Tech Tip: Clear aligners and bisphosphonates

We sometimes get questions about the use of bisphosphonates while undergoing clear aligner treatment.  Here's our take on this topic:

Bisphosphonates

Bisphosphonates are a class of drugs that are used to treat osteoporosis and other diseases involving bone fragility and/or loss of bone mass. These drugs effect bone metabolism by inhibition of osteoclastic activity.

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The disruption of bone metabolism may have as small of an effect as slowing the rate of tooth movement during orthodontic treatment to as drastic an effect as bone failing to heal post-extraction. Much depends on the individual, drug dosage parameters, time and duration of bisphosphonate therapy, pharmocokinetics and other variables.

The option for the patient to be treated with clear aligners for orthodontic movement depends upon the dentist's evaluation of the totality of the patient's condition and the severity of the involved mitigating circumstances. 

Variables including (but not limited to) patient medical history, overall oral health and the treatment being performed, are all factors that can affect the decision of whether or not to perform orthodontic treatment on a patient who is taking or has taken bisphosphonates. 

It is the dentist's responsibility to be informed and familiar with their patient’s medical history and any interactions the patient’s medications may or may not have upon the orthodontic treatment. Consultation with the patient's physician may help to answer specific questions.

What effects do bisphosphonates have on clear aligner treatment?

The relatively gentle pressures associated with tooth movement caused by clear aligners generally does not disturb this activity sufficiently to result in osteonecrosis (the death of bone tissue) of the jaw. However, if your patient is taking or has taken medications containing bisphosphonates, be advised that these drugs may interfere with the patient’s bone’s ability to remodel normally, which may affect the efficacy of the aligners to move teeth.

A helpful literature reference for more information about bisphosphonates and how they may affect different types of orthodontic treatments can be found here

Bottom line: A history of bisphosphonate therapy does not automatically preclude orthodontic treatment with clear aligners. However, it is the dentist's responsibility to determine if clear aligner therapy is appropriate for that particular patient.  

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