Clinical and Surgical Management for Placement of Osseointegrated Implants in a Patient taking Bisphosphonate Medication: Case Report / Manejo Clínico e Cirúrgico para Colocação de Implantes Osseointegrados em Paciente Em Uso de Bifosfonatos: Relato de Caso

Abstract

It is important to have knowledge about bisphosphonates, their composition, presentation, mechanism of action, dosage, benefits and adverse effects, in orderto understand the behavior of these drugs in the human body and their implication in implant dentistry. At present, the risk of medication-related osteonecrosis of the jaw (MRONJ) is being widely discussed. The aim of this study was to describe a conservative protocol, in the form of a case report, for the serial placement of osseointegrated implants in a patient with a history of continuous use of 150 mg, sodium ibandronate (Osteoban®). Case Report. To report the different clinical and surgical managements required in order to avoid or minimize the risk of patients developing MRONJ after the placement of osseointegrated implants. Materials and methods. The procedures performed began with the placement of a single osseointegrated implant, assessment of the patient's postoperative condition, and then, after a control period, concluding the treatment with a more complex surgical intervention consisting of serial placement of 6 osseointegrated implants. Results. After the period of one year, the patient’s condition was found to be normal in relation to the osseointegrated implants, and there was absence of signs of development of MRONJ. Conclusions. The preoperative conduct of instituting the drug holiday of 150 mg sodium ibandronate (Osteoban®), associated with control of the serum CTx level for an extended period allowed the installation of osseointegrated implants in a patient with long-term oral administration of bisphosphonates without the development of MRONJ occurring. The surgical steps, evolving from less complex through to the last procedures, with the installation of multiple osseointegrated implants, helped to assess the risk of the patient for developing MRONJ.