Out of 606 articles 556 articles were excluded because they were either duplicates, case reports, narrative reviews, case series with less than 5 cases or were not associated with the topic at all (Table 1 and Fig. 1). Some of the articles analyzed more than one outcome and are referred to several times. Since the available literature is very inhomogeneous with a low level of evidence a statistical analysis was not performed and the following results are descriptive only.

Dental implants/periimplantitis

The literature dealing with this topic can roughly be separated into three groups:

1. BP-ONJ case series exclusively triggered by implants in patients with malignant and benign diseases
2. BP-ONJ case series analyzing case series of BP-ONJ of which varying amounts are caused by implants in part among patients with malignant and benign diseases and
3. implant studies performed exclusively in patients with benign diseases, mostly osteoporosis. In very few of these studies, the primary disease was not given, but the prescribed bisphosphonates strongly suggest osteoporosis as the primary disease (see Table 2).

In the BP-ONJ case series (a) and (b), the distribution of BP-ONJ patients between malignant and benign diseases is more or less even, e.g. Holzinger describes 13 patients: 5 osteoporosis, 3 breast cancer, 3 multiple myeloma, 1 lung cancer and 1 Langerhans cell histiocytosis patient. Lopez-Cedrun exclusively found patients with benign diseases: 8 osteoporosis and 1 polymyalgia rheumatic. Jacobsen found 14 patients: 5 osteoporosis, 5 breast cancer, 2 multiple myeloma, 1 prostate and 1 lung cancer patient.

However, implant studies (c) were exclusively performed in patients with benign diseases. Nearly all of these studies do not report a single BP-ONJ triggered by the implant insertion.

A systematic review analyzing the sparse literature on clinical denosumab trials mentioning osteonecroses did not describe dental implants as a trigger.

There is no literature describing periimplantitis in these patients.

Denture

The literature dealing with this topic can be separated into two groups:

1. BP-ONJ case series for which varying amounts are caused by dentures in patients with malignant and benign diseases and
2. studies performed on BP patients with dentures analyzing the frequency of BP-ONJ.

Here as well, no imbalance regarding the dignity of the primary disease could be found. Jabbour describes 2 osteoporosis, 1 kidney and 1 breast cancer patient. Kumar found 4 osteoporosis patients, 1 breast cancer patient and 1 patient with multiple myeloma.