To systemically review the literature about the use of bisphosphonates (BP) as adjuvant to periodontal treatment. Three databased were searched for randomized clinical trials that used any BP adjuvant to periodontal treatment. Meta-analyses were performed for clinical attachment level (CAL) and probing pocket depth (PPD). Subgroup analyses were considering diabetes and smoking exposure. Thirteen studies were included. It was showed mean difference (MD) of 1.52 mm (95%CI: 0.97–2.07) and 1.44 mm (95%CI: 1.08–1.79) for PPD reduction and CAL gain, respectively, when BP was locally delivered. Regarding the subgroup analysis, BP did not provide significant improvement in smokers for PPD (MD: 1.35; 95%CI: -0.13–2.83) and CAL (MD: 1.37; 95%CI: -0.17–2.91). The MD for systemically administered BP was 0.40 mm (95%CI: 0.21–0.60) and 0.51 (95%CI: 0.19–0.83) for PPD and CAL, respectively. Additional clinical effects of BP may be expected when administered with periodontal therapy.