Critical Analysis of the Effect of Antiresorptive Drugs on Osteonecrosis Associated With Dental Implants: An Umbrella Review

The overview was carried out to evaluate the impact of antiresorptive drug (ARD) therapy in patients undergoing dental implant treatment who significantly experience medication-related osteonecrosis of the jaw (MRONJ) or not. A comprehensive electronic database search within the timeline of 2014-2024, restricted to the English language, was performed in database search engines like Google Scholar, Web of Science, PubMed, and Scopus. The articles were screened using the specific Medical Subject Headings (MeSH) terms and Boolean operators 'OR' and 'AND'. Studies with patients having a history of ARD before, during, or following implant placement were included in the systematic review, without or with meta-analysis. The AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews) tool was utilized to evaluate the quality of the papers. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024583017). There were 10 systematic reviews as per eligibility criteria. The total number of failed implants was 524, out of which the incidence of MRONJ was between the ranges of 2% and 17%. According to the AMSTAR 2 tool, 20% of the studies were rated as medium quality, 60% were rated as low quality, and 20% were rated as critically low quality. Three meta-analyses were observed for the event "MRONJ," and it found no statistically significant differences between dental implant users with ARD and non-ARD participants. The corroborative evidence presents that patients undergoing dental implants with ARD history significantly experience MRONJ if there is a lack of strategic planning of implant placement.