Antiresorptive drugs, including bisphosphonates and denosumab, are pivotal in bone remodeling and are widely used to treat osteoporosis and various cancer-related conditions [1]. Their role in modulating bone resorption makes them essential in managing disorders linked to bone degradation and loss [2,3]. as more patients receive these medications, oral and maxillofacial surgeons face challenges related to adverse effects, notably medication-related osteonecrosis of the jaw (MRONJ) [4].

MRONJ incidence is strongly correlated with the dosage regimen of antiresorptive drugs [5]. Research shows that cancer patients, who receive doses 12 to 15 times higher than those for osteoporosis, have a significantly increased risk of developing MRONJ [1,6,7]. This dosage-dependent risk complicates the balance between treatment efficacy and safety for healthcare providers.

furthermore, dentoalveolar procedures such as tooth extractions and dental implant placements have been identified as local risk factors for MRONJ, though the specific risk associated with dental implants remains debated. a recent position paper by the american association of oral and maxillofacial surgeons noted that the exact risk in patients on antiresorptive therapy is still uncertain and under investigation [1].

Given the current lack of robust evidence or guidelines regarding the safety of antiresorptive drugs in dental implantology, there is a clear need for updated data and systematic assessments. This review aims to critically evaluate the impact of antiresorptive therapy on dental implant success and failure rates and to propose recommendations that will contribute to safer clinical practices in dental implant procedures [8].

This systematic review was conducted following the PRISMA guidelines [9].

The search strategy initially identified 196 articles. after screening, 35 articles were selected for detailed eligibility assessment, and following full-text evaluations, 26 were excluded. ultimately, 9 articles were included in this systematic review (Fig. 1).

The selected studies comprised one randomized controlled trial (RCT), one prospective cohort study, one case-control study, two case series, and four retrospective cohort studies (Table 1). detailed data on patient demographics, drug regimens, and implant outcomes are provided in Tables 1-3.

Most studies focused on bisphosphonates or a combination of bisphosphonates and denosumab, with only one study exclusively addressing denosumab. the majority of patients were postmenopausal women undergoing antiresorptive therapy for osteoporosis.

Collectively, the studies reported on 1,126 dental implants, though two studies did not specify the implant count (Table 2). regarding administration routes, two studies used intravenous delivery, one did not specify, one used subcutaneous administration, and the remaining studies involved a mix of oral, intravenous, and subcutaneous routes (Table 3).

Patient success rates ranged from 38.9% to 100%, while dental implant success rates varied from 36.2% to 100%, with some studies omitting these data. notably, there was no substantial difference between patient and implant success rates.

Two studies specifically addressed MRONJ. In a case-control study by Giovannacci et al. [10], out of 15 patients, six experienced “implant surgery-triggered” MRONJ and nine were classified as “implant presence-triggered” MRONJ.

Risk of bias was evaluated using the cochrane RoB 2 tool for the RCT and the ROBINS-I tool for non-randomized studies. overall, one study was rated as serious, six as moderate, and one as low in risk of bias (Fig. 2).

The objective of this systematic review was to assess the impact of antiresorptive therapy on dental implant success and failure rates. An analysis of 9 studies-including RCTs, cohort studies, case-control studies, and case series-that evaluated 1,126 dental implants provided robust insights into the relationship between antiresorptive drug use and implant outcomes.

Our findings reveal that dental implant success rates vary widely from 36.2% to 100%, with patient success rates ranging from 38.9% to 100%. This variability appears linked to the dosage and administration routes of antiresorptive drugs, primarily bisphosphonates and denosumab, with lower doses and oral administration correlating with higher success rates [11-17]. Conversely, a heightened risk of MRONJ was observed, especially when the presence or surgical placement of an implant exacerbated the condition [10,18-21].

The review underscores that low-dose, orally administered antiresorptive therapy tends to favor peri-implant bone resorption conducive to osseointegration, whereas high-dose or intravenous administration may increase the risk profile. these findings stress the need for meticulous pre-operative assessment and possible modifications in treatment protocols to mitigate MRONJ risks [22,23].