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 random effects meta-analysis of the incidence of Schneiderian membrane perforation using piezoelectric devices. The weighted average for the incidence rate of Schneiderian membrane perforation was 8%
Fig. 3. Forest plot of random effects meta-analysis of the incidence of Schneiderian membrane perforation using piezoelectric devices. The weighted average for the incidenc...
Fig. 2. Forest plot of random effects meta-analysis of the incidence of Schneiderian membrane perforation using conventional rotative instruments. The weighted average for the incidence rate of Schneiderian membrane perforation was 24%
Fig. 2. Forest plot of random effects meta-analysis of the incidence of Schneiderian membrane perforation using conventional rotative instruments. The weighted...
Fig. 1. Result of the search strategy and included and excluded studies
Fig. 1. Result of the search strategy and included and excluded studies
Piezoelectric
Event rate
Lower limit
Upper limit
z value
p value
...
Conventional
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Jordi, C., Mukaddam, K., Lambrecht, J.T. et al. Membrane perforation rate in lateral maxillary sinus floor augmentation using conventional rotating instruments and piezoelectric device—a meta-analysis.
Int J Implant Dent 4, 3 (2018). https://doi.org/10.1186/s40729-017-0114-2
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Received: 28 September 2017
Accepted: 20 December 2017
Published: 29 January 20...
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 m...
The authors Jordi Corinne, Mukaddam Khaled, Lambrecht Jörg Thomas and Kühl Sebastian state that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Department of Oral Surgery, Oral Radiology and Oral Medicine, University Center for Dental Medicine, University of Basel, Basel, Switzerland
Corinne Jordi, Khaled Mukaddam, Jörg Thomas Lambrecht & Sebastian Kühl
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We would like to express our gratitude to Ms. Irene Mischak for the statistical support.
Delilbasi C, Gurler G. Comparison of piezosurgery and conventional rotative instruments in direct sinus lifting. Implant Dent. 2013;22(6):662–5.
Becker ST, Terheyden H, Steinriede A, Behrens E, Springer I, Wiltfang J. Prospective observation of 41 perforations of the Schneiderian membrane during sinus floor elevation. Clin Oral Implants Res. 2008;19(12):1285–9.
Hernandez-Alfaro F, Torradeflo...
Blus C, Szmukler-Moncler S, Salama M, Salama H, Garber D. Sinus bone grafting procedures using ultrasonic bone surgery: 5-year experience. Int J Periodontics Restorative Dent. 2008;28(3):221–9.
Cortes AR, Cortes DN, Arita ES. Effectiveness of piezoelectric surgery in preparing the lateral window for maxillary sinus augmentation in patients with sinus anatomical variations: a case series. Int J ...
Froum SJ, Khouly I, Favero G, Cho SC. Effect of maxillary sinus membrane perforation on vital bone formation and implant survival: a retrospective study. J Periodontol. 2013;84(8):1094–9.
Stricker A, Voss PJ, Gutwald R, Schramm A, Schmelzeisen R. Maxillary sinus floor augmentation with autogenous bone grafts to enable placement of SLA-surfaced implants: preliminary results after 15-40 months. C...
Wannfors K, Johansson B, Hallman M, Strandkvist T. A prospective randomized study of 1- and 2-stage sinus inlay bone grafts: 1-year follow-up. Int J Oral Maxillofac Implants. 2000;15(5):625–32.
Hallman M, Nordin T. Sinus floor augmentation with bovine hydroxyapatite mixed with fibrin glue and later placement of nonsubmerged implants: a retrospective study in 50 patients. Int J Oral Maxillofac I...
Tawil G, Mawla M. Sinus floor elevation using a bovine bone mineral (Bio-Oss) with or without the concomitant use of a bilayered collagen barrier (Bio-Gide): a clinical report of immediate and delayed implant placement. Int J Oral Maxillofac Implants. 2001;16(5):713–21.
Yilmaz HG, Tozum TF. Are gingival phenotype, residual ridge height, and membrane thickness critical for the perforation of max...
Geminiani A, Tsigarida A, Chochlidakis K, Papaspyridakos PV, Feng C, Ercoli C. A meta-analysis of complications during sinus augmentation procedure. Quintessence Int. 2017;48(3):231–40.
Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev. 2014;5:CD008397.
Galindo-Moreno P, Avila G, Fernandez...
Tatum H. Maxillary and sinus implant reconstructions. Dent Clin N Am. 1986;30(2):207–29.
Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38(8):613–6.
Khoury F. Augmentation of the sinus floor with mandibular bone block and simultaneous implantation: a 6-year clinical investigation. Int J Oral Maxillofac Implants. 1999;14(4):557–6...
The aim of the present study was to resume in a review the literature evaluating the incidence of sinus membrane perforation comparing conventional rotating instruments with piezoelectric devices. Since only scarce studies exist comparing both techniques directly, we decided to additionally include any study on MSA in which information on the applied technique, e.g. conventional or piezosurgery, w...
Atieh [11] found no significant difference in perforation risk. In these studies, occurred in the two groups of the RCTs are almost identical perforations. Maybe due to the fact that they included only one RS, while our study included 22, they see no deviation.
The review of Stacchi [12] also described a lower incidence of membrane perforation during piezosurgery (10.9%) than during conventional ...
Though both techniques exist more than 20 years, only single studies could be found in which the incidence of membrane perforation was focused comparing both operative techniques. This was the rationale for our meta-analysis. Principally, there is a controversy in the literature concerning the use of piezosurgical devices for MSA. Torrella et al. showed a reduced risk for perforations of the sinu...
Finally, a significance analysis was performed between both groups in terms of a t test. The significance level was set at p
The database PubMed and the US National Library of Medicine were screened from January 8, 2012, to January 6, 2016, for potential studies reporting on membrane perforations during MSA from 1980 till 2015. The search was conducted independently and in duplicate by two authors (MK and JC). The following search terms were used:
MeSH Terms:
Piezo-surgery
Ultrasound
Ultrasonic Osteotomy
Maxillary ...
Atieh et al. [11] examined the intra- and postoperative events associated with the use of piezoelectric devices and conventional rotary instruments for lateral MSA in a systematic review. They included four studies with 178 lateral MSA in 120 participants. The meta-analysis did not show any significant difference between the two surgical techniques. Stacchi et al. [12] analysed the occurrence of i...
Maxillary sinus augmentation (MSA) is a successful and predictable procedure to rehabilitate the atrophic edentulous posterior maxilla after postextractional pneumatisation of the sinus and bone loss with dental implants. Different approaches to elevate the maxillary sinus floor have been described and were originally introduced by Tatum [1, 2]. The lateral approach provides drilling a window in t...
Maxillary sinus augmentation (MSA) is a successful and predictable intervention with low complication rates. Perforations of the Schneiderian membrane may occur impairing the general success. The aim of this study was to compare the incidence of membrane perforations between conventional rotating instruments and piezoelectric devices in a meta-analysis.
An electronic research on MEDLINE and PubMe...
Fig. 7. Box and Whisker plot representing median and range values of membrane thicknesses with different morphologies
Fig. 7. Box and Whisker plot representing median and range values of membrane thicknesses with different morphologies
Fig. 6. Box plot representing mean values of membrane thicknesses for the investigated groups
Fig. 6. Box plot representing mean values of membrane thicknesses for the investigated groups
Fig. 5. Endoscopic view from the crestal osteotomy site showing perforation of the sinus lining under the power of magnification and illumination of the endoscope
Fig. 5. Endoscopic view from the crestal osteotomy site showing perforation of the sinus lining under the power of magnification and illumination of the endoscope
Fig. 4. Schematic drawing showing entrance of the endoscope from the crestal osteotomy site after sinus membrane elevation to assess the integrity of the membrane
Fig. 4. Schematic drawing showing entrance of the endoscope from the crestal osteotomy site after sinus membrane elevation to assess the integrity of the membrane
Fig. 3. Endoscopic view from the lateral sinus wall showing the dome-shape elevation of sinus lining
Fig. 3. Endoscopic view from the lateral sinus wall showing the dome-shape elevation of sinus lining
Fig. 2. Malleting instruments supplied from InnoBioSurg (IBS) Company, Korea. a magic sinus splitter: used to widen and split the crest. b magic sinus lifter: used to lift the available bone with its attached membrane
Fig. 2. Malleting instruments supplied from InnoBioSurg (IBS) Company, Korea. a magic sinus splitter: used to widen and split the crest. b magic sinus lifter: used to lift the a...
Fig. 1. A trephined hole (4 mm bone) in the lateral wall of the maxillary sinus to allow entrance of the endoscope
Fig. 1. A trephined hole (4 mm bone) in the lateral wall of the maxillary sinus to allow entrance of the endoscope
Morphology
No perforation
Perforation
P value
No. (%)
No. (%)
Flat (n = 4)
...
