Atrophic maxilla and osseointegrated implants: a systematic review

Abstract

Introduction: In the scenario of the dental implants, what makes implantology unique is the ability to achieve this goal, however, the more teeth a patient loses the more challenging the task becomes. Osteoporosis may be a risk factor for the use of implants. Alternative approaches such as guided surgery and placement of short implants are progressively supplanting more invasive bone regeneration procedures. There are some drugs that help in the treatment of postmenopausal osteoporosis, they are calcitonin, bisphosphonates and the selective modulators of estrogen receptors. Objective: Foi realizar uma revisão sistemática sobre as principais considerações e desfechos clínicos da maxila atrófica no cenário dos implantes dentários osseointegrados, osteoporose e o uso dos bifosfonatos. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from October 2022 to January 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 2005 to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 225 articles were found, and 65 articles were evaluated in full and 31 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 45 studies with a high risk of bias and 90 studies that did not meet GRADE. In the scenario of atrophic maxilla issues, it was concluded that osteoporosis is a metabolic condition that affects alveolar bone density, but does not present problems for the installation of osseointegrated implants, provided there is enough bone mass in the region where the tooth will be implanted. The rehabilitation of atrophic maxilla through dental implants is still challenging, however, alternatives such as guided surgery and the installation of short implants are progressively supplanting the more invasive bone regeneration procedures. Some drugs that help in the treatment of postmenopausal osteoporosis, are calcitonin, bisphosphonates, and the selective modulators of estrogen receptors. Bisphosphonates have been the best drug associated with significant improvement in the quality of life of patients with bone diseases such as Paget's disease, bone metastases, osteogenesis imperfecta, hypercalcemia, and even severe osteoporosis.