Following the trauma induced to the bone tissue during dental implant installation, wound healing involves the fine-tuned coupling of bone resorption and formation [1, 2], which finally leads to the direct bone-to-implant contact, i.e., implant osseointegration [3]. The same biological mechanisms are involved in the wound healing (i.e., remodeling) of a bone defect filled with bone graft and/or bone substitute material [4]. In order to enhance wound healing and thereby achieve an optimized osseointegration and/or bone defect closure, systemic-, and local administration of drugs, including growth and differentiation factors, and/or implant and graft drug-based surface modifications have been employed with variable success [5, 6]. In the past years, the literature regarding the local interventions (mostly based on the modification of implant surfaces to improve the osseointegration process) became highly developed [6]. On the other hand, the additional effect of systemic therapies supplementing such local modification factors, although acknowledged, was not developed in a similar manner [5].

Examples of systemic administration of anabolic and anti-catabolic substances include estrogen [7], parathyroid hormone [8], and bisphosphonates [9, 10]. In particular, systemic administration of bisphosphonates, which are widely used for cancer and osteoporosis treatment, is based on the rationale that suppression of bone resorption—achieved by this type of drugs—results in denser peri-implant bone and thereby in larger amounts of bone-to-implant contact [11]. Indeed, a recent review of animal studies indicated that systemic administration of bisphosphonates enhances implant osseointegration, especially in animals with induced osteoporotic conditions [12]. Nevertheless, the increasing number of reports in recent years of bisphosphonate-related osteonecrosis of the jaws has raised alarm regarding the side-effects of bisphosphonate treatment [13] and has led to the search of alternatives to this group of drugs.

Another type of drug recently developed for osteoporosis treatment is strontium (Sr) ranelate (SRAN) [14,15,16]. This drug is a salt consisting of two atoms of stable strontium (Sr²⁺) and an organic acid (Ranelic acid), and it is usually administrated orally [17, 18]. Sr ions possess a high affinity to hydroxyapatite (HA) [19], and in contrast to bisphosphonates that decrease bone resorption, Sr exerts a dual action, i.e., it is able to simultaneously stimulate bone formation and suppress bone resorption [17, 20, 21]. This has been demonstrated in both animal- (by means of bone mineral content analysis [22], dual-energy X-ray absorptiometry [23], and histomorphometric assessment [24]), and clinical studies (by means of microtomography and histomorphometric assessment) [25]. Further, relatively recent reports from animal studies suggest that the systemic administration of Sr would enhance the osseointegration of implants.