J Clin Periodontol 2013; 39: 408414 doi: 10.1111/j.1600-051X.2012.01854.

Association between oral Julie K. Yip1, Luisa N. Borrell2,

Sang-Choon Cho1, Helena
Francisco3 and Dennis P. Tarnow4

bisphosphonate use and dental 1

Department of Periodontology and Implant
Dentistry, New York University College of
Dentistry, New York, USA; 2Department of

implant failure among Health Sciences, Lehman College, City

University of New York, New York, USA;
3
Biomedical and Oral Sciences Research

middle-aged women Unit, University of Lisbon School of Dental

Medicine, Lisbon, Portugal; 4Department of
Periodontology, Columbia University College
of Dental Medicine, New York, USA

Yip JK, Borrell LN, Cho S-C, Francisco H, Tarnow DP. Association between oral
bisphosphonate use and dental implant failure among middle-aged women. J Clin
Periodontol 2012; 39: 408414. doi: 10.1111/j.1600-051X.2012.01854.x.

Abstract
Aim: To investigate the association between the use of oral bisphosphonate
therapy and dental implant failure.
Materials and Methods: The casecontrol study involved 337 female patients,
aged 40 years and older, who had 1181 implants placed at the Department of
Periodontology and Implant Dentistry at New York University College of Dentis-
try between January 1997 and December 2004. Cases, dened as women with one
or more implant failures, were identied from the departmental database. Con-
trols were then randomly selected for each case. Adjusted odds ratios were esti-
mated using logistic regression models tted through generalized estimating
equations.
Results: After adjusting for selected covariates, the odds of oral bisphosphonate
use was 2.69 (95% condence interval [CI], 1.494.86) times higher in women for
whom implants failed compared with those for whom implants did not fail.
Although no signicant interaction was observed (p = 0.41), the stratied analyses View the pubcast on this paper at http://
suggest that the association between oral bisphosphonate use and dental implant www.scivee.tv/node/47093
failure was stronger in the maxilla (Odds Ratio [OR] = 2.60; 95% CI, 1.364.96)
Key words: dental implant; epidemiology;
than in the mandible (OR = 1.38; 95% CI, 0.513.73). oral bisphosphonates; outcomes; regression
Conclusion: Findings from this study suggest that dental practitioners should be models; women
aware of the increased risk of implant failure associated with oral bisphosphonate
use in the population. Accepted for publication 25 December 2011

Despite improvements in the dental
health of Americans over the
last 20 years, tooth loss remains a
signicant problem for many men
Conflict of interest and source of
funding statement
No external funding, apart from the
support of the authors institution,
was available for this study. The
authors declare that there are no
conicts of interest in this study.
and women, with older women bear-
ing the higher toll. Specically, the
prevalence of edentulism among men
2064 years of age was 3.8%,
whereas the prevalence in women
was 3.7% for the period of 1999
2004. However, the gap widened for
those aged 65 years and older, with
women exhibiting a prevalence of
29.3% and men 24.4% during the
same period (Dye et al. 2007). Loss
of teeth leads to aesthetic problems,
loss of function, occlusal dishar-
mony, problems with speech and
psychological problems. Although
restoring edentulous spaces with
xed or removable dentures remain
treatment options, the advent of
dental implants has provided clini-
cians and patients with a viable, and
in many cases, more functional,
alternative to conventional dental
prostheses.
Research into implant design and
surface microtopography has increased
the success rate of dental implants in

