Periodontal stability and treatment needs in patients under antiresorptive therapy during supportive periodontal care: a retrospective case-control study

Objectives: This study aimed to investigate periodontal stability and treatment needs in patients under antiresorptive therapy (ART) during supportive periodontal care (SPC), with a focus on medication-related osteonecrosis of the jaw (MRONJ) risk and reasons for tooth loss. Method and materials: In this retrospective case-control study, records of 100 stage III/IV SPC patients (50 ART-exposed, 50 unexposed) were analyzed for probing pocket depth, clinical attachment level, bleeding on probing, history of periodontal surgery, tooth loss, and MRONJ risk over a period of up to 15 years after active periodontal therapy.
Results: Baseline patient characteristics were similar between ART-exposed and unexposed patients. Osteoporosis was the underlying condition for ART in 72% of cases, and 74% exhibited an intermediate MRONJ risk profile. Over time, no significant differences between the groups were found in number of teeth, clinical attachment level, probing pocket depth, or bleeding on probing. Periodontal retreatment needs (teeth with probing pocket depth ≥ 4 mm or ≥ 6 mm) were relatively low and comparable between exposed and unexposed patients. However, periodontal surgery was performed more frequently in unexposed patients, also due to the risk of MRONJ in exposed patients. Both groups showed similar numbers of tooth loss, primarily due to periodontal and endodontic causes. Regression analyses identified ART, age, and diabetes mellitus as significant factors associated with higher bleeding on probing, while smoking and diabetes mellitus were linked to higher probing pocket depths.
Conclusion: Achieving periodontal stability during SPC in ART-patients, most of whom had an intermediate MRONJ risk profile, appeared comparable to unexposed patients. However, the different MRONJ risk profiles should be taken into consideration and further investigated. (Quintessence Int 2025;56:108–118; doi: 10.3290/j.qi.b5876508) Keywords: bisphosphonates, denosumab, medication-related osteonecrosis of the jaw, periodontitis, preventive dentistry