Oral implants in patients receiving bisphosphonates: a review and update

This review is made to establish the convenience of dental implant treatment in patients receiving bisphosphonates or programmed to receive such drugs, with a description of their mechanisms of action and the way in which they can affect the mandibular or maxillary bone of dental implant candidates. In turn, a description is provided of the key elements for evaluating the benefit-risk ratio in patients treated with bisphosphonates who require oral surgery. Clinicians must be aware of the potential risk of osteonecrosis in patients treated with bisphosphonates via the oral or intravenous route. When bisphosphonates are administered via the intravenous route, all invasive oral procedures (including implant surgery) are contraindicated, and should be avoided unless absolutely necessary. The indications are more controversial in the case of bisphosphonates administered via the oral route. There is little literature on the influence of oral bisphosphonates upon bone repair, and there are not many published cases of mandibular or maxillary osteonecrosis among patients that receive such medication. The use of bisphosphonates is becoming increasingly widespread, and the duration of such treatment is increasing. It would be of interest to design studies to evaluate the risk factors of maxillary osteonecrosis among dental implant patients receiving treatment with oral bisphosphonates, and to define biomarkers capable of indicating the level of risk in the event of oral surgery in patients receiving such drugs.