Skip to main content
SpringerLink
Log in

Antiresorptive therapy and dental implant survival: an up to 20-year retrospective cohort study in women

Clinical Oral Investigations Aims and scope Submit manuscript

Cite this article

Abstract

Objectives

To investigate the effects of antiresorptive treatment on the survival of plateau-root form dental implants.

Materials and methods

Patients undergoing antiresorptive therapy via oral or intravenous administration as well as patients not undergoing antiresorptive therapy and healthy control patients were included in this retrospective cohort study. In total, 1472 implants placed in 631 postmenopausal patients (M: 66.42 ± 9.10 years old), who were followed for a period of up to 20 years (8.78 ± 5.68 years). Kaplan–Meier survival analysis was performed, and univariate and multivariate Cox regression, clustered by each patient, was used to evaluate and study factors affecting the survival of their implants.

Results

Implants placed in patients undergoing oral antiresorptive treatment presented significantly higher survival rates, than implants placed in the osteoporosis/osteopenia control cohort (p value < 0.001), and similar survival rates, when compared to healthy controls (p value = 0.03). Additionally, clustered univariate and multivariate Cox regression analysis also revealed higher implant survival when oral antiresorptive drugs (p value = 0.01 and 0.007, respectively) were used, and lower implant survival in the presence of untreated osteoporosis/osteopenia (p value = 0.002 and 0.005, respectively). Overall, the 20-year implant survival in osteoporotic patients undergoing antiresorptive therapy was 94%. For the failed implants, newly replaced implants in patients under antiresorptive treatment presented a 10-year survival of 89%.

Conclusions

Long-term plateau-root form implant survival in osteoporotic patients taking oral antiresorptives was similar to a healthy population and significantly higher than the untreated controls.

Clinical relevance

These results suggest that plateau-root form implants provide a robust solution for treating tooth loss in patients, who are undergoing antiresorptive therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Duong HY, Roccuzzo A, Stahli A, Salvi GE, Lang NP, Sculean A (2022) Oral health-related quality of life of patients rehabilitated with fixed and removable implant-supported dental prostheses. Periodontol 2000 88(1):201–237

    Article  PubMed  PubMed Central  Google Scholar 

  2. Buser D, Sennerby L, De Bruyn H (2017) Modern implant dentistry based on osseointegration: 50 years of progress, current trends and open questions. Periodontol 2000 73(1):7–21

    Article  PubMed  Google Scholar 

  3. Chang AY, Skirbekk VF, Tyrovolas S, Kassebaum NJ, Dieleman JL (2019) Measuring population ageing: an analysis of the Global Burden of Disease Study 2017. Lancet Public Health 4(3):e159–e167

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chau SH, Jansen AP, van de Ven PM, Hoogland P, Elders PJ, Hugtenburg JG (2016) Clinical medication reviews in elderly patients with polypharmacy: a cross-sectional study on drug-related problems in the Netherlands. Int J Clin Pharm 38(1):46–53

    Article  PubMed  Google Scholar 

  5. de Oliveira P, Bonfante EA, Bergamo ETP, de Souza SLS, Riella L, Torroni A, Benalcazar Jalkh EB, Witek L, Lopez CD, Zambuzzi WF, Coelho PG (2020) Obesity/metabolic syndrome and diabetes mellitus on peri-implantitis. Trends Endocrinol Metab 31(8):596–610

    Article  PubMed  Google Scholar 

  6. Giro G, Chambrone L, Goldstein A, Rodrigues JA, Zenobio E, Feres M, Figueiredo LC, Cassoni A, Shibli JA (2015) Impact of osteoporosis in dental implants: A systematic review. World J Orthop 6(2):311–315

    Article  PubMed  PubMed Central  Google Scholar 

  7. Consensus Development Conference (1993) Diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94(6):646–650

    Article  Google Scholar 

  8. Kanis JA (2007) Assessment of osteoporosis at the primary health-care level. Technical report. In: World health organization collaborating centre for metabolic bone diseases. University of Sheffield, UK