408 2012 John Wiley & Sons A/S


recent years. However, between 3%
and 10% of implants still fail (Moy
et al. 2005, Alsaadi et al. 2007).
Although much is known about the
implant-related factors that inuence
success rate (Cooper et al. 1998, Masu-
da et al. 1998, Winkler et al. 2000, Al-
saadi et al. 2007), the impact of
systemic conditions and medications
on implant success is much less well
understood. For instance, when
reports of osteonecrosis of the jaw
(ONJ) associated with intravenous and
oral nitrogen-containing bisphospho-
nates surfaced in 2003 (Marx 2003,
Wang et al. 2003), alarm spread
through the dental community as a
majority of the cases had occurred
after dentoalveolar surgery, denture
trauma or other physical trauma in the
oral cavity (Woo et al. 2006). Bis-
phosphonates are potent antiresorptive
agents prescribed in the treatment of
hypercalcaemia of malignancy, skeletal
events associated with metastatic neo-
plasm, multiple myeloma, Pagets dis-
ease of bone and osteoporosis (Fleisch
et al. 2002). Of these conditions, osteo-
porosis is the most commonly encoun-
tered in dental practices. Osteoporosis
is a major health threat for 55% of
Americans over the age of 50, with
80% of the burden being shouldered
by women (National Osteoporosis
Foundation 2011). Despite the risk of
ONJ, bisphosphonates remain the
drugs of choice in the treatment of
osteoporosis today, and treatment is
envisioned to be life-long.
Bisphosphonates aect bone remod-
elling (van Beek et al. 1999, Berg-
strom et al. 2000, Dunford et al.
2001, Li et al. 2001), and a number
of studies have reported that a
cumulative eect of time and dose
contributes to the development of
ONJ (Bamias et al. 2005, Ho et al.
2008). As the pathophysiological
processes leading up to ONJ aect
bone remodelling in the maxilla and
mandible, there has been concern if
dental implants placed in women on
oral bisphosphonate therapy would
have worse prognosis. However,
with the exception of a handful of
case series (Fugazzotto et al. 2007,
Bell & Bell 2008, Grant et al. 2008,
Kasai et al. 2009, Goss et al. 2010,
Koka et al. 2010, Martin et al. 2010,
Shabestari et al. 2010) and a small
controlled trial (Jecoat 2006), there
has been a paucity of well-designed
studies examining the relationship
2012 John Wiley & Sons A/S
Oral bisphosphonates and dental implants
between oral bisphosphonate use
and dental implant failure. There-
fore, the aim of this study was to
investigate the association between
the use of oral bisphosphonate ther-
apy and dental implant failure using
records of women seeking implant
treatment at the Department of Peri-
odontology and Implant Dentistry at
New York University College of
Dentistry between 1997 and 2004.
The study also examined whether
this association diered by implant
length and location.
Methods
Sources of data
The data for this study were derived
from two sources within New York
University College of Dentistry
(NYUCD): (1) the Department of
Periodontology and Implant Den-
tistry database and (2) patient records
at NYUCD. Clinical information per-
taining to each stage of implant treat-
ment and complications was obtained
from the Department of Periodontol-
ogy and Implant Dentistry database.
Information derived from the data-
base included implant failure, year
of implant placement, as well as
implant location, surface, diameter
and length. The other source of data,
patient records in NYUCD, provided
information on patients age at the
date of implant placement, meno-
pausal status, oral bisphosphonate
use, smoking status, diabetes, thyroid
disorders, high blood pressure, heart
attack and stroke.
This study included the records
of women, 40 years and older,
receiving endosseous implants in the
Department of Periodontology and
Implant Dentistry between January
1997 and December 2004. During
this period, 9701 implants were
placed in the department, with 55%
being placed in women (n = 5336).
Furthermore, these implants were
clustered in 1460 women aged
40 years and older.
Study design
A casecontrol study design was used
with an approximate ratio of 1:2 in
female patients seeking care at
Department of Periodontology and
Implant Dentistry between January
409
1997 and December 2004. The study
was limited to the period between
January 1997 and December 2004 to
minimize the likelihood that patients
ceased taking their oral bisphospho-
nate medications just prior to their
surgery for fear of ONJ. This limita-
tion might decrease the potential for
misclassication of exposure. Cases,
dened as women with one or more
rst-time implant failures, were iden-
tied from the departmental data-
base. Implant failure was dened as
failure of the dental implant to osseo-
integrate or an implant that had
become mobile at any time during
the observation period and required
removal. The determination of
whether an implant had failed was
made based on clinical and radio-
graphic criteria. A total of 114 women
aged 40 years and older, who had
their rst implant failure, and had
implants placed in the department
between January 1997 and December
2004, were identied as cases from the
database. The 223 controls were
selected from the same database from
which cases were obtained, and were
dened as patients without any
implant failures. To select the con-
trols, non-cases were frequency
matched with previously identied
cases by year of rst implant place-
ment surgery. An average of two con-
trols was randomly selected for each
case in each of the years. However,
each woman could have multiple
implants placed, resulting in a total of
1181 implants among cases and con-
trols (490 and 691 implants respec-
tively). The mean follow-up time was
6.03 years (SD = 2.85; range = 0.33,
11.89). Cases (4.30, SD = 2.97) had
more implants placed than controls
(3.10, SD = 2.19; p-value = 0.02;
Table 1). Of the 490 implants placed in
cases, there were 163 implant failures.
In general, active records are
stored in the Medical Records
Department at NYUCD, and are
available for review. Patient records
that remain inactive in the Medical
Records Department at NYUCD for
more than 12 months are sent to an
o-site archival facility. Moreover,
patient records that remain inactive
in the archives for more than 7 years
are removed and destroyed. For this
study, active records were readily
available for review, and 217 of the
244 (88.9%) archived records were
successfully recalled.
410 Yip et al.

