Bisphosphonates: how to proceed in orthodontics

Abstract

Bisphosphonates are mainly used in the treatment of osteoporosis and in oncology. They bind to bone and inhibit the action of osteoclasts, leading to a decrease in bone remodeling and thus hindering tooth movement. The main objective was to present, through a review of the literature, the indications and therapeutic modalities for orthodontic treatment of patients who are or have been treated with bisphosphonates. The second objective was to propose a decisional organization chart for medical care. The search was done by keywords on PubMed. 189articles were found, mostly case reports. 1)Intravenous treatment is a contraindication to ODF treatment. 2)Per os treatment is possible with precautions: to be in accordance with the prescribing practitioner, avoid major travels, avoid surgical procedures (extractions...) which must be as atraumatic as possible. A delay in healing is to be expected. The benefit-risk ratio must be taken into account. The risks – the patient must be informed of them– are slowed movement and osteonecrosis. Clinical and radiological follow-up is necessary and may warrant re-evaluation of treatment at any time: excessive tooth mobility, molar furcation damage, unusually persistent periodontal pain and symptoms, fistulas, exposed areas of necrotic bone. The articles are of low grade. Most of the articles are studies made on animals. Research is ongoing to evaluate the value of bisphosphonates as anchorage reinforcement.