Impact of locally delivered diphosphonates on dental implants: A systematic review and meta-analysis

Introduction: Dental implants are a common solution for edentulous patients. This systematic review and meta-analysis aimed to determine whether locally delivered diphosphonates influence the osseointegration of dental implants in humans. Material & methods: In March 2023, we conducted an electronic systematic literature search using three databases (MEDLINE/PubMed, Embase, Web of Science). We included randomized trials documenting locally delivered diphosphonates in partly edentulous patients. Two independent reviewers evaluated study eligibility, extracted data, and assessed study quality. Results: We have identified 752 studies, out of which 7 studies involving 154 patients met the inclusion criteria. The overall meta-analysis indicates that diphosphonates are associated with marginal bone loss during the pre-loading period (mean difference (MD) of -0.18 mm, 95% CI -0.24 to -0.12, p<0.00001; I-2=83%), marginal bone loss after one year (MD -0.35 mm, 95% CI -0.56 to -0.14, p = 0.0009; I-2=14%), and five years loading (MD -0.34 mm, 95% CI -0.56 to -0.13, p = 0.002; I-2=0%). However, the drug did not seem to affect the implant survival rate (risk ratios (RR) of 1.02, 95% CI 0.98 to 1.08, P = 0.33; I-2=9%). Discussion: This study suggests that local use of diphosphonates does not affect implant survival, but it does reduce marginal bone loss and improve the osseointegration of dental implants in humans. However, future research must be more standardized and address methodological biases to draw more conclusive findings. (c) 2023 Elsevier Masson SAS. All rights reserved.