Medication-related osteonecrosis of the jaw and dental implants failures: a systematic review

No well-established evidences supporting the safe use of Bisphosphonates (BPs) or others antiresorptive agents prior, during or after dento-alveolar surgery, are currently available; moreover, the real risk of osteonecrosis of the jaw (ONJ) development is still unknown. The aim of the present systematic review was to assess the scientific literature concerning the implants placement in antiresorptive agents-users and the related risk of implants failure and ONJ development. English papers published from January 2003 until December 2014 were identified on Medline database. Titles and abstracts retrieved form electronic search were screened separately by two examiners; thus, original studies dealing with dental implants placement during or before bone antiresorptive agents therapy, and the relative risk of implant failure or development of osteonecrosis were evaluated. Due to the heterogeneity of the included studies and the high risk of bias, there is no evidence of the safe use of oral antiresorptive agents prior or after dental implant surgery. Indeed, implant failure and ONJ development can occur and represent a devastating side effect that should be considered during the treatment. Within the limitation of the present systematic review, high quality studies are needed to provide an adequate level of evidence regarding the safety of dento-alveolar surgery during or before bone resorption inhibition therapy, and the increase predisposition to osteonecrosis of the jaw (ONJ) development. Therefore, antiresorptive agents therapy should be considered a risk factor until further evidence is prospectively obtained.