Exposure to Reclast: Risks for Implant Treatment?

According to the Marx protocol less than one year exposure to an iv bisphosponates should be okay in regards to BIONJ. Get a medical clearance from her MD to CYA. Place the implant conservatively allow it plenty of time to heal and it should be okay. Good luck. Remember she still has poor bone quality and diabetes so a good informed consent is important.

I apolize for my hasty answer, I did not realize this is a once a year iv infusion with a lot of side effects. She does fit the risk protocol since it is a once a year med.You are rolling the dice since the half life is believed to be eight years. This patient as all your Bisphosphinate patients need close follow up especially with their perio, any restorations that are traumatic ie ill- fitting partials and dentures. Extractions are to be avoided root canals preferred. I did see the article in JOMI on coating implants with Bisphosp to prevent resorption which shows a serious lack of understanding of bone physiology. We just don't know the full ramifications of this chemical in the body since it is so hard to get rid of. The iv meds should be used for serious medical conditions such as multiple myeloma and hypercacemia of malignancy not for the convenience of one year dosing for forgetful osteoporosis patients. Novartis just glances over BIONJ and settles with the patient you may also get pulled into the lawsuit. I would advise a bridge, leave the bone alone! We don't have a treatment just palliative follow up.

How likely to have BRONJ with oral bisphos? Just had a talk with a physician and he had this attitide that it is zero risk and we in the dental professions don't know what we are talking about. And yet in JOMI, there are few occasional cases. Why can't the physicians prescribe other osteoporotic meds? Aren't there other choices other than oral bisphos?

I think that Novartis does a pretty good job of disguising this complication from the physicians. When I first heard about BIONJ I thought it was rare and I would not see it in my practice. I was wrong. The problem is that this med is widely prescribed and MDs don't have much dental training. Anyone exposed more than three years ( the window) for oral starts to develop risk, iv is one year. What the company disclaimer does not say is that there is at least an eight year halflife and there is no treatment only palliative. This chemical gets into the bone and osteoclasts die when they ingest it what you get is a lot of brittle bone which should ave been turned over. There are more treatments out there vit D, calcium which are being used. The drug is also associated with femur fractures. The company probably will continue until lawsuit settlements exceed profits.

There is a true risk of BRONJ with oral bisphosphonates. Your physician colleague is clearly misinformed. Go to the literature. The practice I worked in (3 oral surgeons total) had over 60 documented cases in about 10 years from ORAL bisphosphonates. Risk is greater after 3 years exposure. J Oral Maxillofac Surg. 2012 Aug;70(8):1844-53. doi: 10.1016/j.joms.2011.08.033. Epub 2012 May 16. Bisphosphonate-related osteonecrosis of the jaw in patients with oral bisphosphonate exposure: clinical course and outcomes. O'Ryan FS, Lo JC.

After 3 to 4 months the BPs shut down the osteoblasts activity, in addition to the osteoclasts. They also disrupt angiogenesis. CRS you are correct, the physicians are in the dark about BPs. They are in the dark amount bone physiology.

If you are looking for an option for the bisphosphonates I suggest you look into Prolia (denosumab). This is a monoclonal antibody that is not toxic to osteoclasts. While taking denosumab the patient is just as susceptible to bronj as bisphosphonate patients but the good side is that Prolia does not accumulate in the bone and unlike the bisphosphonates your susceptibly to bronj can go to essentially zero if you suspend use for a time. You are correct about physicians ignoring the existence of bronj. I am a member of the American Society for Bone and Mineral Research which is made up of primarily university MD, PhD's. The bisphosphonates have been a gold mine for their research funding. I have had to sit thru years of dentists (mostly oral surgeons) being ridiculed for noting the existence of bronj. I think your patient has minimal risk. If you do not create any tissue damage you will not need osteoclasts to clean up the necrotic bone so always treat the bone kindly and the patient will be fine. Greg Steiner Steiner Laboratories

I have an unbelievable case of osteo-necrosis in an 89 year old lady with no exposure to any bone density modulator besides prolia. The lady is involved in a trial at a local very prominent dr's office. If I had more time I'd post the case, it's a very interesting one. I don't know what the pathogenesos is here, but I can tell u it's looks very much like bronj to me...

Dr. E., the type of suggestion from your colleague is dangerous. There is no emphatic answer, I can assure you, there is a correlative between po intake of these drugs and "bronj ". My advice, when it comes to removing teeth in these cases is to attempt to leave granulation tissue or in the high risk patient, remove the teeth orthodontically. Success rates with implants in my office with "this patient ", is 100%, granted my patient population pool is small. I'm pretty certain we will find that success rates will be higher on the maxilla, for obvious reasons. B Vinci

Reclast is not for "forgetful" patients in regards to not taking their medications correctly as stated above by an individual whom appears to have read quickly through the material on the infused medication. One major purpose to take the infusion over the oral mediation is due to the inability " to swallow" or for one who has esophageal or stomach ulcers ... "Most patients tolerate Fosamax well; its most common side effects are irritation of the esophagus and stomach ulcer."

Is it safe to have dental implants 5 weeks after a Reclast infusion? I had already had two teeth extracted and bone graft done prior to the infusion. I am 79 Years old. The implants were already scheduled prior to the infusion.