Implant
Author Year Reference
Study type
Patients
Primary disease in BP patients (n)
...
Topic
Identified (n)
Included (n)
Outcome osteonecrosis risk. ST (bisphosphonate OR denosumab) AND osteonecrosis jaw AND
...
Walter, C., Al-Nawas, B., Wolff, T. et al. Dental implants in patients treated with antiresorptive medication – a systematic literature review. Int J Implant Dent 2, 9 (2016). https://doi.org/10.1186/s40729-016-0041-7
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Received: 26 September 2015
Accepted: 23 March 2016
Published: 04 April 2016
DOI: https://doi.org/10.1186/s40729-016-0041-7
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
The authors Christian Walter, Bilal Al-Nawas, Tim Wolff, Eik Schiegnitz, and Knut A. Grötz declare that they have no competing interests.
All authors designed the review. TW made the primary literature acquisition that was evaluated by the other others. All authors interpreted the data. CW drafted the manuscript that was revised by the other authors. All authors read and approved the final manus...
Department of Oral and Maxillofacial Surgery – Plastic Surgery of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany
Christian Walter, Bilal Al-Nawas & Eik Schiegnitz
Department of Oral and Maxillofacial Surgery of the Dr. Horst Schmidt Clinic, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Germany
Tim Wolff & Knut A. Grötz
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Krimmel M, Ripperger J, Hairass M, Hoefert S, Kluba S, Reinert S. Does dental and oral health influence the development and course of bisphosphonate-related osteonecrosis of the jaws (BRONJ)? Oral Maxillofac Surg. 2014;18(2):213–8. doi:10.1007/s10006-013-0408-3.
Tsao C, Darby I, Ebeling PR, Walsh K, O'Brien-Simpson N, Reynolds E, et al. Oral health risk factors for bisphosphonate-associated jaw...
DeBaz C, Hahn J, Lang L, Palomo L. Dental Implant Supported Restorations Improve Quality of Life in Osteoporotic Women. Int J Dent. 2015;2015:451923. doi:10.1155/2015/451923.
Grötz KA, Al-Nawas B. Persisting alveolar sockets-a radiologic symptom of BP-ONJ? J Oral Maxillofac Surg. 2006;64(10):1571–2. doi:10.1016/j.joms.2006.05.041.
Hutchinson M, O'Ryan F, Chavez V, Lathon PV, Sanchez G, Hatche...
Carmagnola D, Celestino S, Abati S. Dental and periodontal history of oncologic patients on parenteral bisphosphonates with or without osteonecrosis of the jaws: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(6):e10–5. doi:10.1016/j.tripleo.2008.07.011.
Jabbour Z, El-Hakim M, Mesbah-Ardakani P, Henderson JE, Albuquerque Jr R. The outcomes of conservative and surgical ...
Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005;63(11):1567–75. doi:10.1016/j.joms.2005.07.010.
Al-Sabbagh M, Robinson FG, Romanos G, Thomas MV. Osteoporosis and bisphosphonate-related osteonecrosis in a dental school implant patient popula...
Javed F, Almas K. Osseointegration of dental implants in patients undergoing bisphosphonate treatment: a literature review. J Periodontol. 2010;81(4):479–84. doi:10.1902/jop.2009.090587.
Bedogni A, Bettini G, Totola A, Saia G, Nocini PF. Oral bisphosphonate-associated osteonecrosis of the jaw after implant surgery: a case report and literature review. J Oral Maxillofac Surg. 2010;68(7):1662–6...
Grötz KA, Piesold JU, Al-Nawas B. Bisphosphonat-assoziierte Kiefernekrose (BP-ONJ) und andere Medikamenten-assoziierte Kiefernekrosen. 2012. AWMF online.
Walter C, Al-Nawas B, Frickhofen N, Gamm H, Beck J, Reinsch L, et al. Prevalence of bisphosphonate associated osteonecrosis of the jaws in multiple myeloma patients. Head Face Med. 2010;6:11. doi:10.1186/1746-160X-6-11.
