Influence of Bisphosphonates on Implant and Peri-Implant Health: A Systematic Review and Meta Analysis

Rikko Hudyono*  -  Sultan Agung Islamic University, Indonesia
Louis Krisna Wardhana  -  Prima Medistra Main Clinic, Indonesia
Adisty Restu Poetri  -  Sultan Agung Islamic University, Indonesia
Taufan Bramantoro  -  Airlangga University, Indonesia

(*) Corresponding Author
DOI: 10.30659/odj.13.2.150-161

Introduction: Bisphosphonates are widely prescribed for osteoporosis, raising concerns regarding their potential impact on dental implant survival. This systematic review and meta-analysis evaluated the association between bisphosphonate therapy and dental implant failure. Material and Methods: Following PRISMA guidelines and registered in PROSPERO (ID: 1136620), electronic searches of ScienceDirect, EBSCOhost, PubMed, MDPI, and Google Scholar were performed up to September 2025. Observational cohort studies comparing dental implant outcomes in bisphosphonate-exposed and non-exposed patient were included. Two reviewers performed data extraction and risk-of-bias assessment using the ROBINS-I. Pooled risk ratios (RRs) were calculated. Results: Six studies comprising 2,196 participants and 86 implant failures were included. Bisphosphonate exposure was associated with a significantly increased risk of implant failure (RR = 2.35; 95% CI, 1.24–4.44). with no heterogeneity (I² = 0%). Discussion: Despite the elevated relative risk, implant failure remained infrequent, resulting in a small absolute risk increase. The certainty of evidence was rated as moderate. Conclusion: Implant therapy should not be routinely avoided in bisphosphonate-treated patients, and individualized risk assessment is recommended. Further prospective studies are needed to clarify causality and patient-level risk modifiers.

