Skip to main content

Advertisement

SpringerLink
Log in

Osteopathology induced by bisphosphonates and dental implants: clinical observations

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

Although there are many reports about risk factors for the development of BP-associated osteonecrosis of the jaws, the role of dental implants as a local risk factor is still discussed, especially in patients with oral BP treatment. Until now, a few case reports and surveys display a possible minor risk in patients with oral BP therapy, whereas the avoidance of implant placement is generally accepted in patients with intravenous BP therapy.

Patient and methods

In this study, the cases of 14 patients with osteonecrosis of the jaws in association with BP therapy and dental implant placement were analyzed carefully with a detailed literature review.

Results

Of 14 patients, nine had underlying malignant disease and five patients had osteoporosis. In ten patients, implants were placed either in the posterior mandible or maxilla; the mean interval between implant insertion and disease onset was 20.9 months. Pain (n12) and signs of infection (n10) were the most common symptoms. Histologically, signs of infection were found in nine of 11 analyzed patients with presence of Actinomyces in six patients. Two patients turned out to have infiltration of underlying malignant disease.

Conclusions

Posteriorly placed implants seem to be of higher risk of development of osteonecrosis of the jaws. Not only the implant placement but also the inserted implant itself seems to be a continuous risk factor.

Clinical relevance

The herein elaborated risk factors help dentists plan dental rehabilitation with implants in this high-risk group of patients and indicate careful and regular dental recall.

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
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Marx RE (2003) Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 61:1115–1117

    Article  PubMed  Google Scholar 

  2. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B, Task Force on Bisphosphonate-Related Osteonecrosis of the Jaws AAoOaMS (2009) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaw—2009 update. Aust Endod J 35:119–130. doi:10.1111/j.1747-4477.2009.00213.x

    Article  PubMed  Google Scholar 

  3. Filleul O, Crompot E, Saussez S (2010) Bisphosphonate-induced osteonecrosis of the jaw: a review of 2,400 patient cases. J Cancer Res Clin Oncol 136:1117–1124. doi:10.1007/s00432-010-0907-7

    Article  PubMed  Google Scholar 

  4. Migliorati CA, Schubert MM, Peterson DE (2009) Bisphosphonate osteonecrosis (BON): unanswered questions and research possibilities. Rev Recent Clin Trials 4:99–109

    Article  PubMed  Google Scholar 

  5. Lodi G, Sardella A, Salis A, Demarosi F, Tarozzi M, Carrassi A (2010) Tooth extraction in patients taking intravenous bisphosphonates: a preventive protocol and case series. J Oral Maxillofac Surg 68:107–110. doi:10.1016/j.joms.2009.07.068

    Article  PubMed  Google Scholar 

  6. Hellstein JW, Marek CL (2006) Bisphosphonate induced osteochemonecrosis of the jaws: an ounce of prevention may be worth a pound of cure. Spec Care Dentist 26:8–12

    Article  PubMed  Google Scholar 

  7. Fehm T, Felsenberg D, Krimmel M, Solomayer E, Wallwiener D, Hadjii P (2009) Bisphosphonate-associated osteonecrosis of the jaw in breast cancer patients: recommendations for prevention and treatment. Breast 18:213–217. doi:10.1016/j.breast.2009.07.001

    Article  PubMed  Google Scholar 

  8. Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws AAoOaMS (2007) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 65:369–376. doi:10.1016/j.joms.2006.11.003

    Article  Google Scholar 

  9. Dannemann C, Grätz KW, Riener MO, Zwahlen RA (2007) Jaw osteonecrosis related to bisphosphonate therapy: a severe secondary disorder. Bone 40:828–834. doi:10.1016/j.bone.2006.11.023

    Article  PubMed  Google Scholar 

  10. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B, Surgeons AAoOaM (2009) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws—2009 update. J Oral Maxillofac Surg 67:2–12. doi:10.1016/j.joms.2009.01.009

    PubMed  Google Scholar 

  11. Fedele S, Kumar N, Davies R, Fiske J, Greening S, Porter S (2009) Dental management of patients at risk of osteochemonecrosis of the jaws: a critical review. Oral Dis 15:527–537. doi:10.1111/j.1601-0825.2009.01581.x

    Article  PubMed  Google Scholar 

  12. Abtahi J, Tengvall P, Aspenberg P (2010) Bisphosphonate coating might improve fixation of dental implants in the maxilla: a pilot study. Int J Oral Maxillofac Surg 39:673–677. doi:10.1016/j.ijom.2010.04.002

    Article  PubMed  Google Scholar 

  13. Zahid T, Wang B-Y, Cohen R (2010) Influence of bisphosphonates on alveolar bone loss around osseointegrated implants. J Oral Implantol. doi:10.1563/AAID-JOI-D-09-00114

