Background. Dental implantology occupies a leading place in the system of comprehensive rehabilitation for patients with dentition defects and has established itself as the safest and the most predictable method. Success of dental implants treatment largely depends on the timely identification and exclusion of risk factors related to development of complications such as peri-implant mucositis and peri-implantitis (peri-implant diseases). However, at the moment, there is no clear understanding about etiology and pathogenesis of peri-implant diseases, which casts doubt on the effectiveness of the applied treatment and prevention protocols. Objective. To summarize the available data on the causes and potential risk factors for the development of peri-implant diseases. Material and methods. A search was conducted for publications in three electronic databases PubMed, ScienceDirect, eLibrary, Google Search, Ebsco, Embase, Web of Science, SciELO from 2013 to 2024, including the results about studying the influence of various factors on the outcome of dental implants and the occurrence of peri-implant diseases, diagnosis, treatment and prevention measures for peri-implantitis. Based on the selection criteria, 69 publications were selected that were included in the systematic review. The methodology complies with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) requirements for systematic reviews and meta-analyses. Results. The main etiological factors in the development of peri-implant diseases, the influence of these factors on the outcome of dental implants along with the development of postoperative complications, and modern approaches of prevention of peri-implantitis are described. Conclusion. The presented detailed systematic analysis showed that the treatment and prevention of peri-implant diseases is an urgent problem and requires a comprehensive understanding of the etiology and risk factors for their occurrence to provide highly functional, aesthetic and long-term treatment of patients with dental implants. The data obtained during the study will help practicing dentists in determining the prognosis of peri-implantitis and developing complex treatment and preventive measures.

Background: Vitamin D3 is an important factor for bone metabolism, and its deficiency may affect dental implantation results. Materials and methods: 384 patients with a diagnosis of tooth loss and vitamin D deficiency were examined and treated with dental implants. Vitamin D3 supplements were prescribed by the endocrinologist for all patients in the individual dose. The patients were divided into two equal study groups (n = 192) depending on the dental implantation period: Group 1—operation after blood serum vitamin D3 level normalization; group 2—before reaching the reference level of vitamin D3. Follow-up examinations were performed on the day of dental implantation, 7 days later, 1, 3, 6, and 12 months later, and every 1 year after treatment (up to 10 years). Implant stability and peri-implant tissue condition were assessed with clinical and X-ray diagnostics. Patients also visited an endocrinologist 2 months after the start of the treatment, then every 6 months. Results: The target vitamin D3 level (30–60 ng/mL) (p < 0.001) was achieved in all patients after treatment. At the control examinations, peri-implantitis was diagnosed in 10 patients (2.6%). It was detected in the group of patients with severe vitamin D deficiency and vitamin D deficiency—2 (25%) and 8 (3.4%) patients; respectively (p < 0.05). There was no significant difference between groups for risk of complications or bone quality after treatment. Conclusions: Timely screening of vitamin D3 levels and the appropriate treatment by an endocrinologist in young and middle-aged patients allow for achieving 97.4% dental implantation success for a ten-year period.

Background. Medication-related osteonecrosis of the jaw (MRONJ) remains a rare but clinically relevant complication of antiresorptive treatment. Its risk is shaped by the interaction of drug exposure, oral inflammatory burden, and systemic comorbidity. Objective. To synthesize evidence on risk factors for MRONJ in patients receiving bisphosphonates and/or denosumab and to derive a practice-oriented prevention algorithm. Material and methods. A PRISMA 2020-oriented systematic review was conducted in PubMed/MEDLINE, Scopus, Web of Science, and eLIBRARY.ru, supplemented by CyberLeninka and hand-searching of reference lists. Guidelines, systematic reviews/meta-analyses, cohort studies, and case-control studies focused on adult patients receiving bisphosphonates and/or denosumab were eligible. Thirty-seven records, including 17 Russian VAK-indexed publications, were included in the qualitative synthesis. Results. The most consistent risk factors were oncology-dose exposure, parenteral high-dose regimens, treatment duration and cumulative exposure, sequential antiresorptive/antiangiogenic therapy, active oral inflammatory disease, tooth extraction and other invasive dental procedures, as well as diabetes, smoking, anemia, and long-term corticosteroid use. Evidence on age, sex, vascular factors, and individual laboratory markers remains heterogeneous. Conclusion. MRONJ risk is multifactorial. The most applicable preventive measures are pre-treatment dental optimization, risk stratification by indication and drug class, scheduled monitoring, and a standardized management algorithm for invasive dental care.

