Bisphosphonates: how to proceed in orthodontics

Introduction: Bisphosphonates are mainly used in the treatment of osteoporosis and in oncology. They bind to bone and inhibit the action of osteoclasts, leading to a decrease in bone remodeling and thus hindering tooth movement. The main objective was to present, through a review of the literature, the indications and therapeutic modalities for orthodontic treatment of patients who are or have been treated with bisphosphonates. The second objective was to propose a decisional organization chart for medical care.

Materials and methods: The search was done by keywords on PubMed.

Results: 189 articles were found, mostly case reports. 1) Intravenous treatment is a contraindication to ODF treatment. 2) Per os treatment is possible with precautions: to be in accordance with the prescribing practitioner, avoid major travels, avoid surgical procedures (extractions...) which must be as atraumatic as possible. A delay in healing is to be expected. The benefit-risk ratio must be taken into account. The risks - the patient must be informed of them - are slowed movement and osteonecrosis. Clinical and radiological follow-up is necessary and may warrant re-evaluation of treatment at any time: excessive tooth mobility, molar furcation damage, unusually persistent periodontal pain and symptoms, fistulas, exposed areas of necrotic bone.

Discussion: The articles are of low grade. Most of the articles are studies made on animals.

Conclusion: Research is ongoing to evaluate the value of bisphosphonates as anchorage reinforcement.