Dental implant failure and medication-related osteonecrosis of the jaw (MRONJ) related to dental implants in patients taking antiresorptive therapy for osteoporosis: a systematic review and meta-analysis.
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OBJECTIVES: To inform the 2024 International Task Force on Osteonecrosis of the Jaw update, we conducted a systematic review and meta-analysis evaluating dental implant failure and medication related osteonecrosis of the jaw (MRONJ) related to antiresorptive therapy for osteoporosis. METHODS: We searched 5 databases (1946-2024) for 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 GRADE. RESULTS: We found 793 unique citations. Nine studies (n=655) were included in the implant failure analysis. Random effects meta-analysis revealed wide confidence intervals for implant failure among those exposed to antiresorptives (RR 0.82, 95% CI 0.52 - 1.28, p = 0.38, very low certainty). Sensitivity analysis at the level of implant suggested antiresorptives may reduce implant failure (RR 0.53, 95% confidence interval 0.34 - 0.81, p = 0.003, very low certainty). We identified 186 cases of MRONJ in implant recipients. The pooled rate of MRONJ following implantation in those exposed to antiresorptive therapy is 0.5% pooled from 21 cohorts. A single report of risk-adjusted MRONJ found bisphosphonates increased MRONJ by 3 cases per 1000 patients (adjusted HR 4.09, 95% CI 2.75 - 6.09, p<0.001, moderate certainty). CONCLUSIONS: The low certainty evidence suggests antiresorptive therapy for osteoporosis may possibly reduce dental implant failure. Bisphosphonates are associated with MRONJ in patients with osteoporosis receiving dental implants with moderate certainty.
