Patient recieving corticosteriods: thoughts on implant treatment?

Several considerations that are of concern here. For a patient with "serious" kidney disease, you have to use antibiotics that are metabolized iin the liver, not excreted by the kidneys. Second, you did not state the dosage of corticosteroids that the patient is taking. Relatively low doses may not be a problem, but higher doses will cause huge problems in healing, as steroids target the inflammatory cascade which is the most critical part of early wound healing. If you must take a patient off of steroids, this must be done gradually. Medical clearance for this type of patient is critical. RJM

Please define serious kidney disease. Is this patient is heading for end stage renal failure there is a significant chance of development of osteomalacia almong with poor wound healing. Patient may not be a suitable candidate for implants. Talk with the physician, do a literature search and find a surgeon with experience with this population

I had a recent case similar to this scenario. It was a mother in her early forties with what she termed "segmental focal nephrotic glomural nephritis. " I had done implant therapy successfully in 3 quadrants prior to her discovering her kidney disease. She now had a 5 unit fixed bridge failing and wanted it replaced with implant restorations. It would require crestal sinus lifts. Prior to committing to her treatment I contacted two people. First, my malpractice attorney because I heard him lecture once on this issue of steroid use and implants. He responded to my call by stating that if she were otherwise healthy, implant therapy would be o.k. in a legal sense by way of a more in depth informed consent alerting her to the increased risks. Secondly, I called her physician. Surprisingly, the physician stated that she did not need to adjust her steroid use for implant surgery and that she could undergo any dental procedure. So far, I have removed the bridge, retreated a failed root canal and some other work, but have not gotten to the implant surgical therapy as of yet. My best advice is that if there are no other medical issues, contact the physician and get a response in writing and make sure that the patient understands the increased risks involved. Best luck to you.

The utilization of steroids will have some possible positive effect on the integration of implants. The reason steroids are used is because of their ability to stabilize cell membrane walls. If your patient is taking steroids, consult with the prescribing physician. It is not unusual for them to encourage increasing doses, primarily because these patients loose their ability to generate normal doses of endogenous steroids. I hate to say this, but a lot of people that are in renal failure are there, secondary to neglect, with the obvious exception, so please consider that. Bv

we have many consideration points how is the general condition of the patient regarding healing, either because of kidney disease or long term steroids therapy.the second point do we need change steroid dose , regarding the implant procedure there is no need. so check with the nephrology doctor about exactly how the general condition of the patient , bone condition ,healing,bleeding and immunity.