Guidelines for Orthodontic Management of Patients Receiving Bisphosphonate Therapy

Background: Bisphosphonates have become an increasingly common treatment for a large number of bone disorders. They have become widely used both in adult and young patients. Since bisphosphonates affect the bone they are a serious concern for dental practitioners, including orthodontists. Furthermore, orthodontic treatment has become common not only in the younger population and the number of adult patients continues to increase. Objectives: Review the literature and propose guidelines for orthodontic treatment of adult and young patients receiving bisphosphonate therapy. Methods: Articles concerning risks to dental patients receiving bisphosphonate treatment from the years 2003 to 2010 were reviewed. Both review type articles and case reports focusing on orthodontic treatment were analyzed. Results: The proposed guidelines differentiate the orthodontic patients receiving bisphosphonates according to risk groups. Only the lowest risk group is suitable for undergoing orthodontic treatment. Consultation with a patient's physician is warranted since a drug holiday is proposed before and during orthodontic treatment. In addition, the orthodontic treatment course should be modified accordingly to incorporate light wires, minimal orthodontic forces and short treatment duration. A slower tooth movement velocity is anticipated. Treatment plan alternatives excluding surgical intervention should be considered. Conclusion: The proposed guidelines describe orthodontic treatment protocol specifically designated for and limited to a low risk group of patients receiving bisphosphonate therapy.