Oral bisphosphonate-related osteonecrosis of the jaws in dental implant patients: a case series

Br J Oral Maxillofac Surg. 2013 Dec;51(8):874-9. doi: 10.1016/j.bjoms.2013.06.011. Epub 2013 Jul 15.


Bisphosphonates have been associated with a serious adverse reaction known as bisphosphonate-related osteonecrosis of the jaws (BRONJ). The aim of this study was to describe its clinical characteristics in patients with dental implants who were taking bisphosphonates orally. We made a retrospective multicentre study in 3 hospitals in Galicia, Spain. The medical records and clinical and radiological follow-up of the oral cavity were reviewed for those patients given bisphosphonates and diagnosed with BRONJ after the placement of dental implants within the previous 3 years. The series comprised 9 white patients (mean age 66 years). The bisphosphonates were alendronate (n=6), ibandronate (n=2), and risedronate (n=1), and the most common indication was osteoporosis (n=7). The mean interval between the initiation of treatment and the onset of BRONJ lesions was 60 months. Most of the lesions were located around the mandibular implants (n=8). The mean interval between placement of dental implants and the onset of BRONJ was 34 (range 1-96) months. After treatment 7/9 patients recovered completely. The prevalence of BRONJ secondary to treatment with bisphosphonates taken orally after placement of dental implants may be higher than expected in a particular geographical region, but to date specific risk factors have not been identified. Clinical characteristics and the outcomes of treatment of lesions are similar to those seen in patients with BRONJ that is unrelated to placement of dental implants.

Keywords: Dental implant; Oral bisphosphonate; Osteonecrosis of the jaws.

Publication types

  • Multicenter Study

MeSH terms

  • Administration, Oral
  • Adrenal Cortex Hormones / therapeutic use
  • Aged
  • Alendronate / administration & dosage
  • Alendronate / adverse effects
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / etiology*
  • Bone Density Conservation Agents / administration & dosage
  • Bone Density Conservation Agents / adverse effects
  • Dental Implants*
  • Diphosphonates / administration & dosage
  • Diphosphonates / adverse effects
  • Etidronic Acid / administration & dosage
  • Etidronic Acid / adverse effects
  • Etidronic Acid / analogs & derivatives
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / complications
  • Ibandronic Acid
  • Male
  • Mandibular Diseases / etiology
  • Maxillary Diseases / etiology
  • Middle Aged
  • Retrospective Studies
  • Risedronic Acid
  • Risk Factors
  • Time Factors


  • Adrenal Cortex Hormones
  • Bone Density Conservation Agents
  • Dental Implants
  • Diphosphonates
  • Risedronic Acid
  • Etidronic Acid
  • Ibandronic Acid
  • Alendronate