Effect of Local vs. Systemic Bisphosphonate Delivery on Dental Implant Fixation in a Model of Osteonecrosis of the Jaw

• Published in: Journal of dental research 2013-03, Vol.92 (3), p.279-283
• Main Authors: Abtahi, J., Agholme, F., Sandberg, O., Aspenberg, P.
• Format: Article
• Language: English
• Subjects: 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; Dentistry; 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
• ISSN: 0022-0345; 1544-0591; 1544-0591
• DOI: 10.1177/0022034512472335

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.