title: What is the impact of bisphosphonate therapy upon dental implant survival? A systematic review and meta-analysis.
abstract: OBJECTIVE
  A systematic review and meta-analysis are carried out to assess the scientific evidence that bisphosphonate therapy can decrease the success rate of dental implants.
  
  
  METHODS
  The PubMed (Medline) database was used to search for articles published up until February 22, 2014. The meta-analysis was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The Newcastle-Ottawa scale (NOS) was used to assess study quality.
  
  
  RESULTS
  The combinations of search terms resulted in a list of 256 titles. Fourteen finally met the inclusion criteria and were thus selected for inclusion in the systematic review. Eight studies (six retrospective and two prospective) were included in the meta-analysis, with a total of 1288 patients (386 cases and 902 controls) and 4562 dental implants (1090 dental implants in cases and 3472 in controls). The summary odds ratio (OR = 1.43, P = 0.156) indicates that there is not enough evidence that bisphosphonates have a negative impact upon implant survival. According to the number need to harm (NNH), over 500 dental implants are required in patients receiving bisphosphonate treatment to produce a single implant failure.
  
  
  CONCLUSIONS
  Our results show that dental implant placement in patients receiving bisphosphonates does not reduce the dental implant success rate. On the other hand, such patients are not without complications, and risk evaluation therefore must be established on an individualized basis, as one of the most serious though infrequent complications of bisphosphonate therapy is bisphosphonate-related osteonecrosis of the jaws. Given the few studies included in our meta-analysis, further prospective studies involving larger sample sizes and longer durations of follow-up are required to confirm the results obtained.
authors.affiliation: Public Dental Health Service, Arnau de Vilanova Hospital, Valencia University Medical and Dental School, Valencia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Ata-Ali
authors.affiliation: Valencia University Medical and Dental School, Valencia, Spain.
authors.forename: Fadi
authors.initials: F
authors.lastname: Ata-Ali
authors.affiliation: Valencia University Medical and Dental School, Valencia, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Peñarrocha-Oltra
authors.affiliation: Department of Oral Surgery and Implant Dentistry, University of Granada, Granada, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Galindo-Moreno
mesh_terms: D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D019232:Dental Restoration Failure; D004164:Diphosphonates / Q000009:adverse effects*; D006801:Humans
chemical_list: D050071:Bone Density Conservation Agents; D015921:Dental Implants; D004164:Diphosphonates
keywords: bisphosphonate-related osteonecrosis of the jaws; dental implant; failure; risk factor; success rate; survival rate