Major considerations of common and zygomatic implants in patients using bisphosphonates and the risk of osteonecrosis: a concise systematic review

Abstract

Introduction: In the context of dental implants and bone strengthening, bisphosphonates (BPs) are antiresorptive agents. However, prolonged use of BPs may increase the risk of medication-related osteonecrosis of the jaw (MRONJ), impairing the placement of common and zygomatic implants. Objective: This study aimed to analyze the major considerations of common and zygomatic implants in patients using bisphosphonates, as well as the risk of osteonecrosis. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from September to October 2025 in the Web of Science, Scopus, Embase, PubMed, Science Direct, SciELO, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: According to the GRADE instrument, most studies presented homogeneity in their results, with X2=81.2%>50%. A total of 81 articles were found and submitted for eligibility analysis, with 07 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 27 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. It was concluded that current evidence does not suggest a strong association between antiresorptive therapy in patients with osteoporosis and failure of common and zygomatic dental implants. Low-certainty evidence suggests that antiresorptive treatment for osteoporosis reduces dental implant failure. Bisphosphonates are associated with medication-related osteonecrosis of the jaw in patients with osteoporosis receiving dental implants, with moderate certainty