Objectives: A considerable portion of the adult population has received and/or is receiving treatment with antiresorptive drugs ( ARD s). It is thus relevant to assess possible side effects of ARD intake in connection to various aspects of implant therapy. The aim of this study was to answer the focused question “In patients with systemic intake of ARD s, what is the outcome and complication rate of implant therapy including associated bone grafting procedures comparing to patients without systemic intake of ARD s?” Materials and Methods: Original studies fulfilled predefined inclusion criteria (e.g., case series, cohort studies, case–control studies, and controlled and/or randomized controlled clinical trials; retro‐ or prospective design; and ≥10 patients with systemic intake of ARD s). Various patient‐, medication‐, and intervention‐related parameters [i.e., implant loss, grafting procedure complication/failure, peri‐implant marginal bone levels/loss, medication‐related osteonecrosis of the jaws ( MRONJ ), and peri‐implantitis] were extracted, and meta‐analyses and quality assessment were performed. Results: Twenty‐four studies with bisphosphonate ( BP ) intake (mainly low dose for osteoporosis treatment) and seven studies on hormone replacement therapy ( HRT ), including ≥10 patients, and controls not taking the medication were identified. Furthermore, seven studies on MRONJ associated with implants were included. Meta‐analyses based on four studies reporting on patient level and eight studies reporting on implant level showed no significant differences in terms of implant loss between patients on BP s (mainly low dose for osteoporosis treatment) and controls. Furthermore, low‐dose BP intake did not compromise peri‐implant marginal bone levels. Based on two studies, no negative effect of HRT was observed on the implant level, while HRT appeared to exert a marginally significant negative effect regarding implant survival on the patient level and regarding peri‐implant marginal bone levels. Based on six studies reporting single‐patient data, MRONJ in patients on BP for osteoporosis appeared in 70% of the cases >36 months after start of drug intake, while in patients with cancer, MRONJ appeared in 64% of the cases ≤36 months after first BP intake. Conclusion: Low‐dose oral BP intake for osteoporosis treatment, in general, does not compromise implant therapy, that is, patients on ARD s do not lose more implants nor get more implant‐related complications/failures comparing to implant patients without BP intake. There is almost no information available on the possible effect on implant therapy of high‐dose BP s or other widely used ARD s (e.g., denosumab), or on the success or safety of bone grafting procedures. Patients with high‐dose ARD intake for management of malignancies, patients on oral BP over a longer period of time, and patients with comorbidities should be considered as high‐risk patients for MRONJ .

Background: Systematic reviews have established the short‐term improvements of periodontal regenerative/reconstructive procedures compared to conventional surgical treatment in intrabony defects. However, a hierarchy of periodontal regenerative/reconstructive procedures regarding the medium‐ to long‐term results of treatment does not exist.Aim: To systematically assess the literature to answer the focused question “In periodontitis patients with intrabony defects, what are the medium‐ and long‐term benefits of periodontal regenerative/reconstructive procedures compared with open flap debridement (OFD), in terms of clinical and/or radiographic outcome parameters and tooth retention?”.Material & Methods: Randomized controlled clinical trials (RCTs), reporting on clinical and/or radiographic outcome parameters of periodontal regenerative/reconstructive procedures ≥3 years post‐operatively, were systematically assessed. Clinical [residual probing pocket depth (PD) and clinical attachment level (CAL) gain, tooth loss] and radiographic [residual defect depth (RDD), bone gain (RBL)] outcome parameters were assessed. Descriptive statistics were calculated, and Bayesian random‐effects network meta‐analyses (NMA) were performed where possible.Results: Thirty RCTs, presenting data 3 to 20 years after treatment with grafting, GTR, EMD, as monotherapies, combinations thereof, and/or adjunctive use of blood‐derived growth factor constructs or with OFD only, were included. NMA based on 21 RCTs showed that OFD was clearly the least efficacious treatment; regenerative/reconstructive treatments resulted in significantly shallower residual PD in 4 out 8 comparisons [range of mean differences (MD): −2.37 to −0.60 mm] and larger CAL gain in 6 out 8 comparisons (range of MD: 1.26 to 2.66 mm), and combination approaches appeared as the most efficacious. Tooth loss after regenerative/reconstructive treatment was less frequent (0.4%) compared to OFD (2.8%), but the evidence was sparse. There were only sparse radiographic data not allowing any relevant comparisons.Conclusion: Periodontal regenerative/reconstructive therapy in intrabony defects results, in general, in shallower residual PD and larger CAL gain compared with OFD, translating in high rates of tooth survival, on a medium (3–5 years) to long‐term basis (5–20 years). Combination approaches appear, in general, more efficacious compared to monotherapy in terms of shallower residual PD and larger CAL gain. A clear hierarchy could, however, not be established due to limited evidence.

Objectives: Implantoplasty, that is, the mechanical modification of the implant, including thread removal and surface smoothening, has been proposed during surgical peri‐implantitis treatment. Currently, there is no information about any potential mechanical and/or biological complications after this approach. The aim of the current review was to systematically assess the literature to answer the focused question “Are there any mechanical and/or biological complications due to implantoplasty?”.Materials and methods: A systematic literature search was performed in three databases until 23/09/2018 to assess potential mechanical and/or biological complications after implantoplasty. All laboratory, preclinical in vivo, and clinical studies involving implantoplasty were included, and any complication potentially related to implantoplasty was recorded and summarized.Results: Out of 386 titles, 26 publications were included in the present review (six laboratory, two preclinical in vivo, and 18 clinical studies). Laboratory studies have shown that implantoplasty does not result in temperature increase, provided proper cooling is used, but leads in reduced implant strength in “standard” dimension implants; further, preclinical studies have shown titanium particle deposition in the surrounding tissues. Nevertheless, no clinical study has reported any remarkable complication due to implantoplasty; among 217‐291 implants subjected to implantoplasty, no implant fracture was reported during a follow‐up of 3–126 months, while only a single case of mucosal discoloration, likely due to titanium particle deposition, has been reported.Conclusions: Based on all currently available, yet limited, preclinical in vivo and clinical evidence, implantoplasty seems not associated with any remarkable mechanical or biological complications on the short‐ to medium‐term.