists and patients good information regarding implant therapy and likelihood of morbidity. Of the 217 patients reviewed not one had BRONJ at 1-4 years.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Orthodontics) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Implant, Implants, Bisphosphonates, BRONJ, Osteonecrosis
ID# 2108
Date of submission: 09/08/2011spacer
E-mail sheridanr@uthscsa.edu
Author Ryan Sheridan
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward Ellis III, DDS
Faculty mentor/Co-author e-mail ELLISE3@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
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Cesar Gonzalez, Mariyam Shah (San Antonio, Texas) on 12/01/2017
At the time this CAT was published,the systematic review by Madrid 2009, (PMID 19663954) provided the best available evidence on the success of implant placement in patients taking oral bisphosphonates for less than 5 years. Since,newer studies have been published along with peer reviewed literature (Javed, 2010, 20367090), all of which continue to support the bottom line of this CAT. In regard to BRONJ (bisphosphonate-related osteonecrosis of the jaw), placement of implants is continues to be considered safe in patients who are taking bisphosphonates (oral & IV) for less than 5 years. Best practice requires that the possibility of BRONJ development should be articulated to patients as a risk and that a full health history and risk-assessment is essential prior to beginning treatment. The current literature demonstrates that intake of oral-BPs does not influence short-term success of placed implants upwards of 4 years
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