title: Osteopathology induced by bisphosphonates and dental implants: clinical observations.
abstract: OBJECTIVE
  Although there are many reports about risk factors for the development of BP-associated osteonecrosis of the jaws, the role of dental implants as a local risk factor is still discussed, especially in patients with oral BP treatment. Until now, a few case reports and surveys display a possible minor risk in patients with oral BP therapy, whereas the avoidance of implant placement is generally accepted in patients with intravenous BP therapy.
  
  
  METHODS
  In this study, the cases of 14 patients with osteonecrosis of the jaws in association with BP therapy and dental implant placement were analyzed carefully with a detailed literature review.
  
  
  RESULTS
  Of 14 patients, nine had underlying malignant disease and five patients had osteoporosis. In ten patients, implants were placed either in the posterior mandible or maxilla; the mean interval between implant insertion and disease onset was 20.9 months. Pain (n12) and signs of infection (n10) were the most common symptoms. Histologically, signs of infection were found in nine of 11 analyzed patients with presence of Actinomyces in six patients. Two patients turned out to have infiltration of underlying malignant disease.
  
  
  CONCLUSIONS
  Posteriorly placed implants seem to be of higher risk of development of osteonecrosis of the jaws. Not only the implant placement but also the inserted implant itself seems to be a continuous risk factor.
  
  
  CONCLUSIONS
  The herein elaborated risk factors help dentists plan dental rehabilitation with implants in this high-risk group of patients and indicate careful and regular dental recall.
authors.affiliation: Department of Craniomaxillofacial Surgery, University Hospital of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland. christine.jacobsen@usz.ch
authors.forename: Christine
authors.initials: C
authors.lastname: Jacobsen
authors.forename: Philipp
authors.initials: P
authors.lastname: Metzler
authors.forename: Matthias
authors.initials: M
authors.lastname: Rössle
authors.forename: Joachim
authors.initials: J
authors.lastname: Obwegeser
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Zemann
authors.forename: Klaus-Wilhelm
authors.initials: KW
authors.lastname: Grätz
mesh_terms: D000196:Actinomycosis / Q000175:diagnosis; D061605:Administration, Intravenous; D000284:Administration, Oral; D019386:Alendronate / Q000008:administration & dosage / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000175:diagnosis / Q000209:etiology*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D054893:Cone-Beam Computed Tomography / Q000379:methods; D003646:Debridement; D015921:Dental Implants / Q000009:adverse effects; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000077557:Ibandronic Acid; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008334:Mandible / Q000601:surgery; D008339:Mandibular Neoplasms / Q000175:diagnosis / Q000556:secondary; D008437:Maxilla / Q000601:surgery; D009369:Neoplasms / Q000188:drug therapy; D010019:Osteomyelitis / Q000382:microbiology; D010024:Osteoporosis / Q000188:drug therapy; D000077268:Pamidronate; D012307:Risk Factors; D013997:Time Factors; D000077211:Zoledronic Acid
chemical_list: D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D015921:Dental Implants; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077268:Pamidronate; D000077557:Ibandronic Acid; D019386:Alendronate