Antiresorptives in implant dentistry

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of patients with antiresorptive therapy to minimize skeletal events in patients with osteoporosis or in oncological indication. Risk factors associated with the occurrence and onset of the disease are divided in systemic (inter alia co-medication with steroids or chemo therapy) and local factors such as dentoalveolar surgical interventions. Prosthetic rehabilitation of these patients with dental implants is still discussed controversially in the literature. On the one hand, implant survival may be compromised by a possibly inhibited osseointegration, and the surgical intervention as well as the implant itself and associated pathologies such as peri-implantitis may lead to the development of MRONJ. On the other hand, implants may help to optimize prosthetic concepts to spare improper gingival loading and raise oral-health-related quality of life. Sufficient oral hygiene and supportive dental care is a crucial prerequisite for every patient with antiresorptive therapy, especially before considering implant treatment. This article summarizes current evidence on the topic of dental implants in patients with antiresorptive treatment. The association between MRONJ and implant survival is analyzed in the context of dosage and indication of antiresorptive therapy. Aim of this article is to support patient-individual risk assessment and therapy decision in the clinical workflow.