Walter C, Sagheb K, Bit...
bisphosphonate
bisphosphonate-associated osteonecrosis of the jaws
C-terminal telopeptide of the type I collagen
patients intervention control outcome
preferred reporting items for systematic reviews and meta-analyses protocols
quality of life
search term
temporomandibular joint
Successful implant therapy is feasible in patients receiving antiresorptive therapy. The risk of osteonecrosis development needs to be explained to the patient. An individual risk assessment is essential, taking the primary disease with the medication and further wound-healing-compromising diseases and medications into account. If possible, bone augmentations should be avoided, and a perioperative...
The use of bone markers is discussed controversially in the literature, and no clear recommendation can be given at the moment [1, 8]. In these cases, where an implant is planned, a perioperative antimicrobial prophylaxis should be administered, similar to the prophylaxis suggested in other surgical procedures performed in these patients, since this seems to be a tool to decrease BP-ONJ frequency ...
Dental implants can improve the Qol in patients with antiresorptive therapy (bisphosphonate/denosumab) [44] analogous to patients without antiresorptive therapy [48]. A recently performed systematic review on masticatory performance, bite force, nutritional state and patient’s satisfaction showed that implant-supported dentures were associated with high patient satisfaction regarding denture com...
Even latest guidelines and statements dealing with medication associated osteonecrosis of the jaws such as the American [7, 8], Scottish [47], Swiss [6] or German [1] do not address implant therapy in these patients in detail. Due to this lack of data a systematic literature review was performed to fill this gap. Unfortunately the literature dealing with this topic is very sparse and consists main...
No articles could be found regarding the prognosis of the remaining dentition depending on implant therapy, neither for patients with bisphosphonate nor denosumab treatment.
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...
The literature dealing with this topic can be separated into two groups:
BP-ONJ case series for which varying amounts are caused by dentures in patients with malignant and benign diseases [2, 33–42] and
studies performed on BP patients with dentures analyzing the frequency of BP-ONJ [15, 43].
Here as well, no imbalance regarding the dignity of the primary disease could be found. Jabbour descr...
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 statisti...
A table was generated and used to collect the relevant information.
A systematic review was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses protocols (PRISMA-P),
The review was performed using the PICO design.
Patients: For which subclientel of patients with antiresorptive therapy
Intervention: do dental implants have a benefit
Control: compared to forgoing dental implants
Outcome: in regards to oral rehabil...
A similar scenario is well known in patients with radiation of the jaws. Initially, radiation therapy was seen as a contraindication for implant insertion [14] because of osteoradionecrosis. In Germany meanwhile, implants are covered by the health insurance by law in some of these patients (§28 SGB V Sozialgesetzbuch). Due to xerostomia sufficient fixation of a denture is rather complicated, and ...
Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is a well-known side effect in patients receiving bisphosphonates (BP) due to e.g. osteoporosis, multiple myeloma or malignant diseases with metastases to the bone; prevalences range between 0.1% for patients with primary osteoporosis to 1% in patients with secondary osteoporosis and up to about 20% for special high risk subpopulations o...
Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is triggered by inflammatory processes. Typical trigger factors are periodontal disease, denture pressure sores, and surgical interventions such as tooth extractions. Unfortunately there is only little data on how to proceed with implant therapy in patients with bisphosphonate treatment. This topic is not addressed in the German guidelin...
Fig. 3. Forest plot of quality of life. A statistically significant improvement was observed in the quality of life parameter with mini implants than standard implants
Fig. 3. Forest plot of quality of life. A statistically significant improvement was observed in the quality of life parameter with mini implants than standard implants
Fig. 2. Risk of bias of the included studies
Fig. 2. Risk of bias of the included studies
Fig. 1. PRISMA flow diagram
Fig. 1. PRISMA flow diagram
Comparison of parameters between standard and mini-implants for implant-supported overdenture:
Outcomes
Parameter values
No. of participants (studies)
...
Author
Participant
Intervention
Comparator
Outcome
De Souza 2015[8]
...
