The purpose of this systematic review was to evaluate the effectiveness of the local application and surface coating of dental implants with bisphosphonates in improving clinical outcomes. A comprehensive search was conducted across three electronic databases (PubMed/MEDLINE, Web of Science and Scopus) up to November 2025, following a PRISMA-based protocol. The major findings indicate that, despite some promising observations, current evidence does not conclusively support that local bisphosphonate use enhances osseointegration or decreases marginal bone loss. Overall, the available data remain insufficient to establish a clear clinical benefit. In conclusion, while bisphosphonate-enhanced implant surfaces represent a biologically appealing concept, further well-designed clinical trials are necessary to clarify whether these modifications effectively improve osseointegration and the quality and quantity of peri‑implant bone.