    Google Scholar 

  9. Seeman E (2002) Pathogenesis of bone fragility in women and men. Lancet 359(9320):1841–1850

    Article  PubMed  Google Scholar 

  10. Riggs BL, Melton LJ 3rd (1986) Involutional osteoporosis. N Engl J Med 314(26):1676–1686

    Article  PubMed  Google Scholar 

  11. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767

    Article  PubMed  Google Scholar 

  12. Black DM, Rosen CJ (2016) Postmenopausal osteoporosis. N Engl J Med 374(21):2096–2097

    PubMed  Google Scholar 

  13. Clynes MA, Harvey NC, Curtis EM, Fuggle NR, Dennison EM, Cooper C (2020) The epidemiology of osteoporosis. Br Med Bull 133(1):105–117

    PubMed  Google Scholar 

  14. Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D (2019) Pharmacological management of osteoporosis in postmenopausal women: an endocrine society* clinical practice guideline. J Clin Endocrinol Metab 104(5):1595–1622

    Article  PubMed  Google Scholar 

  15. Baron R, Ferrari S, Russell RG (2011) Denosumab and bisphosphonates: different mechanisms of action and effects. Bone 48(4):677–692

    Article  PubMed  Google Scholar 

  16. Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, Reid IR, Ruggiero SL, Taguchi A, Tetradis S, Watts NB, Brandi ML, Peters E, Guise T, Eastell R, Cheung AM, Morin SN, Masri B, Cooper C et al (2015) International task force on osteonecrosis of the, diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res 30(1):3–23

    Article  PubMed  Google Scholar 

  17. Temmerman A, Rasmusson L, Kubler A, Thor A, Quirynen M (2017) An open, prospective, non-randomized, controlled, multicentre study to evaluate the clinical outcome of implant treatment in women over 60 years of age with osteoporosis/osteopenia: 1-year results. Clin Oral Implants Res 28(1):95–102

    Article  PubMed  Google Scholar 

  18. Matsuo A, Hamada H, Takahashi H, Okamoto A, Kaise H, Chikazu D (2016) Evaluation of dental implants as a risk factor for the development of bisphosphonate-related osteonecrosis of the jaw in breast cancer patients. Odontology 104(3):363–371

    Article  PubMed  Google Scholar 

  19. 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: a retrospective cohort study. Osteoporos Int 31(9):1749–1758

    Article  PubMed  Google Scholar 

  20. Pichardo SEC, van der Hee JG, Fiocco M, Appelman-Dijkstra NM, van Merkesteyn JPR (2020) Dental implants as risk factors for patients with medication-related osteonecrosis of the jaws (MRONJ). Br J Oral Maxillofac Surg 58(7):771–776

    Article  PubMed  Google Scholar 

  21. Holzinger D, Seemann R, Matoni N, Ewers R, Millesi W, Wutzl A (2014) Effect of dental implants on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 72(10):1937 e1-8

    Article  PubMed  Google Scholar 

  22. Wutzl A, Biedermann E, Wanschitz F, Seemann R, Klug C, Baumann A, Watzinger F, Schicho K, Ewers R, Millesi G (2008) Treatment results of bisphosphonate-related osteonecrosis of the jaws. Head Neck 30(9):1224–1230

    Article  PubMed  Google Scholar 

  23. Wutzl A, Pohl S, Sulzbacher I, Seemann R, Lauer G, Ewers R, Drach J, Klug C (2012) Factors influencing surgical treatment of bisphosphonate-related osteonecrosis of the jaws. Head Neck 34(2):194–200

    Article  PubMed  Google Scholar 

  24. Holzinger D, Seemann R, Klug C, Ewers R, Millesi G, Baumann A, Wutzl A (2013) Long-term success of surgery in bisphosphonate-related osteonecrosis of the jaws (BRONJs). Oral Oncol 49(1):66–70

    Article  PubMed  Google Scholar 

  25. Madrid C, Sanz M (2009) What impact do systemically administrated bisphosphonates have on oral implant therapy? A systematic review. Clin Oral Implants Res 20(Suppl 4):87–95

    Article  PubMed  Google Scholar 

  26. Guazzo R, Sbricoli L, Ricci S, Bressan E, Piattelli A, Iaculli F (2017) Medication-related osteonecrosis of the jaw and dental implants failures: a systematic review. J Oral Implantol 43(1):51–57

    Article  PubMed  Google Scholar 

  27. Stavropoulos A, Bertl K, Pietschmann P, Pandis N, Schiodt M, Klinge B (2018) The effect of antiresorptive drugs on implant therapy: Systematic review and meta-analysis. Clin Oral Implants Res 29(Suppl 18):54–92

    Article  PubMed  Google Scholar 

  28. Schliephake H (2000) The role of systemic diseases and local conditions as risk factors. Periodontol 2000 88(1):36–51