Sivaramakrishnan, G., Sridharan, K. Comparison of patient satisfaction with mini-implant versus standard diameter implant overdentures: a systematic review and meta-analysis of randomized controlled trials.
Int J Implant Dent 3, 29 (2017). https://doi.org/10.1186/s40729-017-0092-4
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Received: 12 April 2017
Accepted: 22 June 2017
Published: 01 July 2017
DOI...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Gowri Sivaramakrishnan and Kannan Sridharan declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Department of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Brown Street, Suva, Fiji
Gowri Sivaramakrishnan
Department of Pharmacology, Fiji National University, Extension Street, Suva, Fiji
Kannan Sridharan
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We acknowledge Cochrane reviews for utilizing RevMan software for generating the pooled results and Forest plots.
No source of funding.
Kumari P, Verma M, Sainia V, Gupta A, Gupta R, Gill S. Mini-implants, mega solutions: a case series. J Prosthodont. 2015. doi:10.1111/jopr.12382.
Jackson BJ. Fixed partial denture treatment with mini dental implants. J Oral Implantol. 2014;40:744–50.
Flanagan D, Mascolo A. The mini dental implant in fixed and removable prosthetics: a review. J Oral Implantol. 2011;37 Spec No:123–32. doi:10.1...
However, considering the results obtained from available evidence, mini-implants tend to provide good patient satisfaction compared to standard diameter implants when used for implant-supported overdentures. The results of this meta-analysis should be interpreted keeping in the mind the limited availability of data to be included. This paper would serve as a basis for future research comparing min...
This study is an attempt to identify patient satisfaction with mini-implant overdentures compared to standard diameter implant-supported overdentures in completely edentulous patients. Implant-supported overdentures have been reported to offer many advantages like decreased bone resorption, reduced prosthesis movement, better esthetics, better occlusion and tooth positioning, improved occlusal loa...
A total of 183 articles were identified using the search strategy. Screening of these papers yielded four studies comparing mini-implant-retained overdentures and standard diameter implant overdentures and were found eligible to be included in the systematic review [8,9,10,11]. Two studies [8, 11] comparing patient satisfaction between the groups were included for the meta-analysis. The PRISMA flo...
The protocol for this review was registered with International prospective register of systematic reviews (PROSPERO) with the registration number CRD42016043075. The review protocol can be accessed at https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016043075. A through literature search was conducted and was completed on 9 July 2016. The primary database used was MEDLINE (via PubMed...
Implants have been considered to improve treatment outcomes of completely edentulous patients with anatomical challenges compromising the retention and stability. The root form dental implants which are 3–5 mm in diameter are considered standard diameter implants while less than 3 mm diameter implants are termed mini-implants [1]. Initially, mini-implants were used as a temporary measure, with...
Mini-implants have certain advantages over standard size implants which are being tested in various randomized controlled trials. This systematic review and meta-analysis aims to compare conventional implant overdentures to mini-implant-retained overdentures as regards to patient satisfaction. Electronic databases were searched for eligible studies data required were extracted. The extracted data ...
Fig. 3. Forest plot of quality of life. A statistically significant improvement was observed in the quality of life parameter with mini implants than standard implants
Fig. 3. Forest plot of quality of life. A statistically significant improvement was observed in the quality of life parameter with mini implants than standard implants
Fig. 2. Risk of bias of the included studies
Fig. 2. Risk of bias of the included studies
Fig. 1. PRISMA flow diagram
Fig. 1. PRISMA flow diagram
Comparison of parameters between standard and mini-implants for implant-supported overdenture:
Outcomes
Parameter values
No. of participants (studies)
...
Author
Participant
Intervention
Comparator
Outcome
De Souza 2015[8]
...
Sivaramakrishnan, G., Sridharan, K. Comparison of patient satisfaction with mini-implant versus standard diameter implant overdentures: a systematic review and meta-analysis of randomized controlled trials.
