title: Current state of orthodontic patients under bisphosphonate therapy.
abstract: BACKGROUND
  Bisphosphonates are a common medication for the prevention and therapy of osteoporosis, but are also applied for tumor diseases. They affect bone metabolism, and therefore also orthodontic treatments, but how it does has yet not been definitively clarified. Therefore, the aim of this research was to evaluate and demonstrate the reported effects and the current state of scientific research regarding orthodontic treatment and bisphosphonate medication exclusively in humans.
  
  
  METHODS
  A systematic research of the literature for selected keywords in the Medline database (Pubmed) as well as a manual search was conducted. The following search terms were used: 'Bisphosphonate' in combination with: orthodontic, orthodontic treatment, tooth movement.
  
  
  RESULTS
  To date, only nine reported patients (case reports/series) and one original article (retrospective cohort study) regarding orthodontic treatment under bisphosphonate medication in humans have been published. Decelerated tooth movement with increased side effects (especially in high-risk patients) and longer treatment duration was reported in some articles. Patients with initial spacing or extraction cases had a higher risk of incomplete space closure and poor root parallelism.
  
  
  CONCLUSIONS
  Orthodontic tooth movement under bisphosphonate medication is possible, especially in low-risk patients (low dose and short period of intake). But the treatment is still not predictable, especially in high-risk patients. Therefore, the altered bone metabolism and higher extent of side effects should be considered in treatment planning, especially in extraction cases or high-risk patients. Regardless, longer treatment duration, decelerated tooth movement, and more side effects, e.g., incomplete space closure and poor root parallelism, should be expected, especially in extraction cases or space closure.
authors.affiliation: Department of Orthodontics, Medical Centre of the Johannes-Gutenberg-University Mainz, Augustusplatz 2, 55131 Mainz, Germany. elena.krieger@unimedizin-mainz.de
authors.forename: Elena
authors.initials: E
authors.lastname: Krieger
authors.forename: Collin
authors.initials: C
authors.lastname: Jacobs
authors.forename: Christian
authors.initials: C
authors.lastname: Walter
authors.forename: Heinrich
authors.initials: H
authors.lastname: Wehrbein
mesh_terms: D019386:Alendronate / Q000009:adverse effects / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016723:Bone Remodeling / Q000187:drug effects; D001842:Bone and Bones / Q000187:drug effects* / Q000378:metabolism*; D006801:Humans; D019516:Orthodontic Space Closure; D009970:Orthodontics; D010024:Osteoporosis / Q000517:prevention & control; D011862:Radiography, Panoramic; D014081:Tooth Extraction; D014087:Tooth Movement Techniques
chemical_list: D050071:Bone Density Conservation Agents; D019386:Alendronate
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