Table 1. Distribution of selected patient characteristics in controls and cases: Department regression models tted through
of Periodontology and Implant Dentistry, NYU College of Dentistry 19972004 Generalized Estimating Equations
Characteristics % Controls (n = 223) % Cases (n = 114) p-value* (GEE) were used to determine the
strength of the association between

Age 57.70 (SD = 10.65) 57.45 (SD = 9.78) 0.83 oral bisphosphonate use and dental
Menopausal status implant failure among women,
Premenopausal 27.80 26.32 0.95 before and after adjusting for selected
Postmenopausal on HRT 10.76 10.53
covariates. GEE accounted for cor-
Postmenopausal not on HRT 61.43 63.16
Bisphosphonate use
relations between the implants
No 95.96 90.35 0.04 placed in the same individual by
Yes 4.04 9.65 modelling the correlations or covari-
Smoking status ances themselves rather than allow-
Former/Never smoker 86.55 80.70 0.16 ing for random eects or random
Current smoker 13.45 19.30 coecients, as in the case of multi-
Diabetes level models (Diggle et al. 2003).
No 93.72 94.74 0.71 Thus, we took such correlations into
Yes 6.28 5.26 account in estimating regression
Thyroid disorders
coecients and their standard errors.
No 89.24 89.47 0.95
Yes 10.76 10.53 As a result, the ORs reported are
Hypothyroidism population averages rather than
No 91.03 91.23 0.77 individual-specic estimates. These
Yes 8.52 8.77 estimates provide an accurate
Cardiovascular diseases approximation of the true exposure
High blood pressure eect on the outcomes (Hubbard
No 77.13 85.96 0.05 et al. 2010).
Yes 22.87 14.04 To ascertain whether the associa-
Heart attack
tion between oral bisphosphonate
No 98.65 97.37 0.40
Yes 1.35 2.63
use and implant failure diered by
Stroke the implant placement location and
No 98.65 98.25 0.77 length, appropriate interaction terms
Yes 1.35 1.75 were tested in the fully adjusted
Number of implants 3.10 (SD = 2.19) 4.30 (SD = 2.97) 0.02 models. Statistical analyses were car-
ried out using SAS Software Release
*p-value for chi-squared test, except for age, where t-test was used.
9.2 (SAS Institute Inc 2009).
Based on individual data.

Mean age in years and number of implants (SD).

Total does not add up to 100% as information is missing from one subject.
Study variables
Exposure
The main exposure for this analysis
was oral bisphosphonate therapy. A
woman was considered to be using
oral bisphosphonates if she reported
taking one or more of the following
medications at the time of implant
placement: Alendronate
TM
(Fosamax,
or Fosamax Plus D ), Risedronate
(Actonel, or Actonel with Cal-
cium), Ibandronate (Boniva), Etidr-
onate (Didronel, or Didrocal) or
Tiludronate (Skelid). All the
women reporting oral bisphospho-
nate use in this study were taking
nitrogen-containing bisphosphonates,
i.e., Alendronate and Risedronate.
Covariates
Covariates identied as potential
confounders in previous studies
(Moy et al. 2005, Alsaadi et al.
2007) age at the date of implant
placement, year of implant place-
ment, smoking status, implant loca-
tion, implant surface, implant
diameter and implant length were
included in the analyses. The follow-
ing variables were also considered as
potential confounders: diabetes, thy-
roid disorders, high blood pressure,
heart attack, stroke and menopausal
status (Olson et al. 2000, Moy et al.
2005, Alsaadi et al. 2007).
Statistical analyses
Distributions of patient characteris-
tics and implant-related factors for
cases and controls were calculated.
In addition, the distribution of
implant-related and local factors for
implants according to failure status
was calculated. To test for statisti-
cally signicant dierences between
groups, chi-square tests were used
for categorical variables, and t-tests
for continuous variables. Logistic
Results
Comparison of characteristics bet-
ween cases and controls showed
that, other than oral bisphosphonate
use, none of the other behavioural
and patient-related factors, namely
age, menopausal status, smoking,
diabetes, thyroid disorders, high
blood pressure, heart attack and
stroke, were dierently distributed
(all p-values > 0.05; Table 1). How-
ever, cases were more likely to report
being oral bisphosphonate users
(9.65%) than controls (4.04%; p =
0.04). In addition, controls (3.10)
received a signicantly lower number
of implants than cases (4.30; p =
0.02)
A higher percentage of implants
placed in the maxillary anterior
(22.70%) and mandibular posterior
(30.06%) failed, compared with
implants in these locations that sur-
vived (16.80% and 23.77% respec-
tively; p = 0.03; Table 2). On the
other hand, a lower percentage of
mandibular anterior implants was
2012 John Wiley & Sons A/S
 Oral bisphosphonates and dental implants 411