Int J Implant Dent 3, 29 (2017). https://doi.org/10.1186/s40729-017-0092-4
Download citation
Received: 12 April 2017
Accepted: 22 June 2017
Published: 01 July 2017
DOI...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Gowri Sivaramakrishnan and Kannan Sridharan declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Department of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Brown Street, Suva, Fiji
Gowri Sivaramakrishnan
Department of Pharmacology, Fiji National University, Extension Street, Suva, Fiji
Kannan Sridharan
You can also search for this author in
PubMed Google Scholar
You can also search for this author in
...
We acknowledge Cochrane reviews for utilizing RevMan software for generating the pooled results and Forest plots.
No source of funding.
Kumari P, Verma M, Sainia V, Gupta A, Gupta R, Gill S. Mini-implants, mega solutions: a case series. J Prosthodont. 2015. doi:10.1111/jopr.12382.
Jackson BJ. Fixed partial denture treatment with mini dental implants. J Oral Implantol. 2014;40:744–50.
Flanagan D, Mascolo A. The mini dental implant in fixed and removable prosthetics: a review. J Oral Implantol. 2011;37 Spec No:123–32. doi:10.1...
However, considering the results obtained from available evidence, mini-implants tend to provide good patient satisfaction compared to standard diameter implants when used for implant-supported overdentures. The results of this meta-analysis should be interpreted keeping in the mind the limited availability of data to be included. This paper would serve as a basis for future research comparing min...
This study is an attempt to identify patient satisfaction with mini-implant overdentures compared to standard diameter implant-supported overdentures in completely edentulous patients. Implant-supported overdentures have been reported to offer many advantages like decreased bone resorption, reduced prosthesis movement, better esthetics, better occlusion and tooth positioning, improved occlusal loa...
A total of 183 articles were identified using the search strategy. Screening of these papers yielded four studies comparing mini-implant-retained overdentures and standard diameter implant overdentures and were found eligible to be included in the systematic review [8,9,10,11]. Two studies [8, 11] comparing patient satisfaction between the groups were included for the meta-analysis. The PRISMA flo...
The protocol for this review was registered with International prospective register of systematic reviews (PROSPERO) with the registration number CRD42016043075. The review protocol can be accessed at https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016043075. A through literature search was conducted and was completed on 9 July 2016. The primary database used was MEDLINE (via PubMed...
Implants have been considered to improve treatment outcomes of completely edentulous patients with anatomical challenges compromising the retention and stability. The root form dental implants which are 3–5 mm in diameter are considered standard diameter implants while less than 3 mm diameter implants are termed mini-implants [1]. Initially, mini-implants were used as a temporary measure, with...
Mini-implants have certain advantages over standard size implants which are being tested in various randomized controlled trials. This systematic review and meta-analysis aims to compare conventional implant overdentures to mini-implant-retained overdentures as regards to patient satisfaction. Electronic databases were searched for eligible studies data required were extracted. The extracted data ...
Abbreviations
BP:
bisphosphonate
BP-ONJ:
bisphosphonate-associated osteonecrosis of the jaws
CTX:
C-terminal telopeptide of the type I collagen
PICO:
patients intervention control outcome
PRISMA-P:
preferred reporting items for systematic reviews and meta-analyses protocols
QoL:
quality of life
ST:
search term
TMJ:
temporomandibular joint
...
Next to this, the patients need to be compliant with an appropriate motivation for oral hygiene and the necessary skills to transfer this. Infectious foci should be treated before implant therapy to further reduce the risk of osteonecrosis development. The surgical sites should be followed up clinically (persisting sharp bone edges without any tendency to remodel) and radiologically (e...
Although there are only very few cases in the literature with augmentation of bone/sinus lift, these procedures are linked to a functioning vascular recipient site with working osteoclastic resorption and osteoblastic bone formation, and this is compromised in patients with antiresorptive therapy. Due to the denudation of the bone at the recipient site the vascular situation might be e...