  14. Bedogni A, Bettini G, Totola A, Saia G, Nocini PF (2010) Oral bisphosphonate-associated osteonecrosis of the jaw after implant surgery: a case report and literature review. J Oral Maxillofac Surg 68:1662–1666. doi:10.1016/j.joms.2010.02.037

    Article  PubMed  Google Scholar 

  15. Bell BM, Bell RE (2008) Oral bisphosphonates and dental implants: a retrospective study. J Oral Maxillofac Surg 66:1022–1024. doi:10.1016/j.joms.2007.12.040

    Article  PubMed  Google Scholar 

  16. Favia G, Piattelli A, Sportelli P, Capodiferro S, Iezzi G (2011) Osteonecrosis of the posterior mandible after implant insertion: a clinical and histological case report. Clin Implant Dent Relat Res 13:58–63. doi:10.1111/j.1708-8208.2009.00181.x

    Article  PubMed  Google Scholar 

  17. Goss A, Bartold M, Sambrook P, Hawker P (2010) The nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in dental implant patients: a South Australian case series. J Oral Maxillofac Surg 68:337–343. doi:10.1016/j.joms.2009.09.037

    Article  PubMed  Google Scholar 

  18. Lazarovici TS, Yahalom R, Taicher S, Schwartz-Arad D, Peleg O, Yarom N (2010) Bisphosphonate-related osteonecrosis of the jaw associated with dental implants. J Oral Maxillofac Surg 68:790–796. doi:10.1016/j.joms.2009.09.017

    Article  PubMed  Google Scholar 

  19. Martin DC, O'Ryan FS, Indresano AT, Bogdanos P, Wang B, Hui RL, Lo JC (2010) Characteristics of implant failures in patients with a history of oral bisphosphonate therapy. J Oral Maxillofac Surg 68:508–514. doi:10.1016/j.joms.2009.09.055

    Article  PubMed  Google Scholar 

  20. Shin E-Y, Kwon Y-H, Herr Y, Shin S-I, Chung J-H (2010) Implant failure associated with oral bisphosphonate-related osteonecrosis of the jaw. J Periodontal Implant Sci 40:90–95. doi:10.5051/jpis.2010.40.2.90

    Article  PubMed  Google Scholar 

  21. Shirota T, Nakamura A, Matsui Y, Hatori M, Nakamura M, Shintani S (2009) Bisphosphonate-related osteonecrosis of the jaw around dental implants in the maxilla: report of a case. Clin Oral Implants Res 20:1402–1408. doi:10.1111/j.1600-0501.2009.01801.x

    Article  PubMed  Google Scholar 

  22. Starck WJ, Epker BN (1995) Failure of osseointegrated dental implants after diphosphonate therapy for osteoporosis: a case report. Int J Oral Maxillofac Implants 10:74–78

    PubMed  Google Scholar 

  23. Ferlito S, Liardo C, Puzzo S (2011) Bisphosponates and dental implants: a case report and a brief review of literature. Minerva Stomatol 60:75–81

    PubMed  Google Scholar 

  24. Pirih FQ, Zablotsky M, Cordell K, McCauley LK (2009) Case report of implant placement in a patient with Paget's disease on bisphosphonate therapy. J Mich Dent Assoc 91:38–43

    PubMed  Google Scholar 

  25. Torres J, Tamimi F, García I, Cebrian JL, López-Cabarcos E, Lopez A (2008) Management of atrophic maxilla in severe osteoporosis treated with bisphosphonates: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:668–672. doi:10.1016/j.tripleo.2008.03.008

    Article  PubMed  Google Scholar 

  26. Torres J, Tamimi F, Garcia I, Herrero A, Rivera B, Sobrino JA, Hernández G (2009) Dental implants in a patient with Paget disease under bisphosphonate treatment: a case report. Oral Surg Oral Med Oral Pathol Oral Rradiol Endod 107:387–392. doi:10.1016/j.tripleo.2008.11.024

    Article  Google Scholar 

  27. Fugazzotto PA, Lightfoot WS, Jaffin R, Kumar A (2007) Implant placement with or without simultaneous tooth extraction in patients taking oral bisphosphonates: postoperative healing, early follow-up, and the incidence of complications in two private practices. J Periodontol 78:1664–1669. doi:10.1902/jop. 2007.060514

    Article  PubMed  Google Scholar 

  28. Grant B-T, Amenedo C, Freeman K, Kraut RA (2008) Outcomes of placing dental implants in patients taking oral bisphosphonates: a review of 115 cases. J Oral Maxillofac Surg 66:223–230. doi:10.1016/j.joms.2007.09.019

    Article  PubMed  Google Scholar 

  29. Uebelhart B, Rizzoli R (2009) Osteoporosis. Rev Med Suisse 5:124–129

    PubMed  Google Scholar 

  30. Leonida A, Vescovi P, Baldoni M, Rossi G, Lauritano D (2010) Immediate loading of dental implants in mandible full-arch: pilot study in patients with osteoporosis treated with bassoonists therapy. J Oral Implantol. doi:10.1563/AAID-JOI-D-09-00132.1

