Dental implant treatment in oral bisphosphonates patients using a drug holiday protocol: a prospective study

Aim Bisphosponates are the most important class of antiresorptive agents commonly used in the management of osteoporosis, Paget€™s disease, and tumor-associated osteolysis. Oral bisphosphonateinduced osteonecrosis is a rare but real entity caused by the antiosteoclastic effects of bisphosphonates which inhibit bone turnover. The aim of this work is to determine the extent to which bisphosphonate-associated osteonecrosis occurs after dental implant surgery. We also wanted to determine whether there was any indication that bisphosphonates affected the overall success of the implants. Materials and methods We described 21 patients undergoing dental implants surgery who were taking or had taken oral bisphosphonates. All patients were informed about the risk of osteonecrosis and a written informed consent was obtained from each individual. Results A total of 38 implants were placed in 21 patients who reported having received oral bisphosphonates. None had received intravenous bisphosphonates. There is no evidence of osteonecrosis in any of the patients evaluated. Of the 38 implants, all but 2 fully integrated and met implant success criteria. Conclusion Implant surgery on patients receiving oral bisphosphonates did not result in osteonecrosis. Moreover, oral bisphosphonates did not appear to significantly affect implant success. Nevertheless, sufficient evidence exists to suggest that all patients undergoing implant placement should be questioned about bisphosphonate therapy including the drug taken, the dosage, and length of treatment prior to surgery.