Bisphosphonates, therapeutic agents that inhibit bone resorption, commonly are utilized to treat metabolic bone diseases and cancers that metastasize to the skeleton. The impact of bisphosphonates on orthodontic therapy and the associated risk of osteonecrosis of the jaw (ONJ) have been investigated infrequently. ONJ has been identified as an idiosyncratic oral complication of bisphosphonate therapy. While the American Dental Association (ADA), the American Association of Oral and Maxillofacial Surgeons (AAOMS), and the American Society for Bone and Mineral Research (ASBMR) have established treatment recommendations for bisphosphonate patients, these recommendations fail to address orthodontic therapy specifically. Bisphosphonate related ONJ of the jaw frequently is associated with manipulation of the osseous structures of the jaw. Orthodontic tooth movement and the placement of microimplants for anchorage during orthodontic therapy involve the alveolar bones of the jaws directly. Animal studies and case reports suggest bisphosphonate therapy may inhibit orthodontic tooth movement without increasing the incidence of ONJ. Clinical studies and case reports suggest that oral bisphosphonate therapy does not influence implant outcomes or alter the risk of ONJ. Practitioners should disclose to patients that bisphosphonate therapy may affect orthodontic treatment outcomes and the risk of osteonecrosis of the jaw.
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