- Bisphosphonates (BP) maintain bone mass and stability and are used in treatment of bone diseases such as osteoporosis.
- BP therapy in osteoporosis patients is not a contra-indication for implant treatment.
- BP medication for bone cancers like multiple myeloma constitute a contra-indication for implant treatment.
Bisphosphonates - general
Bisphosphonates (BP) inhibit osteoclast activity and remain in the bone for a prolonged period. Bisphosphonates are the most commonly prescribed drugs to treat osteoporosis, bone fragility disorders, like Paget’s disease, osteogenesis imperfecta, fibrous dysplasia and bone cancers.
In the oro-maxillo-facial region, when administered over a long period, bisphosphonates may predispose to ‘bisphosphonate-related osteonecrosis of the jaw’ (BRONJ). The mandible is affected twice as frequently as the maxilla.
Risk for implant treatment
A variety of studies indicate that implant placement, as such, does not predispose the patient with a history of bisphosphonate therapy to implant failure or to developing BRONJ. However, each individual patient should be evaluated for key factors such as delivery mode (IV or oral intake) and duration of bisphosphonate therapy and any antecedents of healing problems following osseous surgery. Patients who have a long duration of bisphosphonate therapy and a history of poor bone healing following surgery are not candidates for implant placement.