DENTAL IMPLANTS IN PATIENTS USING BISPHOSPHONATES: RISK OF OSTEONECROSIS AND SAFETY PROTOCOLS

The use of bisphosphonates (BFs) has become common in the treatment of bone diseases such as osteoporosis, metastatic cancer, and other conditions affecting bone metabolism. However, prolonged administration of BFs, especially intravenous ones, has been associated with the development of medication-related osteonecrosis of the jaw (MRONJ), particularly following invasive dental procedures, such as dental implant placement. Literature shows that patients using intravenous BFs, especially those with cancer, are at a higher risk for MRONJ, although the incidence is lower in patients with osteoporosis using oral BFs. A review of safety protocols emphasizes the importance of preoperative dental evaluation, focusing on identifying risk factors such as the type of bisphosphonate used and associated comorbidities, along with recommendations for temporary suspension of BFs before invasive procedures. Performing atraumatic procedures, using prophylactic antibiotics, and rigorous postoperative monitoring are also essential strategies to reduce the risk of severe complications. Interdisciplinary collaboration among dentists, physicians, and pharmacists is crucial to ensure safe treatment. Despite existing protocols, the lack of consensus on suspending BFs in osteoporosis patients still causes controversy, and personalized dental treatment remains an area for improvement. The findings of this study are relevant to clinical practice, providing guidelines that can help reduce the risk of MRONJ and improve the management of patients on bisphosphonates.