Bone necrosis around dental implants: a patient treated with oral bisphosphonates, drug holiday and no risk according to serum CTX

Aj Flichy-Fernandez,Ma Penarrocha-Diago,Jv Bagan,D Penarrocha-Oltra,J Balaguer-Martinez,S Gonzalez-Lemonnier

doi:10.4317/jced.50698

Aj Flichy-Fernandez, Ma Penarrocha-Diago + Show 4 more

Open Access

https://doi.org/10.4317/jced.50698

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Journal: Journal of clinical and experimental dentistry	Publication Date: Jan 1, 2012
Citations: 8	License type: CC BY 2.5

Abstract

Osteonecrosis of the jaw (ONJ) may appear following certain oral surgery procedures in patients treated with oral bisphosphonates (OB). Guidelines for the treatment of these patients were set out in the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper on Bisphosphonate-Related Osteonecrosis of The Jaws (Position Paper) and Approved by the Board of Trustees in September 2006. For the AAOMS the placement of implants in these patients is not contraindicated. In addition, the serum C-terminal telopeptide bone suppressor marker (CTX) test is available to determine the risk of ONJ. A case is presented of ONJ in a patient with 6 months of OB discontinuation (“drug holiday”) before dental implant placement (following the guidelines of the AAOMS) and with no risk of osteonecrosis according to the serum CTX value (340 pg/ml). The wound healed favorably with complete healing at 7 months. In this case, the serum CTX test must be questioned as to its predictive value of ONJ, and more reliable markers of this risk are needed. Key words:Bisphosphonates, dental implants, bone necrosis, serum CTX.

Highlights

Osteonecrosis of the jaw (ONJ) is defined as the appearance of exposed bone in the maxillofacial region persisting for more than 8 weeks in patients with current or previous treatment with a bisphosphonate and no history of radiation therapy to the jaws (American Association of Oral and Maxillofacial Surgeons (AOMS)) (1)
Osteonecrosis of the jaw (ONJ) may appear following certain oral surgery procedures in patients treated with oral bisphosphonates (OB)
A case is presented of ONJ in a patient with 6 months of OB discontinuation (“drug holiday”) before dental implant placement and with no risk of osteonecrosis according to the serum CTX value (340 pg/ml)

Summary

Introduction

Osteonecrosis of the jaw (ONJ) is defined as the appearance of exposed bone in the maxillofacial region persisting for more than 8 weeks in patients with current or previous treatment with a bisphosphonate and no history of radiation therapy to the jaws (American Association of Oral and Maxillofacial Surgeons (AOMS)) (1). A case is presented of ONJ in a patient with 6 months of OB discontinuation (“drug holiday”) before dental implant placement (following the guidelines of the AAOMS) and with no risk of osteonecrosis according to the serum CTX value (340 pg/ml). Marx et al (2) found 2 cases of ONJ after placement of dental implants in patients taking OB for more than 3 years, without specifying whether the bisphosphonates were removed before surgery.

Results

Conclusion