Research update: osteoporosis and implants

osteoporosis

Implant Dentistry Today presents the latest papers published on osteoporosis.

Tabrizi R, Mousavi F, Ghasemi S, Ozkan BT (2020)

Does osteoporosis increase marginal bone loss around dental implants in the posterior of the maxilla?

Int J Oral Maxillofac Surg 50(7): 964-968

The aim of this study was to compare the marginal bone loss (MBL) around dental implants placed in the posterior maxilla between osteoporotic and non-osteoporotic female patients. This was a prospective cohort study. Female patients needing a dental implant restoration in the posterior maxilla were included. Dual-energy X-ray absorptiometry was performed and the T-score recorded. MBL was measured at 12 months after loading.

The patients were assigned to one of two groups: group 1, osteoporotic (T-score ≥2.5); group 2, non-osteoporotic (T-score <2.5). In this study, osteoporosis was the primary predictor variable and MBL was the outcome variable. The mean MBL was compared between the two groups using an independent t-test. Pearson’s correlation test was applied to identify any correlation between the T-score and MBL. Ninety female patients were studied, 44 in group 1 and 46 in group 2.

The mean MBL was 1.20±0.29mm in group 1 and 0.87±0.15 in group 2; this difference in mean MBL was statistically significant (P=0.001). There was a correlation between T-score and MBL (P=0.001). Despite the correlation between T-score and MBL, this study did not provide enough evidence to prove any causal relationship between MBL and osteoporosis.

Kim JY, Choi H, Park JH, Jung HD, Jung YS (2020)

Effects of anti-resorptive drugs on implant survival and peri-implantitis in patients with existing osseointegrated dental implants

Osteoporos Int 31(9):1749-1758

The effect of anti-resorptive drug (ARD) usage among patients with successful dental implant osseointegration is controversial. This study showed an increased risk of implant failure in ARD users. Risk factors included pre-existing marginal bone loss, overdenture, diabetes, and a short interval between implant placement and ARD administration.

This retrospective study aimed to determine whether ARD usage increased risk of implant failure in patients with successful osseointegration. It investigated risk factors that affected implant survival rate in ARD users.

Implant survival rates were 89.83% in ARD users and 96.03% in non-ARD users. In the univariate Cox proportional hazard model, risk of implant failure was significantly higher in patients with pre-existing marginal bone loss (MBL), diabetes, and concurrent bone augmentation. However, risk of implant failure was significantly lower when the interval between implant placement and ARD administration was < 36 months. Compared with overdenture, single crown and fixed splinted users had lower risk of implant failure. In multivariate analysis, variables including pre-existing MBL, diabetes, < 36-month interval between implant placement and ARD treatment, and usage of fixed splinted prosthesis were significantly associated with increased risk of implant failure.

ARD administration after implant osseointegration was correlated with a reduced implant survival rate. Pre-existing MBL, diabetes, type of final prosthesis, and the interval between implant placement and initiation of ARD administration influenced risk of implant failure.

Sher J, Kirkham-Ali K, Luo JD, Miller C, Sharma D (2021)

Dental implant placement in patients with a history of medications related to osteonecrosis of the jaws

J Oral Implantol 47(3): 249-268

The present systematic review evaluates the safety of placing dental implants in patients with a history of antiresorptive or antiangiogenic drug therapy. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Pubmed, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Opengrey databases were used to search for clinical studies (English only) to July 16, 2019.

Study quality was assessed regarding randomisation, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting. Also, other biases using a modified Newcastle-Ottawa scale and the Joanna Briggs Institute critical appraisal checklist for case series. A broad search strategy resulted in the identification of 7,542 studies. There were 28 studies reporting on bisphosphonates (five cohort, six case control, and 17 case series). There was one study reporting on denosumab (case series) that met the inclusion criteria and were included in the qualitative synthesis. The quality assessment revealed an overall moderate quality of evidence among the studies.

Results demonstrated that patients with a history of bisphosphonate treatment for osteoporosis are not at increased risk of implant failure in terms of osseointegration. However, all patients with a history of bisphosphonate treatment, whether taken orally for osteoporosis or intravenously for malignancy, appear to be at risk of ‘implant surgery-triggered’ medication-related osteonecrosis of the jaw (MRONJ). In contrast, the risk of MRONJ in patients treated with denosumab for osteoporosis was found to be negligible.

In conclusion, general and specialist dentists should exercise caution when planning dental implant therapy in patients with a history of bisphosphonate and denosumab drug therapy. Importantly, all patients with a history of bisphosphonates are at risk of MRONJ, necessitating this to be included in the informed consent obtained before implant placement.

This article first appeared in Implant Dentistry Today magazine. You can read the latest issue here. 

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