<![CDATA[Introduction: Bisphosphonates are widely prescribed for osteoporosis, raising concerns regarding their potential impact on dental implant survival. This systematic review and meta-analysis evaluated the association between bisphosphonate therapy and dental implant failure. Material and Methods: Following PRISMA guidelines and registered in PROSPERO (ID: 1136620), electronic searches of ScienceDirect, EBSCOhost, PubMed, MDPI, and Google Scholar were performed up to September 2025. Observational cohort studies comparing dental implant outcomes in bisphosphonate-exposed and non-exposed patient were included. Two reviewers performed data extraction and risk-of-bias assessment using the ROBINS-I. Pooled risk ratios (RRs) were calculated. Results: Six studies comprising 2,196 participants and 86 implant failures were included. Bisphosphonate exposure was associated with a significantly increased risk of implant failure (RR = 2.35; 95% CI, 1.24–4.44). with no heterogeneity (I² = 0%). Discussion: Despite the elevated relative risk, implant failure remained infrequent, resulting in a small absolute risk increase. The certainty of evidence was rated as moderate. Conclusion: Implant therapy should not be routinely avoided in bisphosphonate-treated patients, and individualized risk assessment is recommended. Further prospective studies are needed to clarify causality and patient-level risk modifiers.]]>
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