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Efficacy of systemic bisphosphonate delivery on osseointegration of implants under osteoporotic conditions: lessons
Fahim Vohra1, Mohammad Qasim Al-Rifaiy1, Khalid Almas2
1Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, PO Box 60169, Riyadh 11545, Saudi Arabia.
Background:
The aim was to systematically review the role of systemic bisphosphonate (BP) delivery on osseointegration of implants under osteoporotic conditions.
Methods:
The addressed focused question was "Does systemic BP delivery enhance osseointegration of implants under osteoporotic conditions?" PubMed/MEDLINE and Google-Scholar databases were searched from 1994 up to and including December 2013 using different combinations of the following keywords: "bone to implant contact", "implant", "bisphosphonate", "osseointegration" and "osteoporosis". Review articles, case-reports, commentaries, letters to the Editor, unpublished articles and articles published in languages other than English were excluded.
Results:
Fifteen animal studies fulfilled our eligibility criteria. Osteoporotic conditions were induced via bilateral ovariectomy (OVX). BPs used in the studies were ibandronate, zoledronic acid and alendronate. Results from 12 studies showed that systemic BP delivery significantly increased bone volume and bone-to-implant contact under osteoporotic conditions. Two studies reported no significant difference in osseointegration among OVX animals with and without systemic BP delivery. In one study, systemic BP delivery negatively influenced implant osseointegration. Rough-surfaced and polished implants were used in 11 and one study respectively. In 3 studies implant surface characteristics remained unclear.
Conclusion:
Within the limits of the present study, it is concluded that systemic BP delivery enhances implant osseointegration in animals with induced osteoporotic conditions. However, in a clinical scenario, the potential risk of BP related ONJ in osteoporotic patients undergoing dental implant therapy cannot be disregarded.