Discussion
Even latest guidelines and statements dealing with medication associated osteonecrosis of the jaws such as the American, Scottish, Swiss or German do not address implant therapy in these patients in detail. Due to this lack of data a systematic literature review was performed to fill this gap. Unfortunately the literature dealing with this topic is very sparse and consists mainl...
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 ris...
Results
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...
Introduction
Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is a well-known side effect in patients receiving bisphosphonates (BP) due to e.g. osteoporosis, multiple myeloma or malignant diseases with metastases to the bone; prevalences range between 0.1% for patients with primary osteoporosis to 1% in patients with secondary osteoporosis and up to about 20% for special high risk ...
Dental implants in patients treated with antiresorptive medication – a systematic literature review
Abstract
Objective
Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is triggered by inflammatory processes. Typical trigger factors are periodontal disease, denture pressure sores, and surgical interventions such as tooth extractions. Unfortunately there is only little data on how...
Figure 9. a Mandibular implant-fixed prosthesis inserted into the mouth.
Figure 8. Periapical radiographs of the implants. a Postoperative, 1 year. b Postoperative, 16 years
Figure 7. a Intraoral photograph. b Gold Dolder bar and screws; marked wear of a prosthetic screw (arrow)
Figure 6. a Mandibular implant-supported overdenture inserted into the mouth. b Panoramic radiograph after insertion of the prosthesis
Figure 3. Photomicrographs of the biopsy specimen showing the intermingling of (a), (b), and (c). a Moderately differentiated epidermoid tumor cells with a duct-like structure (hematoxylin and eosin [H&E], original magnification × 100). b Intermediate cells (H&E, original magnification × 100). c Clear cells (H&E, original magnification × 100)
Figure 4. a Intraoperative photograph of resection of the alveolar ridge and bilateral upper neck dissection. b Transplantation of a lateral tongue flap to cover the alveolar ridge defect. c Surgical specimen
Figure 2. Panoramic radiograph showing notable alveolar bone resorption in the left mandibular premolar region and slight resorption in the right mandibular canine region (arrows)
Figure 1. Intraoral photograph showing diffuse tumor formation on the alveolar gingiva (arrows)
We inserted an implant-supported overdenture on a gold bar retainer splinting four implants. However, the patient was not satisfied with this prosthesis because of the mucosal pain and discomfort that developed over time. In such cases, prosthetic loading of atrophic mucosa is often not well tolerated. As such, we proposed replacement with an implant-fixed prosthesis. Initially, the patient ...
Conclusions
Prosthetic rehabilitation of edentulous patients after surgical management of oral cancer is difficult and therefore often avoided. However, adequate prosthetic rehabilitation is a pivotal factor for patients to regain oral function. In terms of the masticatory rehabilitation of these patients, the application of a removable prosthesis unsupported by implants may be difficult or...
However, she was not satisfied with the prosthesis; she experienced denture discomfort and developed a decubital ulcer in the tongue flap area, and she gradually ceased use of the denture. The patient was followed for more than 10 years on a regular basis to examine recurrence or metastasis of the gingival carcinoma. Mild erythema and swelling of the mandibular and implant-surrounding mucosa secon...
Case presentation
A 16-year-old female patient developed slight tenderness of the gingiva in the left mandibular premolar region, and her dentist referred her to our clinic in April 1992. Oral examination showed erythematous granular swellings that bled easily on the alveolar gingiva involving the area extending from the right second premolar to the left second molar (Fig. 1). The lesion showed...
Background
Surgical treatment of oral cancer may lead to significant disability, including facial deformity, loss of hard and soft tissue, and impaired function of speech, swallowing, and mastication. Bone resection because of surgical treatment of a large mandibular tumor can cause long-term defects. Rehabilitation with a removable prosthesis can be difficult or impossible due to the distorted...
Dental implant treatment in a young woman after marginal mandibulectomy for treatment of mandibular gingival carcinoma: a case report
Abstract
Dental implants play an important role in postoperative rehabilitation after surgical treatment of oral cancer through the provision of prosthetic tooth replacement. Two major implant prosthesis designs are available: fixed implant-supported prostheses ...