Purpose: We conducted a systematic review and meta-analysis evaluating dental implant failure and osteonecrosis related to antiresorptive therapy for osteoporosis.
Methods: We searched 5 databases between 1946 and January 2022. We included interventional and non-interventional studies reporting rates of dental implant failure or osteonecrosis in those with osteoporosis or osteopenia. Two reviewers independently screened all titles and abstracts, and full-texts. Risk of bias was assessed using the modified Ottawa-Newcastle scale, and the evidence was assessed using the GRADE framework. We adhered to PRISMA 2020 and MOOSE reporting standards.
Results: Our search revealed 793 unique citations that underwent title and abstract screening. We included 112 studies for full text screening, 33 underwent data abstraction, and ultimately nine (n=655) were included for the implant failure analysis. Random effects meta-analysis revealed a point estimate suggesting a decrease in relative risk of implant failure in those exposed to antiresorptives (RR 0.82, 95% CI 0.52 – 1.28, p = 0.38, very low certainty). We identified 128 cases of MRONJ in implant recipients. The rate of MRONJ following implantation in those exposed to antiresorptive therapy is 0.40% pooled from 20 cohorts. A single comparative study assessed risk adjusted MRONJ in osteoporotic patients undergoing dental implant placement and found use of bisphosphonates increased osteonecrosis of the jaw by 3 cases per 1000 patients (adjusted HR 4.09, 95% CI 2.75 – 6.09, p<0.001, moderate certainty).
Conclusions: The limited evidence does not suggest an association between antiresorptive therapy for osteoporosis and dental implant failure. The certainty of evidence is very low due to serious methodologic concerns. Antiresorptive therapy likely causes MRONJ in osteoporotic patients receiving dental implants with moderate certainty evidence. / Thesis / Master of Science (MSc) / We sought to generate an up-to-date and comprehensive analysis of whether standard treatment for osteoporosis with anti-resorptives increases the risk of adverse outcomes when receiving dental implants.
We conducted a search of all studies published on this between 1946 and 2022, and found 793 studies. Nine studies provided numbers related to dental implant outcomes. We are very uncertain whether anti-resorptive increase or reduce the absolute risk of dental implant failure. The estimated worst case scenario is that anti-resorptives cause 3 more implant failures per 100 patients.
We also looked at the rare outcome where there’s death of the jaw bone (osteonecrosis). We found this occurs 0.4% of time in patients undergoing implant when exposed to anti-resorptive drugs. We estimate that exposure to anti-resorptives increases the risk of osteonecrosis of the jaw by 3 per 1000 patients. The evidence supporting this is from one moderate quality study.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/29095 |
| Date | January 2023 |
| Creators | Mirza, Reza |
| Contributors | Guyatt, Gordon, Health Research Methodology |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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