Effects of Bisphosphonates and Denosumab on Dental Implants: A Systematic Review With Meta-Analysis

This review aimed to evaluate the effects of bisphosphonates (BP) and denosumab on dental implants, including implant failure (IF), marginal bone loss (MBL), and medication-related osteonecrosis of the jaw (MRONJ).

A literature search was conducted in four databases and OpenGrey. Studies examining IF/MBL/MBRONJ associated with BP or denosumab were included. ROBINS-I was used to assess the risk of bias. Trial sequential analysis and the GRADE approach were used to examine the certainty of evidence. Statistical analyses were conducted using R version 4.3.1.

Twenty-one studies were included. BP was associated with IF only at the implant level (RR 1.74; 95% CI: 1.10-2.75) but not at the patient level (RR 1.01; 95% CI: 0.35-2.91). The analysis of two studies indicated no significant correlation between BP and MBL (MD 0.05; 95% CI: -0.12 to 0.21). BP was associated with MRONJ (RR 3.45; 95% CI: 2.56-4.65), whereas denosumab showed no significant statistical correlation with MRONJ (RR 25.98; 95% CI: 0.31-2165.63).

In patients with dental implants, the existing very low certainty level evidence suggests that BP intake may be associated with greater risks of IF and MRONJ but not with MBL, whereas it is currently unknown whether denosumab is associated with MRONJ.