Subscribe!
Implant Abstracts
Implant Cases
Ask UsOsteonecrosis Risk from Bisphosphonates?
« Immediate Insertion for Teeth with Periapical Infections? | Dental Implant Liability? »
David, a dentist, comments:
I am wondering if anyone has any comments on a recent study out of U of P Dental School that concluded that, “On the basis of 2 controlled clinical studies, oral bisphosphonate usage was not associated with occurrence of osteonecrosis of the jaws (ONJ).” Do you think future studies will support this non-association or is the link between bisphosphonates and ONJ still a major concern despite this recent data?
This result was published in the May-June 2006 issue of Int J Oral
Maxillofac Implants. In one study, a total of 335 patients (162 men and
173 women, aged 30 to 79 years) with moderate or severe periodontal
disease were randomized to either placebo or 70 mg alendronate once
weekly. Alveolar bone height and safety were assessed over a 2-year
period. A second study was a longitudinal single-blind controlled
design comparing implant success in 50 consecutive patients (210
implants), 25 patients who received bisphosphonate therapy and 25
age-matched control subjects. Implant success and safety, including
incidence of osteonecrosis of the jaws (ONJ), was blindly assessed for
at least 3 years.
Interestingly, in another study published in the August 2006 issue of
Int J Periodontics Restorative Dent, Braun E, Iacono VJ, argued that:
“Although it is believed that the risk of developing ONJ is low when
treating patients nonsurgically, practitioners must be able to
recognize and understand the presentation and difficulties in managing
osteochemonecrosis, even when only nonsurgical therapy is performed..”
So is non-surgical treatment vs. surgical procedure the proper
framework for deciding on osteonecrosis risk from bisphosphonates?
I’d be interested in others experiences with dental implant patients on
bisphosphonates. Thanks for any comments or thoughts you may have on
this continuing debate.
Featured Sponsor
Free Daily Email Alert Click Here>>
Get OsseoNews.com Comments delivered daily! Click Here to subscribe.FREE Weekly Email
Keep current on the latest dental implant discussions! It's Free!
>>Click Here to Subscribe to OsseoNews.com Now!
-
Hot Topics
-
Editor Picks
-
Patient Issues
- Cone Beam CT
- Mini Implants
- Bone Grafting
- Oral Bisphosphonates
- Sinus Lifts
- Implant Complications
- Immediate Loading
- Overdentures
- Nobel Biocare
- >>See All Main Topics
6 Responses to “ Osteonecrosis Risk from Bisphosphonates? ”
Did you notice that Merck paid for the study?
Thanks for the observation in the last post. If there is no risk, why do we all keep hearing about cases?
The jury is certainly still out on the issue of bisphosphonates. A retrospective study in the Periodontology Division of the University of Louisville on around 1000+ subjects who had received implants also showed no relationship between bisphosphonates used in low doses for treatment or prevention of osteoporosis and implant failure… and there were no instances of osteonecrosis. On the other hand, I have been involved in the diagnosis of five cases of osteonecrosis in the past 10-12 months, and four of these individuals had received relatively high doses of bisphosphonate as part of a regimen in cancer management. The fifth case was radiologically and clinically identical to the others but was not associated with ingestion of bisphosphonates. All subjects with osteonecrosis were elderly.
When osteonecrosis is superimposed by osteomyelitis the condition generally resists local surgical intervention and can lead to loss of a jaw, and complex reconstruction.
My feeling is that one needs to be very careful to differentiate between persons who are receiving low bisphosphonate dosages for osteoporosis and cancer patients who have received bisphosponates as part of their therapy. Great care is still warranted in this second population.
I know this is just emperical evidence, but I’ve never had any problem after many implants in patients on low doseage biphosphonates for osteoporosis prevention…many done before the “alerts” went out. I am much more careful inslsection now and I’m sure to give the patient all information IN WRITING WITH A SIGNED CONSENT before proceeding with surgery.
I had dental implants 8 yrs ago,been taking Fosamax for 2 yrs, I developed an infection around the implants,my gums have receeded to the point that you can see the post on one,and the gum on the tooth beside has receeded,but the oral surgeon says that this is not related to Fosamax. I believe it is. I had tissue replaced,and now a bone replacement is scheduled. Wish I knew if it was related or not.
i had done many surgical exodontia procedures in women of age 50s and 60s taking different oral forms of biophosphonates for years as there was no knowledge of association these drugs to osteonecrosis.i did not have a single case of osteonecrosis even in cases where extensive ridge augmentation procedures were performed.
only case which ended up in osteonecrosis(wound is open after 40 months)is a woman suffering from multiple myeloma and taking IV biophosphonate.at that time i did not have any knowledge about this matter and surgical extractions were done with onchologists clearance.
funny thing is that between me and oms total 6 teeth were extracted and only one site tooth no.18 did not heal.
patient is still visiting oms for follow up.
Leave a Comment
Note: Please refrain from ad hominem attacks, and promotional comments. Outside links are not permitted in comments. Though we require an email to route questionable comments to our editors, we will NEVER publish your email or use it for any other purpose. Thank you for your understanding.
Note: At times your comment may not appear on the website immediately, because it has been sent to our editors for approval. Once approved, we will publish the comment. There is NO need to resubmit your comment, if it does not appear on the website immediately.