J Oral Maxillofac Surg66:223-230, 2008 Outcomes of Placing Dental Implants in Patients Taking Oral Bisphosphonates: A Review of 115 Cases Bao-Thy Grant, DDS,* Christopher Amenedo, DDS,† Katherine Freeman, DrPH,‡ and Richard A. Kraut, DDS§ Purpose: In recent years, numerous cases of bisphosphonate-associated osteonecrosis of the jaw havebeen reported involving both intravenous and oral therapy regimens. The majority of these cases haveinvolved intravenous bisphosphonates. Subsequently, drug manufacturers and the US Food and DrugAdministration issued warnings about possible bisphosphonate-associated osteonecrosis of the jaw. TheAmerican Dental Association and the American Association of Oral and Maxillofacial Surgeons assembledexpert panels to formulate treatment guidelines. Both panels differentiated between patients receivingbisphosphonates intravenously and those receiving the drugs orally. However, the recommendationswere based on limited data, especially with regard to patients taking oral bisphosphonates. We wantedto ascertain the extent to which bisphosphonate-associated necrosis of the jaw has occurred in our dentalimplant patients. We also wanted to determine whether there was any indication that the bisphospho-nate therapy affected the overall success of the implants as defined by Albrektsson and Zarb.Patients and Methods: We identified 1,319 female patients over the age of 40 who had received dentalimplants at Montefiore Medical Center between January 1998 and December 2006. A survey about bisphos-phonate therapy was mailed to all 1,319 patients. Responses were received from 458 patients of whom 115reported that they had taken oral bisphosphonates. None had received intravenous bisphosphonates. All 115patients were contacted and informed about the risk of bisphosphonate-associated osteonecrosis of the jaw.Seventy-two patients returned to the clinic for follow-up clinical and radiological evaluation.Results: A total of 468 implants were placed in the 115 patients who reported that they had receivedoral bisphosphonate therapy. There is no evidence of bisphosphonate-associated osteonecrosis of thejaw in any of the patients evaluated in the clinic and those contacted by phone or e-mail reported nosymptoms. Of the 468 implants, all but 2 integrated fully and meet criteria for establishing implantsuccess. Implant success rates were comparable for patients receiving oral bisphosphonate therapy andthose not receiving oral bisphosphonate therapy.Conclusions: Guidelines for treatment of dental patients receiving intravenous bisphosphonate treatmentsshould be different than for patients taking the oral formulations of these medications. In this study, oralbisphosphonate therapy did not appear to significantly affect implant success. Implant surgery on patientsreceiving bisphosphonate therapy did not result in bisphosphonate-associated osteonecrosis of the jaw.Nevertheless, sufficient evidence exists to suggest that all patients undergoing implant placement should bequestioned about bisphosphonate therapy including the drug taken, the dosage, and length of treatment priorto surgery. For patients having a history of oral bisphosphonate treatment exceeding 3 years and those havingconcomitant treatment with prednisone, additional testing and alternate treatment options should be con-sidered.© 2008 American Association of Oral and Maxillofacial SurgeonsJ Oral Maxillofac Surg 66:223-230, 2008