A review of Bisphosphonates in Dentistry: A "Double-Edged Sword" in the Process of Bone Remodeling

Abstract Bisphosphonates are strong agents which inhibit bone resorption and have therefore become valuable in the treatment of osteoporosis, Paget disease, hypercalcemia due to malignancy, multiple myeloma and skeletal complications caused by metastatic cancer. Because of their high affinity for hydroxyapatite and their ability to selectively inhibit osteoclast activity, bisphosphonates have a significant effect on bone remodelling and this in turn has important consequences for dental practice. The dental importance of bisphosphonates is paradoxical: while the suppression of excessive bone resorption may be beneficial for the preservation of periodontal and peri-implant bone, oversuppression of bone remodelling may lead to medication-related osteonecrosis of the jaw (MRONJ), especially in patients who are susceptible. This article looks at the mechanism of action and the pharmacological classification of bisphosphonates and gives a thorough examination of their indications, contraindications, advantages, disadvantages and implications for restorative dentistry, endodontics, periodontology, oral surgery, implant dentistry, prosthodontics and orthodontics. Present evidence indicates that bisphosphonate treatment for osteoporosis alone is not a contraindication to routine dental treatment or the placement of dental implants. On the other hand, patients who are receiving high-dose antiresorptive therapy for cancer constitute a much higher-risk group in whom elective dentoalveolar surgery and the placement of implants should generally be avoided. Modern management places emphasis on prevention, controlling oral infection, carrying out an individual risk assessment and using conservative surgical techniques rather than on routinely stopping antiresorptive therapy. New applications, such as the local delivery of bisphosphonates and the use of bisphosphonate-functionalized implant surfaces, are promising but are still in the investigational stage. Keywords: Bisphosphonates; Antiresorptive agents; Osteoclasts; Medication-Related Osteonecrosis of the Jaw (MRONJ).