Antiresorptive therapy influence on peri-implant diseases: Clinical implications and osteoimmunological perspectives

Antiresorptive therapy represents a cornerstone in the management of osteoporosis and cancer-related bone disease through suppression of osteoclast-mediated bone resorption. As implant therapy becomes more common in aging populations, clinicians increasingly encounter patients receiving these medications, thus making their impact on peri-implant tissues clinically relevant.

This narrative review critically examines clinical evidence on implant survival, peri-implant bone stability, peri-implantitis progression, and treatment considerations in patients receiving antiresorptive therapy, while integrating mechanistic insights.

Evidence suggests that implant survival and marginal bone loss in osteoporotic patients are generally comparable to untreated individuals, indicating that suppression of bone resorption does not inherently compromise osseointegration. However, these outcomes may not fully reflect peri-implant tissue dynamics. Antiresorptives alter osteoclast functions and bone remodeling, potentially affecting the osteoimmune balance required to adapt to mechanical and oral microbial challenges. While these effects may remain subclinical under healthy conditions, they may become relevant during chronic peri-implant inflammation or repeated surgical interventions, where remodeling demands are increased. Altered remodeling may result in lesion persistence, impaired structural recovery, and late complications. Although medication-related osteonecrosis of the jaw remains rare, antiresorptives may modify osteoimmune interactions within inflamed tissues. Therefore, peri-implantitis may act as a contextual modifier influencing healing outcomes.

Antiresorptive therapy should not be regarded as an absolute contraindication to implant therapy in appropriately selected patients, particularly those receiving osteoporosis-dose regimens. However, chronic peri-implant inflammation, repeated surgical intervention, and high-dose oncologic antiresorptive exposure may impair osteoimmune adaptation and increase susceptibility to delayed healing and MRONJ-related complications.

Early control of peri-implant inflammation, individualized risk stratification, and strict supportive maintenance should be considered central components of clinical management in antiresorptive-exposed patients.