    Article  Google Scholar 

  29. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O'Ryan F (2014) American Association of S. Maxillofacial, American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg 72(10):1938–1956

    Article  PubMed  Google Scholar 

  30. Aghaloo T, Pi-Anfruns J, Moshaverinia A, Sim D, Grogan T, Hadaya D (2019) The effects of systemic diseases and medications on implant osseointegration: a systematic review. Int J Oral Maxillofac Implants 34:s35–s49

    Article  PubMed  Google Scholar 

  31. Fretwurst T, Nelson K (2021) Influence of medical and geriatric factors on implant success: an overview of systematic reviews. Int J Prosthodont 34:s21–s26

    Article  PubMed  Google Scholar 

  32. Gelazius R, Poskevicius L, Sakavicius D, Grimuta V, Juodzbalys G (2018) Dental implant placement in patients on bisphosphonate therapy: a systematic review. J Oral Maxillofac Res 9(3):e2

    Article  PubMed  PubMed Central  Google Scholar 

  33. Schwarz F, Schar A, Nelson K, Fretwurst T, Flugge T, Ramanauskaite A, Trimpou G, Sailer I, Karasan D, Fehmer V, Guerra F, Messias A, Nicolau P, Chochlidakis K, Tsigarida A, Kernen F, Taylor T, Vazouras K, Herklotz I, Sader R (2021) Recommendations for implant-supported full-arch rehabilitations in edentulous patients: the oral reconstruction foundation consensus report. Int J Prosthodont 34:s8–s20

    Article  PubMed  Google Scholar 

  34. Escobedo MF, Cobo JL, Junquera S, Milla J, Olay S, Junquera LM (2020) Medication-related osteonecrosis of the jaw. Implant presence-triggered osteonecrosis: Case series and literature review. J Stomatol Oral Maxillofac Surg 121(1):40–48

    Article  PubMed  Google Scholar 

  35. Giovannacci I, Meleti M, Manfredi M, Mortellaro C, Greco Lucchina A, Bonanini M, Vescovi P (2016) Medication-related osteonecrosis of the jaw around dental implants: implant surgery-triggered or implant presence-triggered osteonecrosis? J Craniofac Surg 27(3):697–701

    Article  PubMed  Google Scholar 

  36. Carr AB, Revuru VS, Lohse CM (2019) Risk of dental implant failure associated with medication use. J Prosthodont 28(7):743–749

    Article  PubMed  Google Scholar 

  37. Petsinis V, Kamperos G, Alexandridi F, Alexandridis K (2017) The impact of glucocorticosteroids administered for systemic diseases on the osseointegration and survival of dental implants placed without bone grafting-A retrospective study in 31 patients. J Craniomaxillofac Surg 45(8):1197–1200

    Article  PubMed  Google Scholar 

  38. Chuang SK, Tian L, Wei LJ, Dodson TB (2001) Kaplan-Meier analysis of dental implant survival: a strategy for estimating survival with clustered observations. J Dent Res 80(11):2016–2020

    Article  PubMed  Google Scholar 

  39. Watts NB, Grbic JT, Binkley N, Papapoulos S, Butler PW, Yin X, Tierney A, Wagman RB, McClung M (2019) Invasive oral procedures and events in postmenopausal women with osteoporosis treated with denosumab for up to 10 years. J Clin Endocrinol Metab 104(6):2443–2452

    Article  PubMed  Google Scholar 

  40. Otomo-Corgel J (2012) Osteoporosis and osteopenia: implications for periodontal and implant therapy. Periodontol 2000 59(1):111–139

    Article  PubMed  Google Scholar 

  41. Tomasi C, Derks J (2022) Etiology, occurrence, and consequences of implant loss. Periodontol 2000 88(1):13–35

    Article  PubMed  PubMed Central  Google Scholar 

  42. Basudan AM, Shaheen MY, de Vries RB, van den Beucken J, Jansen JA, Alghamdi HS (2019) antiosteoporotic drugs to promote bone regeneration related to titanium implants: a systematic review and meta-analysis. Tissue Eng Part B Rev 25(2):89–99

    Article  PubMed  Google Scholar 

  43. Lu B, Zhang X, Liu B (2021) A systematic review and meta-analysis on influencing factors of failure of oral implant restoration treatment. Ann Palliat Med 10(12):12664–12677