Table 2. Distribution of implant-related and local factors for implants that survived and change in log odds was 6.7% and
implants that failed: Department of Periodontology and Implant Dentistry, NYU College 1.3% respectively). Therefore, chart
of Dentistry 19972004 status and a history of hypertension
Variables % implant survival % implant failure p-value* were not included in the nal model.
(n = 1018 implants) (n = 163 implants) No interaction was observed
between oral bisphosphonate use
Implant location and implant length (p = 0.78) or oral
Mandible 38.80 41.10 0.58
bisphosphonate use and implant
Maxilla 61.20 58.90
Site
location (p = 0.41) in the fully
Anterior 31.83 33.74 0.63 adjusted model. However, the strati-
Posterior 68.17 66.26 ed analyses suggested that the asso-
Jaw location ciation between oral bisphosphonate
Mandibular anterior 15.03 11.04 0.03 use and dental implant failure was
Mandibular posterior 23.77 30.06 stronger and signicant in the max-
Maxillary anterior 16.80 22.70 illa (adjusted OR = 2.60; 95% CI,
Maxillary posterior 44.40 36.20 1.364.96), while of less magnitude
Implant length and non-signicant in the mandible
>10.0mm 72.15 58.90 <0.001
(adjusted OR = 1.38; 95% CI, 0.51
 10.0mm 27.85 41.10
Implant diameter 3.73).
1.83.25mm 31.63 30.06 <0.001
>3.253.5mm 4.93 3.07 Discussion
>3.54.5mm 50.25 41.72
>4.55.5mm 13.20 25.15 This study found that a history of
Implant surface oral bisphosphonate use at the time
Machined 7.07 7.98 0.68 of implant placement was associated
Moderately roughened 92.93 92.02 with dental implant failure. Speci-
*p-value for chi-squared test. cally, the odds of reporting use of
bisphosphonates among women with
Based on implant data.
implant failure were almost three
times greater than among their coun-
found among implants that failed for whom dental implants failed terparts without implant failure.
(11.04%) than among implants that when compared with those for While the association between oral
survived (15.03%). Among the whom their implants did not fail bisphosphonate use and dental implant
implant-related and local factors, (Table 3). This association remained failure did not vary by implant
implant length, diameter and loca- signicant regardless of the variables length, there was evidence that this
tion were signicantly associated used during the adjustment. Further- association may be stronger in the
with implant failure (Table 2; all more, after controlling for all maxilla than in the mandible.
p-values < 0.05). Failed implants had covariates, the odds of oral bis- Evidence for the association
a higher percentage of short (  10.0 phosphonate use was 2.7 (95% CI, between oral bisphosphonate use
mm) implants (41.10%) than did 1.494.86) times greater among and dental implant failure is mixed,
implants that survived (27.85%). women with implant failures com- with one study nding an association
Compared with surviving implants pared with those without failures (Kasai et al. 2009) and others not
(13.20%), failed implants also had (Model 4). It is worth noting that (Jecoat 2006, Fugazzotto et al.
signicantly more wide diameter additional adjustment for chart sta- 2007, Bell & Bell 2008, Grant et al.
(>4.55.5 mm) implants (25.15%). tus (active or inactive) or a history 2008). The only study nding an
In the unadjusted analysis, the of hypertension did not change the association was a university-based
odds of reporting use of oral bis- eect estimate in the oral bisphosph- patient chart review study that iden-
phosphonates was 2.5 (95% CI, 1.45 onate-implant failure association to tied 11 patients on oral bisphosph-
4.28) times greater among women any signicant degree (percentage onate therapy of 65 female patients
who had dental implants placed
Table 3. Crude and adjusted odds ratios (OR) and their 95% condence intervals (CI) for between 1994 and December 31,
the association between oral bisphosphonate and implant failure: Department of Periodon- 2006, and reported an implant sur-
tology and Implant Dentistry, NYU College of Dentistry 19972004 vival rate of 86% in the bisphospho-
Crude OR Model 1* Model 2 Model 3 Model 4 nate group compared with 95% in
(95% CI) the unexposed group (Kasai et al.
2009). The present studys ndings,
Bisphosphonate use consistent with those of Kasai et al.
No 1.00 1.00 1.00 1.00 1.00 (2009), suggests that women who
Yes 2.50 2.54 2.72 2.69 2.69 reported oral bisphosphonate use at
(1.45, 4.28) (1.47, 4.41) (1.59, 4.63) (1.58, 4.58) (1.49, 4.86) the time of implant placement were
*Adjusted for age (Model 1); additionally adjusted for year (Model 2); additionally adjusted more likely to experience dental
for smoking (Model 3); additionally adjusted for implant location, surface, diameter and implant failure. Among the studies
length (Model 4). that did not nd an association, a
2012 John Wiley & Sons A/S
412 Yip et al.
single-blind controlled study reported
a survival rate of 100% in the bis-
phosphonate arm (n = 25 patients)
and 99.2% in the control arm
(n = 25 patients) (Jecoat 2006),
whereas a hospital-based study
found no dierence in implant sur-
vival rates among users (99.6%) and
non-users (99.0%) of oral bisphosph-
onates (Grant et al. 2008). Finally,
a recent systematic review also
reported that intake of oral bis-
phosphonates did not inuence
short-term implant survival rates
(Madrid & Sanz 2009). In addition,
although our results concur with
studies that have reported a greater
proportion of implant failures occur-
ring in the maxilla of women who
had received oral bisphosphonates
prior to implant placement (Bell &
Bell 2008, Kasai et al. 2009), they
dier from those of Martin et al.
(2010) who found a nearly equal
proportion of patients with implant
