Effects of systematic bisphosphonate use in patients under orthodontic treatment: a systematic review
Kaklamanos, Eleftherios G.
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Background: Bisphosphonates are a class of drugs prescribed for several osseous related disorders owing to their ability to regulate bone turnover, which could in turn affect orthodontic treatment outcomes. Objective: To examine the effect of bisphosphonate (BP) use on orthodontic patients through clinical and radiographic measurements. Search methods: Systematic and unrestricted search of 17 databases complemented with additional hand-searches were performed up to March 2019. Selection criteria: Articles reporting on human patients with a history of BPs administration that received orthodontic treatment were eligible for inclusion. Data collection and analysis: Data regarding the medical profile of the patients, the specific type of malocclusion and the performed treatment plan, as well as the clinical and radiographic outcomes were extracted. Quality assessment was performed by the ROBINS-I tool for the cohort studies and by a slightly modified checklist from the original one proposed by Agbabiaka et al. for the case reports. Results: 7 articles (1 retrospective cohort study and 6 case reports) were eventually included in the present review including 122 subjects (29 patients and 93 controls) reporting on the clinical and radiographic changes following orthodontic treatment of patients during or after BPs use. BPs seem to have a controversial effect on the clinical and patient-reported variables, even though the majority of the included patients presented with compromised treatment results and a rather slow rate of tooth movement. Most radiographic findings revealed mild root resorption, widened periodontal ligament spaces and sclerotic changes on the surrounding alveolar bone. However, these results should be interpreted with caution, due to the limited number of the eligible articles and their limitations. Limitations: The included studies were of rather low quality due to study design and incomplete reporting. Conclusions and implications: BP administration seems to be associated with compromised clinical outcomes, prolonged treatment time, and moderate changes on the roots and surrounding tissues of orthodontic patients.