Introduction/Background: The rising use of anti-resorptive agents, including denosumab, for bone metastases has led to an increased incidence of medication-related osteonecrosis of the jaw. This particular case represents an important, but also often overlooked, potential late sequelae that may be seen in cancer patients, which is the failure of a previously well-functioning dental implant years down the line, which may then become a causative factor for MRONJ. Case Presentation: A 70-year-old female patient, a chronic user of high-dose denosumab for metastatic breast carcinoma, presented with pain and infection of the mandibular implant, which was functionally osseointegrated for seven years before the onset of symptoms. The patient was evaluated and was found to have a bony sequestrum containing the implant, meaning the diagnosis was a Stage 2 MRONJ. Conservative management was ineffective; thus, surgical intervention involving sequestrectomy and removal of the implant en bloc was performed. Conclusion: This case of treating the patient also shows us that patients undergoing any treatment with denosumab, who have dental implants, are continuously at risk of late-onset MRONJ and hence need long-term surveillance, and thereby, more emphasis needs to be placed on giving them informed consent for such a lifelong risk of acquiring the disease. Thus, great care must be taken before performing any such surgical procedure. This case also shows that the surgery has been successful in treating the patient, without the need to withdraw any ongoing antiresorptive drugs.

Purpose. To systematize current concepts regarding the etiopathogenesis, risk factors, approaches to early diagnosis, and comprehensive management of medication-related osteonecrosis of the jaws (MRONJ) in patients receiving bisphosphonates, denosumab, and/or antiangiogenic agents. Materials and methods. A systematic review of Russian and international publications from 2003 to 2024 was conducted using PubMed, Scopus, and eLIBRARY, selecting studies addressing the clinical presentation, imaging diagnostics, and treatment strategies for MRONJ. In addition, consensus statements and clinical practice guidelines issued by professional maxillofacial surgery societies (including AAOMS 2007–2022) were analyzed with respect to diagnostic criteria and patient care pathways. Results. The pathogenesis of MRONJ is multifactorial and involves suppression of bone remodeling, infection–inflammation with bacterial biofilms (including Actinomyces spp.), microcirculatory/angiogenic disturbances (VEGF-dependent mechanisms), and local immune dysregulation. According to multiple studies, the risk of complications increases with drug type, route of administration, cumulative dose, and treatment duration; in some reports, denosumab is associated with a higher risk than oral bisphosphonates. The most common triggering factors are invasive dental procedures—particularly tooth extraction—performed in the setting of chronic inflammation. The AAOMS staging system, based on the presence of exposed bone, may limit detection of early disease; incorporating CBCT findings into a dynamic classification enables identification of preclinical changes and refinement of treatment planning. Conclusions. Reducing MRONJ incidence requires interdisciplinary prevention, including oral sanitation prior to initiating antiresorptive therapy, control of inflammatory foci, and patient education on individualized oral hygiene. Decisions regarding a “drug holiday” should be individualized based on a risk–benefit balance. Management is stage-dependent: early stages prioritize conservative measures with adjunctive modalities (low-level laser therapy, platelet-rich fibrin), whereas progressive disease necessitates surgical debridement (sequestrectomy/resection) and subsequent rehabilitation.

INTRODUCTION. Drug-induced osteonecrosis of the jaw (MRONJ) is one of the most severe complications of antiresorptive therapy in patients with osteoporosis, significantly impairing the quality of life. Despite the growing awareness of doctors, the frequency of MERS with prolonged use of bisphosphonates or denosumab remains in the range of 0.8–12.0%. The purpose of this work was to develop a comprehensive preventive strategy based on the analysis of risk factors aimed at reducing the incidence of MRONJ in patients with osteoporosis. MATERIALS AND METHODS. A retrospective analysis of the medical records of 267 patients who received antiresorptive therapy at the Yizhida Dental Clinic in Shangqiu (China) from 2019 to 2023 was conducted. Dental status, biochemical markers of bone metabolism, treatment regimens, and concomitant risk factors were assessed. Various preventive approaches were compared. The results show that dental screening and oral sanitation before starting antiresorptive treatment reduces the risk of MERS by 72.6%. RESULTS. Maintaining the level of β-CrossLaps above 150 pg/ml was associated with a 63.8% reduction in risk. Individualized surgical interventions, taking into account risk stratification, reduced the incidence of postoperative complications from 11.1% to 0% (with the combined protocol). The comprehensive preventive model provided a significant reduction in the 4-year cumulative incidence of MRONJ from 7.1% to 1.1%, while the effectiveness of the main antiresorptive therapy was not affected. CONCLUSIONS. The analysis makes it possible to recommend a multi-level prevention system, including dental screening, biomarker monitoring, and surgical tactics adapted to individual risk, as an effective strategy for preventing MERS in patients with osteoporosis.