failures in the mandible versus the
maxilla.
A recent study that focused on
the oral cavity reported that daily
oral bisphosphonate treatment over
a period of 3 years signicantly
reduced intracortical bone turnover
rate of mandibular alveolar bone,
and increased the incidence of matrix
necrosis within the mandible in the
dog model (Allen & Burr 2008).
These ndings are consistent with
the mechanism of action behind
nitrogen-containing bisphosphonates
eective inhibition of osteoclast-
mediated resorption: through the
inhibition of farnesyl diphosphonate
synthase (van Beek et al. 1999, Berg-
strom et al. 2000, Dunford et al.
2001) and the induction of apoptosis
in osteoclasts (Reszka et al. 1999);
and the long skeletal half-life of bis-
phosphonates (Lin et al. 1999). Fur-
thermore, an in vitro study also
found that pretreatment of oral
mucosal cells with clinically relevant
doses of pamidronate inhibited cell
proliferation and wound healing
(Landesberg et al. 2008). These stud-
ies provide evidence that bisphosph-
onate use signicantly reduces
alveolar bone turnover and wound
healing, processes that potentially
render the mandible and maxilla sus-
ceptible to osteonecrosis of the jaw
and implant failure.
This study has a number of
strengths. For one, the NYU
Department of Periodontology and
Implant Dentistry database is one of
the largest databases of its kind in
the US. Control selection was per-
formed to minimize selection bias.
Moreover, as the data in the data-
base were derived from written
records long before the present
hypothesis was expressed, information
bias was unlikely. Other strengths of
the study include its large number of
cases to test the hypothesis; the use
of the patient medical history review
taken at the time of implant place-
ment, and therefore, information
bias with respect to the patients
medical and social history, was unli-
kely; the good ascertainment and
reporting of implant outcomes; and
accounting for the clustering of
implants within individuals.
However, this study has several
shortcomings. First, it is possible
that some patients chose to receive
treatment for their failed implants at
another institution or private oce,
leading to misclassication of cases
as controls. However, it is unlikely
this happened; as the implants were
being placed in an academic institu-
tion, patients knew that implants
that did fail would be replaced at no
charge to them. Second, the study
involved a retrospective chart review,
which limited our ability to obtain
information regarding the duration
of bisphosphonate usage. This would
have been an important variable to
examine, as the absorbed nitrogen-
containing bisphosphonates remain
bound to their bone targets until
they are released when the bone is
resorbed (Lin et al. 1999). This limi-
tation prevented us from stratifying
the population of oral bisphospho-
nate users by duration to analyse the
eect of increasing duration on
implant failure rate. Third, the
patient medical and behavioural his-
tories were self-reported. However,
given that the data were collected
prior to the outcome, any error
would be non-dierential with
respect to the outcome. Moreover,
studies comparing the validity and
reliability of common conditions
such as diabetes and hypertension
have shown self-reported informa-
tion to be highly correlated with
physicians records in local and
national studies (Giles et al. 1995,
Vargas et al. 1997, Martin et al.
2000, Ngo et al. 2003). Fourth, cases
had more implants placed than con-
trols, and this could have biased the
results. However, additional adjust-
ment for the number of implants did
not change the estimate for the asso-
ciation between oral bisphosphonate
and implant failure to any signicant
degree (percentage change in log
odds was less than 1%). Thus, it is
unlikely that the dierence in the
number of implants between cases
and controls biased the study results.
Fifth, as the study utilized informa-
tion that had been collected for pur-
poses other than research, our
investigation was limited by the data
that were already collected, and
therefore, we were unable to examine
the eect of dose and time of smok-
ing, as this information was not con-
sistently collected. However, if there
was a dierence in dose and time of
smoking between cases and controls,
our response will have been underes-
timated, given that cases were more
likely to smoke (Table 1).
Another limitation was the
unavailability of records for some
selected patients, because their
records were destroyed after 7 years,
since we were reviewing charts
between 1997 and 2004. As a sensi-
tivity analysis, selected baseline char-
acteristics of active and inactive
patients from the years 2000 through
2004 were compared to determine
whether there was any dierence in
the cases and controls for which the
records were located, and those for
which the records have been
destroyed. Inactive patients were
found to be similar to active patients
on baseline patient-related character-
istics. To corroborate the similarity
between active and inactive records,
the addition of chart status (active
or inactive) to the fully adjusted
model (Model 4 in Table 3) did not
change the eect estimate in the
oral bisphosphonate-implant failure
association to any signicant degree
(percentage change in log odds was
6.7%). Therefore, it is unlikely that
bias was introduced into the study
due to the inability to obtain all
requested charts as a result of
destruction of some of the older
inactive charts.
Additional analyses were per-
formed, taking into consideration
the periodontal status of the
patients. Baseline periodontal status
was not found to be dierentially
2012 John Wiley & Sons A/S

