The risk of osteonecrosis of the jaw and adverse outcomes in patients using antiresorptive drugs undergoing orthodontic treatment: A systematic review

Julian Woolley; Oladapo Akintola; Julian Yates; Monica Diuana Calasans-Maia; Jose de Albuquerque Calasans-Maia; Iryna Kocherhina; Roberto Sacco

doi:10.1016/j.heliyon.2021.e05914

The risk of osteonecrosis of the jaw and adverse outcomes in patients using antiresorptive drugs undergoing orthodontic treatment: A systematic review

Heliyon. 2021 Jan 13;7(1):e05914. doi: 10.1016/j.heliyon.2021.e05914. eCollection 2021 Jan.

Authors

Julian Woolley¹, Oladapo Akintola¹, Julian Yates², Monica Diuana Calasans-Maia³, Jose de Albuquerque Calasans-Maia⁴, Iryna Kocherhina⁵, Roberto Sacco^{1

2}

Affiliations

¹ King's College Dental Hospital, Oral Surgery Department, London, UK.
² The University of Manchester, Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK.
³ Universidade Federal Fluminense, Dental School, Oral Surgery Department, Rio de Janeiro, Brazil.
⁴ Universidade Federal Fluminense, Dental School, Orthodontics Department, Rio de Janeiro, Brazil.
⁵ Orthodontics Postgraduate Center, Guy's Dental Hospital, London, UK.

Abstract

Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is rare. It is a serious adverse effect of certain drugs, of which bisphosphonates (BPs) are the most widely known. The aim of this systematic review was to analyze all published evidence for the reported adverse outcomes as a result of orthodontic treatment in patients undergoing antiresorptive therapy.

Data: All types of studies involving patients undergoing orthodontic treatment and treated with antiresorptive drugs were considered. A meta-analysis was not conducted due to the high amount of variability and heterogeneity in the reporting and presentation of data among the studies meeting the inclusion criteria.

Sources: A systematic search was performed using 4 databases (PubMed, MEDLINE, EMBASE and CINAHL).

Study selection: Seven studies matched the inclusion criteria for this review, reporting a total of 29 patients. MRONJ was only reported in 1 patient. The adverse outcomes following orthodontic treatment included difficulty achieving root parallelism (n = 4), difficulty achieving complete space closure (n = 3), exaggerated tooth mobility post-debond (n = 2), increased duration of orthodontic treatment beyond expected completion (n = 1), sclerotic alveolar bone changes seen on post-op radiographic images (n = 2), and an increased amount of root resorption (n = 1).

Conclusions: The high amount of heterogeneity and limited evidence precluded a valid interpretation and analysis of the results through pooling of data. Additional data with sufficient quality, a reduction of bias, and a greater prospective cohort of patients is crucial to assess adverse effects, mechanisms of action, and associated risk factors in at-risk patients.

Clinical significance: Based on the limited evidence available in the literature, it is unclear whether orthodontic treatment alone can precipitate MRONJ. However, antiresorptive drug therapy may be associated with a sub-optimal treatment outcome.

Keywords: Antiresorptive drugs; MRONJ; Orthodontic treatment; Orthodontics; Osteonecrosis; Tooth movement.

Publication types

Review