Is medication-related osteonecrosis of the jaw around dental implants associated with the implant design and prosthesis characteristics?

Abstract

Purpose: This study aimed to identify risk factors associated with medication-related osteonecrosis of the jaw (MRONJ) around dental implants, focusing on implant/prosthesis characteristics and peri-implantitis. Methods: This retrospective study included 355 dental implants obtained from 67 patients, each with at least one implant affected by MRONJ, who visited Yonsei University Dental Hospital between January 2008 and March 2022. The outcome variable was the presence or absence of MRONJ. Predictor variables included implant location, crestal module design, prosthesis type, emergence profile, emergence angle (EA), and peri-implantitis. A generalized estimating equation model was used to adjust for within-patient clustering effects. Results: A total of 355 implants were analyzed, of which 112 implants were affected by MRONJ and 243 were not affected. External-type implants had higher odds of MRONJ than tissue-level implants (OR, 4.07; 95 % CI, 1.23-13.45). The odds of MRONJ were higher in implants with peri-implantitis compared to those without peri-implantitis (OR, 7.43; 95 % CI, 2.74-20.14). In tissue-level implants, MRONJ was significantly associated with a convex profile (39.1 %) than in those with straight or concave profiles (15.8 %). In bone-level implants, MRONJ was significantly higher in prostheses with an EA of >30 degrees on at least one side, compared to those with EA of <= 30 degrees on both sides. In addition, implants placed in the molar region had a significantly wider EA and more frequent convex profiles than those placed in the premolar region. Conclusions: MRONJ affected dental implants may be associated with crestal module design. In addition, implant prosthesis characteristics may influence MRONJ occurrence depending on the implant design, and in patients receiving antiresorptive therapy, implant design should be carefully planned with consideration of the anatomical location to minimize the risk of MRONJ. Clinical Significance: Implant design should be considered when planning implant treatment in patients receiving antiresorptive therapy, especially in anatomically vulnerable areas such as the molar region.