distributed between cases and con-
trols (p-value = 0.86). Moreover,
adding periodontal status to the
nal model adjusted for all covari-
ates (Model 4 in Table 3) yielded an
odds ratio of 2.82 (95% CI, 1.55
5.14). Although adjusting for peri-
odontal status seemed to strengthen
the eect estimate, the change of
estimate for the association between
oral bisphosphonate and implant
failure was not of signicant degree
(percentage change in log odds was
4.9%). Therefore, periodontal status
was not included in the nal model
presented in this study.
This study indicates that women
with implant failure had increased
odds of reporting a history of oral bis-
phosphonate use compared with those
without implant failure. This associa-
tion remained nearly unchanged after
the adjustment for selected character-
istics. Findings from this study suggest
that dental practitioners should be
aware of the increased risk of implant
failure associated with oral bisphosph-
onate use in certain patient popula-
tions. The ndings also support recent
recommendations for the discontinua-
tion of oral bisphosphonate therapy in
long-term oral bisphosphonate users
for 36 months prior to implant inser-
tion, and several months after, to
allow for the recovery of bone remod-
elling (Marx et al. 2007). However,
more research is needed to establish
the true benet of a drug holiday to
implant survival. Furthermore, there
is also a need to weigh the benets of a
drug holiday for implant therapy
against the risk of progression of oste-
oporosis in the absence of oral bis-
phosphonate therapy.
Acknowledgements
The authors thank the sta in the
Medical Records Department at
New York University College of
Dentistry for their invaluable help in
chart retrieval and Dr. Nuno Gon-
calves for his contribution in the ini-
tial stages of this study.
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414 Yip et al.
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Clinical Relevance
Scientific rationale for the study:
Oral bisphosphonates aect bone
remodelling. However, there is a
paucity of well-designed studies on
the relationship between oral bis-
phosphonate use and dental implant
failure.
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Principal findings: The odds of
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implant failure than among their
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Address:
Julie K. Yip
Department of Periodontology and Implant
Dentistry
New York University College of Dentistry
345 East 24th Street
New York, NY 10010
USA
E-mail: julie.yip@nyu.edu
Practical implications: Practitioners
need to weigh the benets of a
drug holiday against the risk of
progression of osteoporosis in the
absence of oral bisphosphonate
therapy in postmenopausal women
seeking implant therapy.
2012 John Wiley & Sons A/S