Morphology
Mean ± SD (mm)
Median (range)
P value
Perforation rate (%)
Flat (n = 4)
...
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No perforation
Perforation
P value
No. (%)
No. (%)
Group (A)
...
Group
Membrane thickness
Mean ± SD (mm)
Median (range)
Percentage (%) (from total)
Perforation rate (%...
Elian, S., Barakat, K. Crestal endoscopic approach for evaluating sinus membrane elevation technique.
Int J Implant Dent 4, 15 (2018). https://doi.org/10.1186/s40729-018-0126-6
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Received: 08 November 2017
Accepted: 20 March 2018
Published: 17 May 2018
DOI: https://doi.org/10.1186/s40729-018-0126-6
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 m...
Faculty of Dentistry, Minia University ethics committee approved the study. All patients gave the consent to participate in the surgery.
All patients approved for publications.
The authors Samy Elian and Khaled Barakat declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Faculty of Dentistry, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
Samy Elian
Faculty of Dental Surgery, Royal College of Physicians and Surgeons of Glasgow, Glasgow, Scotland
Samy Elian
Dentistry Department, Sohag University Hospital, Sohag, Egypt
Samy Elian
Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Minya University, Minya, Egypt
Khaled Barakat
You c...
We would like to express our gratitude to Ass. Prof. Hamed Gad for his clinical collaboration.
This research was carried out without funding.
The data supporting our findings can be requested for free at any time.
Berengo M, Sivolella S, Majzoub Z, Cordioli G. Endoscopic evaluation of the bone-added osteotome sinus floor elevation procedure. Int J Oral Maxillofac Surg. 2004;33(2):189–94.
Nkenke E, Schlegel A, Schultze-Mosgau S, Neukam FW, Wiltfang J. The endoscopically controlled osteotome sinus floor elevation: a preliminary prospective study. Int J Oral Maxillofac Implants. 2002;17(4):557–66.
Nahlie...
Summers RB. A new concept in maxillary implant surgery: the osteotome technique. Compendium. 1994;15(2):152. 54-6, 58 passim; quiz 62
Zitzmann NU, Scharer P. Sinus elevation procedures in the resorbed posterior maxilla. Comparison of the crestal and lateral approaches. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(1):8–17.
Ardekian L, Oved-Peleg E, Mactei EE, Peled M. The clinical ...
Crestal sinus lifting technique is a simple less invasive procedure. Nevertheless, it suffers a serious disadvantage of being a blind technique. Thus, perforation can easily occur without being detected which will lead to later implant failure especially when bone graft is added [1, 12,13,14]. We used endoscopic-assisted evaluation as a dependable method to assess the safety of the Schneiderian me...
On the other hand, assessing the effect of membrane morphology pattern on the perforation risk revealed that the polyp type has the lowest risk of perforation, whereas the irregular type represents the most insecure pattern. There was a relation between different membrane morphology and perforation.
All patients tolerated the procedure without major complications. Minor complications included postoperative swelling, edema, and pain that were managed by antibiotic and anti-inflammatory drugs. All implants were successfully osseo-integrated and loaded after about 6 months.
The floor was lifted without perforation in 83.33% of cases. The lifter was able to raise and stretch the sinus membrane ...
After completing the elevation of the Schneiderian membrane, the endoscope (70° lens) was removed from the lateral wall of the maxillary sinus and re-inserted (with 0°) from the crestal osteotomy site of the implant (Fig. 4) to check the integrity of the Schneiderian membrane, as well as to ensure the absence of any undetected minor perforation (Fig. 5). The implant was finally inserted in the...
Twelve patients (4 males and 8 females) ranging in age from 25 to 60 years were included in the study. All patients have bone height ranging 3–5 mm below the sinus membrane. They all performed closed sinus lifting and simultaneous immediate implant insertion.
Under local anesthesia, the flap was elevated and retracted exposing the crestal and buccal bone. A trephine bur 4 mm diameter on hand...
The evolution of closed sinus lift techniques since 1994 [1] was proposed as a less invasive method for management of atrophic posterior maxillae [2]. However, it is a blind technique that lacks the ability to confirm an intact sinus floor elevation without perforation and thus represented a real shortcoming [3]. Various forms of osteotome lifters were designed to guarantee safe elevation of maxil...
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...