Keywords: Bisphosphonate; Dental Implant; Peri-Implantitis

  1. Park J, Kim H, Lee J, Lee H, Kim J. Consequence of Bisphosphonate Use on Dental Implant Removal in Osteoporotic Patient: A Nationwide Cohort Study. Clinical Implant Dentistry & Related Research. 2025;27(3):1–9.
  2. Mardiyantoro F, Pratiwi AR. One-Piece Dental Implant untuk Rehabilitasi Ruang Kaninus yang Sempit. ODONTO : Dental Journal. 2017;4(1):61. doi:10.30659/odj.4.1.61-66
  3. Guillaume B. Dental implants: A review. Morphologie. 2016;100(331):189–98. doi:10.1016/j.morpho.2016.02.002
  4. Kwon TG. Impacts of the rapid increase in aged patients on implant dentistry. JKAOMS. 2025;51(2):71–2. doi:10.5125/jkaoms.2025.51.2.71
  5. Wijaya L, Suwandi T, Eddy E, Tjandrawinata R, Erawati J, Pratiwi D. Evaluation of Titanium Alloy Surface Roughness After Phosphoric Acid Etching. Odonto : Dental Journal. 2025;12(3):280. doi:10.30659/odj.12.3.280-291
  6. Chandran M, Brind’Amour K, Fujiwara S, Ha YC, Tang H, Hwang JS, et al. Prevalence of osteoporosis and incidence of related fractures in developed economies in the Asia Pacific region: a systematic review. Osteoporos Int. 2023;34(6):1037–53. doi:10.1007/s00198-022-06657-8
  7. Adami G, Fassio A, Gatti D, Viapiana O, Benini C, Danila MI, et al. Osteoporosis in 10 years time: a glimpse into the future of osteoporosis. Therapeutic Advances in Musculoskeletal. 2022;14:1759720X221083541. doi:10.1177/1759720X221083541
  8. Fardellone P, Lello S, Cano A, De Sá Moreira E, Watanabe De Oliveira R, Julian GS, et al. Real-world Adherence and Persistence with Bisphosphonate Therapy in Postmenopausal Women: A Systematic Review. Clinical Therapeutics. 2019;41(8):1576–88. doi:10.1016/j.clinthera.2019.05.001
  9. Arjunan D, Bhadada T, Mohankumar SB, Bhadada SK. Non-biological Antiresorptive: Bisphosphonates. JOIO. 2023;57(S1):120–6. doi:10.1007/s43465-023-01054-7
  10. Jelin-Uhlig S, Weigel M, Ott B, Imirzalioglu C, Howaldt HP, Böttger S, et al. Bisphosphonate-Related Osteonecrosis of the Jaw and Oral Microbiome: Clinical Risk Factors, Pathophysiology and Treatment Options. IJMS. 2024;25(15):8053. doi:10.3390/ijms25158053
  11. Fathurrahman H, Hudyono R. TITANIUM MESH APLICATION ON ANTERIOR ALVEOLAR PROCESS AUGMENTATION PROCEDUR : A CASE REPORT. ODONTO : Dental Journal. 2020;7(1):68. doi:10.30659/odj.7.1.68-72
  12. Syahraini SI, Kiswanjaya B, Priaminiarti M, Bachtiar-Iskandar HH. Field of view and voxel size considerations in cone-beam computed tomography: a systematic review. Odonto: Dental Journal. 2024;11(2):221. doi:10.30659/odj.11.2.221-240
  13. Kochar SP, Reche A, Paul P. The Etiology and Management of Dental Implant Failure: A Review. Cureus. 2022. doi:10.7759/cureus.30455
  14. Jeffcoat MK. Safety of oral bisphosphonates: Controlled studies on alveolar bone. The Journal of Prosthetic Dentistry. 2007;97(2):106. doi:10.1016/j.prosdent.2006.08.021
  15. Kim JY, Choi H, Park JH, Jung HD, Jung YS. Effects of anti-resorptive drugs on implant survival and peri-implantitis in patients with existing osseointegrated dental implants: a retrospective cohort study. Osteoporos Int. 2020;31(9):1749–58. doi:10.1007/s00198-019-05257-3
  16. Siebert T, Jurkovic R, Statelova D, Strecha J. Immediate Implant Placement in a Patient With Osteoporosis Undergoing Bisphosphonate Therapy: 1-Year Preliminary Prospective Study. Journal of Oral Implantology. 2015;41(S1):360–5. doi:10.1563/AAID-JOI-D-13-00063
  17. Kasai T, Pogrel MA, Hossaini M. The Prognosis for Dental Implants Placed in Patients Taking Oral Bisphosphonates. Journal of the California Dental Association. 2009;37(1):39–42. doi:10.1080/19424396.2009.12222946
  18. Koka S, Babu NMS, Norell A. Survival of dental implants in post-menopausal bisphosphonate users. Journal of Prosthodontic Research. 2010;54(3):108–11. doi:10.1016/j.jpor.2010.04.002
  19. Zahid TM, Wang BY, Cohen RE. Influence of Bisphosphonates on Alveolar Bone Loss Around Osseointegrated Implants. Journal of Oral Implantology. 2011;37(3):335–46. doi:10.1563/AAID-JOI-D-09-00114
  20. Thiebot N, Hamdani A, Blanchet F, Dame M, Tawfik S, Mbapou E, et al. Implant failure rate and the prevalence of associated risk factors: a 6-year retrospective observational survey. J Oral Med Oral Surg. 2022;28(2):19. doi:10.1051/mbcb/2021045
  21. Tobias G, Chackartchi T, Haim D, Mann J, Findler M. Dental Implant Survival Rates: Comprehensive Insights from a Large-Scale Electronic Dental Registry. JFB. 2025;16(2):60. doi:10.3390/jfb16020060
  22. Hickin MP, Shariff JA, Jennette PJ, Finkelstein J, Papapanou PN. Incidence and Determinants of Dental Implant Failure: A Review of Electronic Health Records in a U.S. Dental School. Journal of Dental Education. 2017;81(10):1233–42. doi:10.21815/JDE.017.080
  23. Lee ES, Tsai MC, Lee JX, Wong C, Cheng YN, Liu AC, et al. Bisphosphonates and Their Connection to Dental Procedures: Exploring Bisphosphonate-Related Osteonecrosis of the Jaws. Cancers. 2023;15(22):5366. doi:10.3390/cancers15225366
  24. University Hospitals of North Midlands NHS Trust Dept of O and MS. Dental Management of Patients Prescribed Bisphosphonates - Clinical Guidance [Internet]. 2015. Available from: https://www.england.nhs.uk/mids-east/wp-content/uploads/sites/7/2015/03/bisphosphonates-guidelines-2015.pdf
  25. American Dental Association Council on Scientific Affairs. Dental management of patients receiving oral bisphosphonate therapy. The Journal of the American Dental Association. 2006;137(8):1144–50. doi:10.14219/jada.archive.2006.0355

Lisensi Creative Commons
This work is licensed under a Lisensi Creative Commons Atribusi-BerbagiSerupa 4.0 Internasional.
Contact us: Odonto Dental Journal: Jl. Raya Kaligawe Km.4, PO BOX 1054/SM Semarang, Central Java, Indonesia, 50112. Email: odontodentaljournal@unissula.ac.id
apps