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Dental implants in patients treated with antiresorptive medication – a systematic literature review

Results : Dental implants in patients treated with antiresorptive medication (2)

author: Christian Walter,Bilal Al-Nawas,Tim Wolff,Eik Schiegnitz,Knut A Grtz | publisher: drg. Andreas Tjandra, Sp. Perio, FISID

Nibbe analyzed 128 patients with IV BP or denosumab separated into 3 groups. In the first group 5 out of 60 patients with no denture had an osteonecrosis (8%), in the 2nd group 5 out of 34 patients with a fixed partial denture had an osteonecrosis 15%, and in the 3rd group 11 out of 34 patients with a removable denture had an osteonecrosis (32%). Kyrgidis determined that dentures increase the risk of BP-ONJ development.

Augmentation/sinus lift/antibiotics/xerostomia/CTX

There was no literature available meeting the inclusion criteria. There is evidence in the literature that sinus lifts can be successful and might contribute to BP-ONJ development.

Outcome masticatory efficiency/TMJ disorder

There was no literature available meeting the inclusion criteria.

Outcome quality of life (QoL)

There is nearly no literature available on the change of the quality of life due to implants in patients with antiresorptive therapy. One article could be identified that analyzed the quality of life in partially edentulous osteoporosis patients that were restored with (1) a dental implant-supported prosthesis, (2) a non-implant-supported fixed restoration, (3) a non-implant-supported removable restauration, and (4) no restoration that showed a statistically significant difference regarding the improvement of the QoL in patients with a dental implant-supported prosthesis compared to the other sub-groups. Out of the 237 patients, 134 patients had an oral BP and 51 patients an IV BP therapy.

Outcome remaining dentition

No articles could be found regarding the prognosis of the remaining dentition depending on implant therapy, neither for patients with bisphosphonate nor denosumab treatment.

Outcome future implants

There are no reliable parameters indicating the success of implants in patients with anti-resorptive therapy. The risk of osteonecrosis development has already been described in the chapter referring to the osteonecrosis risk. Two articles mentioned the radiologic finding of a persisting alveolar socket as a marker indicating the osteonecrosis risk. In addition, other radiologic changes in patients with bisphosphonates have been described, such as regional or diffuse osteosclerosis, confluence of cortical and cancellous bone, prominence of the canal of the inferior alveolar nerve, a prominent lamina dura, radiolucences around the apex and cortical disruptions. Their existence reflects the changes in the bone remodeling due to the anti-resorptive therapy and might be associated with a higher osteonecrosis risk, but there is no evidence supporting this theory.

 

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