Bisphosphonate therapy has transformed the management of osteoporosis and metastatic bone disease, but its implications in implant dentistry demand careful consideration. By suppressing bone turnover, these drugs can compromise healing and increase the risk of Medication-Related Osteonecrosis of the Jaw following surgical procedures. While dental implants are generally safe in patients on short-term oral bisphosphonates, the risk escalates with prolonged use, systemic comorbidities, and especially intravenous formulations. This article explores the biological basis, risk stratification, and clinical decision-making protocols to help clinicians balance implant success with patient safety.