Effect of local vs. systemic bisphosphonate delivery on dental implant fixation in a model of osteonecrosis of the jaw

J Dent Res. 2013 Mar;92(3):279-83. doi: 10.1177/0022034512472335. Epub 2012 Dec 21.


Locally applied bisphosphonates may improve the fixation of metal implants in bone. However, systemic bisphosphonate treatment is associated with a risk of osteonecrosis of the jaw (ONJ). We hypothesized that local delivery of bisphosphonate from the implant surface improves the fixation of dental implants without complications in a setting where systemic treatment induces ONJ. Forty rats were randomly allocated to 4 groups of 10. All groups received a titanium implant inserted in an extraction socket. Group I received the implants only. Group II received dexamethasone (0.5 mg/kg). Group III received dexamethasone as above plus alendronate (200 µg/kg). Group IV received zoledronate-coated implants and dexamethasone as above. The animals were sacrificed 2 weeks after tooth extraction. All 10 animals with systemic alendronate treatment developed large ONJ-like changes, while all with local treatment were completely healed. Implant removal torque was higher for the bisphosphonate-coated implants compared with the other groups (p < 0.03 for each comparison). Micro-computed tomography of the maxilla showed more bone loss in the systemic alendronate group compared with groups receiving local treatment (p = 0.001). Local bisphosphonate treatment appears to improve implant fixation in a setting where systemic treatment caused ONJ.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Alendronate / administration & dosage
  • Alendronate / adverse effects
  • Animals
  • Anti-Inflammatory Agents / administration & dosage
  • Bisphosphonate-Associated Osteonecrosis of the Jaw* / diagnostic imaging
  • Bisphosphonate-Associated Osteonecrosis of the Jaw* / etiology
  • Bisphosphonate-Associated Osteonecrosis of the Jaw* / prevention & control
  • Bone Density Conservation Agents / administration & dosage*
  • Bone Density Conservation Agents / adverse effects
  • Coated Materials, Biocompatible*
  • Dental Implantation, Endosseous / methods*
  • Dental Implants, Single-Tooth
  • Dental Prosthesis Retention / instrumentation
  • Dental Prosthesis Retention / methods*
  • Dental Stress Analysis
  • Dexamethasone / administration & dosage
  • Diphosphonates / administration & dosage*
  • Drug Delivery Systems*
  • Imidazoles / administration & dosage*
  • Injections, Intravenous / adverse effects
  • Male
  • Maxilla / diagnostic imaging
  • Osseointegration
  • Rats
  • Rats, Sprague-Dawley
  • Surface Properties
  • Tooth Socket / surgery
  • X-Ray Microtomography
  • Zoledronic Acid


  • Anti-Inflammatory Agents
  • Bone Density Conservation Agents
  • Coated Materials, Biocompatible
  • Diphosphonates
  • Imidazoles
  • Zoledronic Acid
  • Dexamethasone
  • Alendronate