Dental implants safe after being on Fosamax for 14 months?

Fosamax as any allendronic acid med and derivates has the possibility of generating BRONJ.... most studies are mainly annecdotal and there are , as fa as I know, NO clear protocols and procedures to avoid BRONJ.... So here it goes, I would say that if your patient has had several vertebral fractures you are in for a very hard ride, and so is the patient , bone quality must be awful and if it is taking 70mg a week for a few months you maybe in the clear for now. But seriously, if it was your mom would you? there are pre surgical techniques that you could use to prevent BRONJ like Hyperbaric O2, that has had good results, but as I said before... annecdotal. The treatment of Bronj is hard and painful for everybody in every possible sense and I don´t know if there is an informed conscent that will protec you enough if something happens.

sorry one more thing, I would not install implants in somebody having fosamax for 14 months ( in case it was not clear enough) and yes patient should stop taking it before surgery but as I said there are no real guidances of how long before you could go in. Chances of success? mmmm implant survival or not getting a BRONJ case????? be aware of what can happen cheers

Having had two cases of well healed implants (over five years) go south a year , after Fosamax was started, I am gun shy of any bisphosinate treated individual. Unfortunately even a partial denture as an alternate treatment needs vigilant attention. Be cautious and don't be greedy. The hassle of a poor outcome is not worth the reward expected.

A patient needs to be on bisphosphonates for 3 years before there is any significant potential for BRONJ so no worries there. A drug holiday is of no benefit because the drug is embedded in bone. I advise patients to consult with their physician to switch to Prolia because a drug holiday works with this medication. The bisphosphonates do not compromise integration but this patient has a bone disease so you have a compromised tissue and you can expect the bone to have poor mineralization and poor vitality. I would phase this patients treatment. Extract and graft with a regenerative bone graft to improved the vitality and mineralization of the bone and then do a delayed implant and bury the implants for the most favorable environment for integration. Greg Steiner Steiner Biotechnology

1 - Would you please give us more information of patient ( he /she, old,...) and interoral examinations, radiograph(s) to see at aleast present sitution and overall position. What tooth/teeth must be extracted, full mouth or four teeth extraction for 4 implant. Although having these informatioms may not help, but I think for case presentation and diagnosis and treatment planning these are needed. 2- I totally agree and like Dr. Greg Steiner nice comment. Even, if it is possible, leave patient alone till the fracture treatment is over or give Patient (he or She) immediate temporary tratments meanwhile. Thank you and good luck

Consult with the patients physician, coordinate treatment and weigh the risks benefits for the treatment, these patients need to be tuned up dentally prior to the Bisphos threshold being reached. If you are not comfortable with these medical indications then work with an OMS who has experience and knowledge in this patient population. If the Bisphos are going to be long term the patient will need this coordination of care and a plan. I have found in my practice that most physicians and patients appreciate this. There is a lot of guessing in the above comments, as dental professionals we need to keep current on the literature it is always changing and there are many alternatives with coordinated care. Also managing any complications with the treatment dental/ medical. Awareness and education along with informed consent is key. The guidelines are not difficulty and a bit of due diligence will pay off.

refer cases to a MAX FAX surgeon as he/she will have the adquate training fo rthis The fact that you are in doubt may be enough of an indicator to refer and have peace of mind that you have managed the patient to the best of your ability and you will be thanked ,I believe, by the patient by showing a reasonable degree of care and concern

If you even have to ask, you're not qualified enough to treat this patient. Needless to say you didn't provide sufficient and important pertinent details for a case presentation (x-rays, patient's age, sex, reason/causes/official diagnosis for those 4 vertebral fractures, duration on biophosphonates, other ailments, meds, or ongoing treatment , etc.) Defer to an OMS who is more experienced than you and who can properly coordinate with the patient's physician. About 8 years ago, when BRONJ was just beginning to be described (it wasn't even called BRONJ yet), with only 0.1% of cases that had shown up of patients on biophosphonates, I had a female patient come in requesting implants. There were no clear protocols established yet at the time, except for interrupting the biophosponate medication for a minimum of 3 months prior to any oral surgery or extractions. The patient refused to interrupt the medication because she wanted the implants done right away. Needless to say that I refused to treat her and referred her out. Best decision I ever made.