Major aspects of the use of bisphosphonates and the formation of osteonecrosis in the involvement of dental implants: a systematic review

Abstract

Introduction: Bisphosphonates are widely used to treat osteoporosis and malignant tumors due to their effectiveness in increasing bone density and inhibiting bone resorption. Dental patients receiving bisphosphonate treatment are at higher risk of bisphosphonate-related osteonecrosis of the jaws (BRONJ), necessitating dentists' awareness of these risks. Objective: It was to highlight the main aspects of the use of bisphosphonates and the formation of osteonecrosis in the involvement of dental implants, as well as possible treatments. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from April to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. 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 120 articles were found, 40 articles were evaluated in full and 15 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 14 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=89.5%>50%. Therefore, the present study suggests that patients undergoing treatment with BFs should be informed about the potential risk of BRONJ. Furthermore, it would be advisable for providers responsible for BF therapy to refer patients for dental check-ups before starting treatment, allowing for patient monitoring by a multidisciplinary team. Although the morbidity rate of this pathology is not high, prevention should be mandatory, thus avoiding mutilating and painful processes. However, if surgery is necessary, the use of these new adjuvant therapies, such as lowlevel laser therapy and magnetotherapy, can be proposed in the treatment of BRONJ. It is essential to increase our caseload and also involve other institutions in the use of these new effective and safe therapies in BRONJ.