Abstract
Objective: To review the current literature and provide the latest information on anti-resorptive agent-induced osteonecrosis of the jaw (ARONJ), including our basic and clinical research findings, as well as discuss the risks of developing osteonecrosis in patients undergoing dental implant surgery in use of anti-resorptive drugs (ARDs). Methods: A literature review was performed using articles published in indexed journals based on Pubmed, Web of Science, Embase and Scopus databases. Results: Our results show that the placement of dental implants in patients treated with ARDs should be carefully evaluated, these patients are not free from complications and, therefore, the risk assessment should be done individually, as one of the most serious complications, although rare, is the ARONJ. Conclusion: Thus, all patients treated with this type of drug should be informed about the risk of implant loss or the possibility of osteonecrosis, being necessary to inform about the increased risk also patients who already have osteointegrated implants and will start therapy with bisphosphonates (BPT). And, in addition, establishing a relationship and collaboration between doctor, dentist and patient is essential for the good prognosis of these cases.
Highlights
The most commonly used therapeutic resource for the treatment of osteoporosis involves the use of anti-resorptive drugs (ARDs) (Kunchur et al, 2009), which have the function of decreasing abnormal bone remodeling and/or increasing bone resorption (Ata-Ali et al, 2016)
The authors conducted an electronic search on PubMed / MEDLINE, Web of Science, Embase and Scopus databases for articles published since September 2011 until September 2021 according to the eligibility criteria, using the following search term “Osteonecrosis; Antiresorptive drugs; Bisphosphonates; Dental implant; Sucess rate”
Our results show that the placement of dental implants in patients treated with ARDs should be carefully evaluated, these patients are not free from complications and the risk assessment should be done individually, as one of the most serious complications, rare, is ARONJ
Summary
The most commonly used therapeutic resource for the treatment of osteoporosis involves the use of anti-resorptive drugs (ARDs) (Kunchur et al, 2009), which have the function of decreasing abnormal bone remodeling and/or increasing bone resorption (Ata-Ali et al, 2016). One of the most serious, not as frequent, complications of ARDs therapy is bisphosphonate-related osteonecrosis of the jaws (BRONJ) (Ata-Ali et al, 2016), this condition, already recognized for more than a decade in relation to BPs, described for the first time by Marx, in 2003 (Marx et al, 2003), it is characterized by exposed and unhealed necrotic bone caused by current or previous treatment with anti-resorptive or anti-angiogenic agents (Ruggiero et al, 2014), which can be probed through an intraoral or extraoral fistula in the maxillofacial region and which persists for more than 8 weeks (Stavropoulos et al, 2018) The lesions of this pathology are located in the bone matrix of the jaws, with a higher prevalence in the mandible compared to the maxilla (ratio 2:1) (Ruggiero et al, 2009), this fact can be justified due to the great vascularization, high rate of bone turnover, high risk of surgical trauma and local infections in the mandible (Vescovi et al, 2012). 1.1 Clinical implications The relationship of ARDs with osteonecrosis is extremely relevant for professional practice, since, in any area in which the dental surgeon works, he/she must necessarily carry out a good anamnesis and clinical examination, in order to reach a correct diagnosis, as well as to know the conduct that should be used for the treatment of each phase of this disease
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