    Article  PubMed  Google Scholar 

  44. Walter C, Al-Nawas B, Wolff T, Schiegnitz E, Grotz KA (2016) Dental implants in patients treated with antiresorptive medication - a systematic literature review. Int J Implant Dent 2(1):9

    Article  PubMed  PubMed Central  Google Scholar 

  45. de Medeiros F, Kudo GAH, Leme BG, Saraiva PP, Verri FR, Honorio HM, Pellizzer EP, Santiago Junior JF (2018) Dental implants in patients with osteoporosis: a systematic review with meta-analysis. Int J Oral Maxillofac Surg 47(4):480–491

    Article  PubMed  Google Scholar 

  46. Grisa A, Veitz-Keenan A (2018) Is osteoporosis a risk factor for implant survival or failure? Evid Based Dent 19(2):51–52

    Article  PubMed  Google Scholar 

  47. Compston JE, McClung MR, Leslie WD (2019) Osteoporosis. Lancet 393(10169):364–376

    Article  PubMed  Google Scholar 

  48. D. (2001) NIH consensus development panel on osteoporosis prevention, therapy, osteoporosis prevention, diagnosis, and therapy. JAMA 285(6):785–795

    Google Scholar 

  49. Urdaneta RA, Daher S, Leary J, Emanuel KM, Chuang SK (2012) The survival of ultrashort locking-taper implants. Int J Oral Maxillofac Implants 27(3):644–654

    PubMed  Google Scholar 

  50. Lombardo G, Marincola M, Signoriello A, Corrocher G, Nocini PF (2020) Single-crown, short and ultra-short implants, in association with simultaneous internal sinus lift in the atrophic posterior maxilla: a three-year retrospective study. Materials (Basel) 13(9)

  51. Lombardo G, Signoriello A, Marincola M, Nocini PF (2020) Assessment of peri-implant soft tissues conditions around short and ultra-short implant-supported single crowns: a 3-year retrospective study on periodontally healthy patients and patients with a history of periodontal disease. Int J Environ Res Public Health 17(24)

  52. Lombardo G, Signoriello A, Simancas-Pallares M, Marincola M, Nocini PF (2020) Survival of short and ultra-short locking-taper implants supporting single crowns in the posterior mandible: a 3-year retrospective study. J Oral Implantol 46(4):396–406

    Article  PubMed  Google Scholar 

  53. Sailer I, Karasan D, Todorovic A, Ligoutsikou M, Pjetursson BE (2022) Prosthetic failures in dental implant therapy. Periodontol 2000 88(1):130-144

  54. Naujokat H, Kunzendorf B, Wiltfang J (2016) Dental implants and diabetes mellitus-a systematic review. Int J Implant Dent 2(1):5

    Article  PubMed  PubMed Central  Google Scholar 

  55. Xiao JR, Li YF, Guan SM, Song L, Xu LX, Kong L (2011) The biomechanical analysis of simulating implants in function under osteoporotic jawbone by comparing cylindrical, apical tapered, neck tapered, and expandable type implants: a 3-dimensional finite element analysis. J Oral Maxillofac Surg 69(7):e273–e281

    Article  PubMed  Google Scholar 

  56. Agarwal R, Gonzalez-Garcia C, Torstrick B, Guldberg RE, Salmeron-Sanchez M, Garcia AJ (2015) Simple coating with fibronectin fragment enhances stainless steel screw osseointegration in healthy and osteoporotic rats. Biomaterials 63:137–145

    Article  PubMed  PubMed Central  Google Scholar 

  57. Ashrafi M, Ghalichi F, Mirzakouchaki B, Doblare M (2021) On the effect of antiresorptive drugs on the bone remodeling of the mandible after dental implantation: a mathematical model. Sci Rep 11(1):2792

    Article  PubMed  PubMed Central  Google Scholar 

  58. Bonfante EA, Jimbo R, Witek L, Tovar N, Neiva R, Torroni A, Coelho PG (2019) Biomaterial and biomechanical considerations to prevent risks in implant therapy. Periodontol 2000 81(1):139-151

  59. Coelho PG, Jimbo R (2014) Osseointegration of metallic devices: current trends based on implant hardware design. Arch Biochem Biophys 561:99–108

    Article  PubMed  Google Scholar 

  60. Coelho PG, Jimbo R, Tovar N, Bonfante EA (2015) Osseointegration: hierarchical designing encompassing the macrometer, micrometer, and nanometer length scales. Dent Mater 31(1):37–52

