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http://hdl.handle.net/11375/29095
Title: | Osteonecrosis of the Jaw and Dental Implant Failure Related to Antiresorptive Therapy for Osteoporosis: a systematic review and meta-analysis |
Other Titles: | Implant outcomes with Antiresorptives |
Authors: | Mirza, Reza |
Advisor: | Guyatt, Gordon |
Department: | Health Research Methodology |
Keywords: | Osteoporosis;Dental Implantation;Anti-resorptives;Methodology |
Publication Date: | 2023 |
Abstract: | Purpose: We conducted a systematic review and meta-analysis evaluating dental implant failure and osteonecrosis related to antiresorptive therapy for osteoporosis. Methods: We searched 5 databases between 1946 and January 2022. We included interventional and non-interventional studies reporting rates of dental implant failure or osteonecrosis in those with osteoporosis or osteopenia. Two reviewers independently screened all titles and abstracts, and full-texts. Risk of bias was assessed using the modified Ottawa-Newcastle scale, and the evidence was assessed using the GRADE framework. We adhered to PRISMA 2020 and MOOSE reporting standards. Results: Our search revealed 793 unique citations that underwent title and abstract screening. We included 112 studies for full text screening, 33 underwent data abstraction, and ultimately nine (n=655) were included for the implant failure analysis. Random effects meta-analysis revealed a point estimate suggesting a decrease in relative risk of implant failure in those exposed to antiresorptives (RR 0.82, 95% CI 0.52 – 1.28, p = 0.38, very low certainty). We identified 128 cases of MRONJ in implant recipients. The rate of MRONJ following implantation in those exposed to antiresorptive therapy is 0.40% pooled from 20 cohorts. A single comparative study assessed risk adjusted MRONJ in osteoporotic patients undergoing dental implant placement and found use of bisphosphonates increased osteonecrosis of the jaw by 3 cases per 1000 patients (adjusted HR 4.09, 95% CI 2.75 – 6.09, p<0.001, moderate certainty). Conclusions: The limited evidence does not suggest an association between antiresorptive therapy for osteoporosis and dental implant failure. The certainty of evidence is very low due to serious methodologic concerns. Antiresorptive therapy likely causes MRONJ in osteoporotic patients receiving dental implants with moderate certainty evidence. |
URI: | http://hdl.handle.net/11375/29095 |
Appears in Collections: | Open Access Dissertations and Theses |
Files in This Item:
File | Description | Size | Format | |
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Mirza_Reza_D_2023September_MSc.pdf | 1.63 MB | Adobe PDF | View/Open |
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