Bisphosphonate-related Osteonecrosis of the Jaw Triggered by Dental Implants

Japan is a super-aged society with the highest life expectancy in the world. The prevalence of osteoporosis drastically increases with age following menopause. It is said that 12.8 million patients in Japan suffer from osteoporosis and patients administered bisphosphonate , which is considered the top choice drug for osteoporosis according to the guidelines, have a high probability of undergoing implant treatment. Bisphosphonate (BP) is specifically incorporated into osteoclasts, thereby inducing apoptosis and suppressing bone resorption, and is therefore widely used for osteoporosis and cancer metastasis of the bone. However, cases of BP-related osteonecrosis of the jaw (BRONJ) are problematically increasing as a complication thereof. While dental extraction often triggers the onset thereof, dental implant treatment may also act as a trigger. There is still no treatment established for BRONJ, so once it occurs, it is intractable. We herein report on our experience regarding cases in which good results were achieved by carrying out surgical treatment on patients in which BRONJ was triggered by dental implants. Moreover, we report on the current state and correspondence of implant treatment with respect to osteoporosis patients with some bibliographical considerations. Dental implant treatment should be given careful consideration when there is a strong demand from osteoporosis patients being administered BP. Dentists should explain to patients the onset risk of osteonecrosis of the jaw, obtain their consent, and consider the advisability while taking into consideration the administration period of BP and the risk factors of such patients. Keywords: Bisphosphonate-related osteonecrosis of the jaw, Japan, dental implants