MRONJ Risk Related to Dental Implants in Osteoporosis Treated With Denosumab: A Systematic Review

OBJECTIVES: The aim of this systematic review was to assess the impact of dental implants in osteoporotic patients undergoing treatment with denosumab on MRONJ development, considering both implant surgery-triggered osteonecrosis (ISTO) and implant presence-triggered osteonecrosis (IPTO). METHODS: An electronic literature search was conducted applying the clinical PICO question, "What is the effect of dental implants on the risk of developing MRONJ in osteoporotic patients undergoing treatment with denosumab?" The full texts of 239 retrieved articles were screened, and 10 studies were included in the quality assessment and data extraction process. RESULTS: 10 articles were selected for data extraction: 6 case series, 2 cohort studies, 1 case control study, and 1 randomized controlled trial. The main findings reported in these studies were evaluated, including factors such as the timing of implant placement, the influence of peri-implantitis and comorbidities, antiresorptive therapy, and the cases of MRONJ. CONCLUSIONS: The current literature shows high heterogeneity, small sample sizes, and a lack of standardization, making it difficult to draw definitive conclusions. However, despite MRONJ being relatively rare, important factors were identified that could influence outcomes, such as transitioning from bisphosphonates to denosumab therapy, timing of implant placement, and the presence of peri-implantitis.