Impact of novel systemic cancer therapies on osseointegration and dental implant outcomes: a systematic review

Clinical Snapshot

Key Findings

• P Value: Not applicable - no statistical testing performed

• Effect Size: Not quantifiable - qualitative synthesis only

• Primary Outcome: Dental implant success/failure rates by cancer therapy type

• Nnt Or Sensitivity: Anti-angiogenic agents associated with 5/7 adverse outcomes; TKIs with 2/2 successful outcomes

• Confidence Interval: Not applicable - case reports only

Clinical Application

Limited clinical applicability due to case report evidence; requires individualized risk-benefit assessment Relevant to Australian oncology and oral surgery practice; TGA-approved cancer therapies included; may inform multidisciplinary care planning Cancer patients considering dental implants while on or after novel systemic therapies

Abstract

PURPOSE: Advances in systemic cancer therapies such as immune checkpoint inhibitors (ICIs), tyrosine kinase inhibitors (TKIs), and anti-angiogenic agents have markedly improved survival in patients with solid and hematologic malignancies. As survivorship increases, oral rehabilitation with dental implants is increasingly sought to restore quality of life. However, these therapies may adversely affect bone healing, angiogenesis, and immune regulation, raising concerns regarding implant-related complications. This systematic review aimed to evaluate reported dental implant outcomes and complications in patients receiving novel systemic cancer therapies, emphasizing the implications for supportive oncology. METHODS: This review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251142681). PubMed/MEDLINE, Scopus, ScienceDirect, and the Cochrane Library were searched for English-language clinical reports describing dental implant outcomes in patients treated with ICIs, TKIs, or anti-angiogenic agents. Study selection, data extraction, and quality appraisal using the Joanna Briggs Institute checklist for case reports were performed independently by two reviewers. RESULTS: Seven case reports (2017-2024) were included, representing Level IV evidence. Two cases involving TKIs reported successful osseointegration and long-term survival. In contrast, five cases described adverse outcomes including early failure and MRONJ predominantly associated with anti-angiogenic agents, either alone or in combination with ICIs and antiresorptive agents. These complications often resulted in significant functional morbidity and the need for invasive surgical intervention. CONCLUSION: Based on limited case report evidence, anti-angiogenic therapies were more frequently observed in cases with adverse outcomes, including implant-related MRONJ and failure, while TKIs were associated with favorable outcomes in limited cases. The role of ICIs remains unclear due to sparse data, particularly regarding monotherapy effects. Given the preliminary nature of current evidence derived from case reports, prospective studies with appropriate control groups are urgently needed to establish evidence-based guidelines. PROSPERO NUMBER AND DATE OF REGISTRATION: CRD420251142681; 08/09/2025.

References

1. 1.Chouksey, G., Singhal, K., Arya, N., Parihar, A., & Agrawal, A. (2026). Impact of novel systemic cancer therapies on osseointegration and dental implant outcomes: a systematic review. Supportive Care in Cancer. https://doi.org/10.1038/ni.3535