Systemic or local administration of bisphosphonate and the orthodontic tooth movement in animals: a systematic review.

Background: Applying a pharmacological substance to provide appropriate anchorage is a simple procedure that does not depend on the patient, does not irritate the soft tissue inside or outside the mouth, is accepted by the patient aesthetically, and has a lower cost than anchorage devices. Bisphosphonates (BPs) have been suggested in the orthodontic literature for anchorage, but there is little evidence regarding their effectiveness.

Objectives: This systematic review aimed to assess the quality of evidence from animal research that demonstrated how bisphosphonate, when administered locally and systemically, reduced the movement of teeth in orthodontics.

Search methods: We performed a broad electronic search to retrieve relevant studies from eight databases and hand-searching from 1990 up to June 2024 to identify the animal trials that met the inclusion criteria of this systematic review.

Selection criteria: The review included animal studies that evaluated the rate of tooth movement following localized injection of bisphosphonates with simulated orthodontic tooth movement.

Data collection and analysis: The Systematic Review Centre for Laboratory Animal Experimentation's tool (SYRCLE) was used to assess the risk of bias for the included papers.

Results: 690 titles were found using the search method. Following screening, 361 articles were excluded. The full texts of the remaining 65 papers were read entirely, and ten papers were included in this review. Two studies were judged as having a 'low risk of bias', whereas the other showed an 'unclear risk of bias'. When BPs treatment was used in comparison to the naive and saline groups, the results showed a decrease in OTM, osteoclast number, and alveolar bone loss, but there are conflicting findings about how BPs affect root resorption. In the periodontal ligament, the BPs groups showed decreased vascularization and increased necrotic zones without causing osteonecrosis.

Conclusions: Local or systemic application of bisphosphonate can alter the bone remodeling cycle, affecting osteoclast activity and, consequently, orthodontic tooth movement. So, they could be applied to give a high degree of anchorage to limit adverse movement. However, longer-term research is needed to evaluate potential side effects from bisphosphonate use during orthodontic treatment.

Registration: The systematic review protocol was registered on 23/8/2022 in the National Institute of Health Research's PROSPERO; the registration number is CRD42022348745.