  31. Shabestari GO, Shayesteh YS, Khojasteh A, Alikhasi M, Moslemi N, Aminian A, Masaeli R, Eslami B, Treister NS (2010) Implant placement in patients with oral bisphosphonate therapy: a case series. Clin Implant Dent Relat Res 12:175–180. doi:10.1111/j.1708-8208.2009.00150.x

    PubMed  Google Scholar 

  32. Kasai T, Pogrel MA, Hossaini M (2009) The prognosis for dental implants placed in patients taking oral bisphosphonates. J Calif Dent Assoc 37:39–42

    PubMed  Google Scholar 

  33. Koka S, Babu NMS, Norell A (2010) Survival of dental implants in post-menopausal bisphosphonate users. J Prosthodont Res 54:108–111. doi:10.1016/j.jpor.2010.04.002

    Article  PubMed  Google Scholar 

  34. Bornstein MM, Cionca N, Mombelli A (2009) Systemic conditions and treatments as risks for implant therapy. Int J Oral Maxillofac Implants 24:12–27

    PubMed  Google Scholar 

  35. Edwards BJ, Hellstein JW, Jacobsen PL, Kaltman S, Mariotti A, Migliorati CA, Jaw ADACoSAEPoB-AOot (2008) Updated recommendations for managing the care of patients receiving oral bisphosphonate therapy: an advisory statement from the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 139:1674–1677, 1939

    PubMed  Google Scholar 

  36. Flichy-Fernández A-J, Balaguer-Martínez J, Peñarrocha-Diago M, Bagán JV (2009) Bisphosphonates and dental implants: current problems. Med Oral Patol Oral Cir Bucal 14:E355–360

    PubMed  Google Scholar 

  37. Hwang D, Wang H-L (2006) Medical contraindications to implant therapy: part I: absolute contraindications. Implant Dent 15:353–360. doi:10.1097/01.id.0000247855.75691.03

    Article  PubMed  Google Scholar 

  38. Javed F, Almas K (2010) Osseointegration of dental implants in patients undergoing bisphosphonate treatment: a literature review. J Periodontol 81:479–484. doi:10.1902/jop. 2009.090587

    Article  PubMed  Google Scholar 

  39. Madrid C, Sanz M (2009) What impact do systemically administrated bisphosphonates have on oral implant therapy? A systematic review. Clin Oral Implants Res 20:87–95. doi:10.1111/j.1600-0501.2009.01772.x

    Article  PubMed  Google Scholar 

  40. Mellado-Valero A, Ferrer-García JC, Calvo-Catalá J, Labaig-Rueda C (2010) Implant treatment in patients with osteoporosis. Med Oral Patol Oral Cir Bucal 15:e52–57

    PubMed  Google Scholar 

  41. Montoya-Carralero J-M, Parra-Mino P, Ramírez-Fernández P, Morata-Murcia IM, MdC M-G, Calvo-Guirado J-L (2010) Dental implants in patients treated with oral bisphosphonates: a bibliographic review. Med Oral Patol Oral Cir Bucal 15:e65–69

    PubMed  Google Scholar 

  42. Scully C, Madrid C, Bagan J (2006) Dental endosseous implants in patients on bisphosphonate therapy. Implant Dent 15:212–218. doi:10.1097/01.id.0000236120.22719.02

    Article  PubMed  Google Scholar 

  43. Reid IR (2009) Osteonecrosis of the jaw: who gets it, and why? Bone 44:4–10. doi:10.1016/j.bone.2008.09.012

    Article  PubMed  Google Scholar 

  44. Kaplan I, Anavi K, Anavi Y, Calderon S, Schwartz-Arad D, Teicher S, Hirshberg A (2009) The clinical spectrum of Actinomyces-associated lesions of the oral mucosa and jawbones: correlations with histomorphometric analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108:738–746. doi:10.1016/j.tripleo.2009.06.019

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Craniomaxillofacial Surgery, University Hospital of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland

    Christine Jacobsen, Philipp Metzler, Joachim Obwegeser, Wolfgang Zemann & Klaus-Wilhelm Grätz

  2. Institute of Pathology, University Hospital of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland

    Matthias Rössle

Authors
  1. Christine Jacobsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philipp Metzler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthias Rössle
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joachim Obwegeser
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wolfgang Zemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Klaus-Wilhelm Grätz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christine Jacobsen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jacobsen, C., Metzler, P., Rössle, M. et al. Osteopathology induced by bisphosphonates and dental implants: clinical observations. Clin Oral Invest 17, 167–175 (2013). https://doi.org/10.1007/s00784-012-0708-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-012-0708-2

Keywords

Search

Navigation