    Article  PubMed  Google Scholar 

  61. Coelho PG, Suzuki M, Marin C, Granato R, Gil LF, Tovar N, Jimbo R, Neiva R, Bonfante EA (2015) Osseointegration of plateau root form implants: unique healing pathway leading to haversian-like long-term morphology. Adv Exp Med Biol 881:111–128

    Article  PubMed  Google Scholar 

  62. Coelho PG, Bonfante EA, Marin C, Granato R, Giro G, Suzuki M (2010) A human retrieval study of plasma-sprayed hydroxyapatite-coated plateau root form implants after 2 months to 13 years in function. J Long Term Eff Med Implants 20(4):335–342

    Article  PubMed  Google Scholar 

  63. Coelho PG, Marin C, Granato R, Suzuki M (2009) Histomorphologic analysis of 30 plateau root form implants retrieved after 8 to 13 years in function. A human retrieval study. J Biomed Mater Res B Appl Biomater 91(2):975–979

    Article  PubMed  Google Scholar 

  64. Gil LF, Suzuki M, Janal MN, Tovar N, Marin C, Granato R, Bonfante EA, Jimbo R, Gil JN, Coelho PG (2015) Progressive plateau root form dental implant osseointegration: A human retrieval study. J Biomed Mater Res B Appl Biomater 103(6):1328–1332

    Article  PubMed  Google Scholar 

  65. Baldassarri M, Bonfante E, Suzuki M, Marin C, Granato R, Tovar N, Coelho PG (2012) Mechanical properties of human bone surrounding plateau root form implants retrieved after 0.3-24 years of function. J Biomed Mater Res B Appl Biomater 100(7):2015–2021

    Article  PubMed  Google Scholar 

  66. Khan A, Morrison A, Cheung A, Hashem W, Compston J (2016) Osteonecrosis of the jaw (ONJ): diagnosis and management in 2015. Osteoporos Int 27(3):853–859

    Article  PubMed  Google Scholar 

  67. Yarom N, Yahalom R, Shoshani Y, Hamed W, Regev E, Elad S (2007) Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, clinical features, predisposing factors and treatment outcome. Osteoporos Int 18(10):1363–1370

    Article  PubMed  Google Scholar 

  68. Khosla S, Shane E (2016) A Crisis in the Treatment of Osteoporosis. J Bone Miner Res 31(8):1485–1487

    Article  PubMed  Google Scholar 

  69. Khosla S, Cauley JA, Compston J, Kiel DP, Rosen C, Saag KG, Shane E (2017) Addressing the crisis in the treatment of osteoporosis: a path forward. J Bone Miner Res 32(3):424–430

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors acknowledge FAPESP grants #2021/06730-7, #2019/08693-1 and BEPE 2021/08108-2, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) grants #307255/2021-2, and CAPES Finance Code 001.

Author information

Authors and Affiliations

  1. Department of Biology, Massachusetts Institute of Technology, Cambridge, MA, USA

    Yu-Chi Cheng

  2. University Hospital for Cranio-Maxillofacial and Oral Surgery and CMF Institute Vienna, Vienna, Austria

    Rolf Ewers

  3. Implant Dentistry Centre, Boston, MA, USA

    Katherine Morgan, Muneki Hirayama, Laura Murcko & John Morgan

  4. Department of Prosthodontics and Periodontology, University of Sao Paulo – Bauru School of Dentistry, 9-75 Octavio Pinheiro Brizola, Bauru, SP, 17012-901, Brazil

    Edmara T. P. Bergamo & Estevam A. Bonfante

Authors
  1. Yu-Chi Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rolf Ewers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katherine Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Muneki Hirayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laura Murcko
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Edmara T. P. Bergamo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Estevam A. Bonfante
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edmara T. P. Bergamo.

Ethics declarations

Ethical approval

This retrospective cohort study was approved by an Institutional Review Board (NEIRB# 14-338, 2014).

Informed consent

All patients signed an informed consent and authorized the disclosure of their health information.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 4845 kb)

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cheng, YC., Ewers, R., Morgan, K. et al. Antiresorptive therapy and dental implant survival: an up to 20-year retrospective cohort study in women. Clin Oral Invest 26, 6569–6582 (2022). https://doi.org/10.1007/s00784-022-04609-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-022-04609-4

Keywords

search

Navigation