Osteonecrosis of the jaw as a result of bisphosphonate therapy for osteoporosis and the success of dental implantation – a review of current scientific evidence

Introduction: Bisphosphonates and other antiresorptive drugs are the basis of pharmacotherapy for osteoporosis and cancerous diseases affecting the bones. Despite their high clinical efficacy, a growing number of scientific reports indicate a risk of osteonecrosis of the jaw (ONJ), especially in patients receiving intravenous and long-term treatment. Due to the increasing frequency of dental implant use and the延长ing average life expectancy of patients, the relationship between antiresorptive therapy and the success of implantation has become an important clinical issue. Understanding the mechanisms of ONJ development, risk factors, and current treatment guidelines is crucial to ensuring the safety of patients undergoing implant procedures. Purpose of work: The aim of this paper is to present the current state of knowledge on the relationship between bisphosphonate therapy for osteoporosis and the risk of osteonecrosis of the jaw in the context of implant procedures. The study aims to discuss the mechanisms of action of bisphosphonates, factors predisposing to MRONJ, clinical course and treatment principles, as well as to review current recommendations for patient eligibility for implant procedures. Materials and methods: An analysis of research papers available on PubMed and Google Scholar was undertaken using the following keywords: bisphosphonates; osteoporosis; MRONJ; medication-related osteonecrosis of the jaw; osteonecrosis; jawbone necrosis; antiresorptive therapy; dental implants; implantology; osseointegration. Results: Analysis of current research confirms that the use of bisphosphonates, especially in intravenous form and in long-term therapy, significantly increases the risk of developing osteonecrosis of the jaw (ONJ), which may affect the success of dental implantation. In patients treated orally, this risk is lower, but not completely eliminated, especially after several years of therapy. The highest number of implant failures was reported in the lateral segments of the mandible and maxilla and in patients with existing inflammation, such as peri-implantitis, which may be a factor initiating MRONJ. Most studies indicate that implantation in patients taking oral bisphosphonates is possible but requires individual risk assessment and close monitoring. In patients treated with intravenous bisphosphonates, implantation is associated with a significantly higher risk of complications.