Beyond ONJ - A review of the potential uses of bisphosphonates in dentistry

There is evidence, although limited, for beneficial effects of bisphophonates (BPs) across multiple dental specialties. Within implant dentistry BP coatings have been shown to significantly increase pull out forces and bone density in animal models, and significantly increase implant stability whilst reducing marginal bone loss in humans. Adjunctive topical and systemic application of BPs during conventional periodontal treatment have shown significant improvements in probing depth and clinical attachment level in various forms of periodontal disease. Within orthodontics, BPs have been shown to significantly reduce root resorption and have benefits with respect to anchorage maintenance. Case reports have suggested the use of BPs in the management of diffuse sclerosing osteomylitis. Whilst this review highlights these potential benefits and acknowledges there are no reported cases of osteonecrosis of the jaw associated with locally applied BP, there remains a paucity of human and long-term studies exploring BPs in the context of significant clinical benefit. Further human studies are required to understand the long-term clinical outcomes of these drugs when used as primary therapeutic agents, or adjuncts to conventional treatment.