Osteopathology induced by bisphosphonates and dental implants: clinical observations

• Published in: Clinical oral investigations Vol. 17; no. 1; pp. 167 - 175
• Main Authors: Jacobsen, Christine, Metzler, Philipp, Rössle, Matthias, Obwegeser, Joachim, Zemann, Wolfgang, Grätz, Klaus-Wilhelm
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.01.2013; Springer Nature B.V
• Subjects: Actinomycosis - diagnosis; Administration, Intravenous; Administration, Oral; Alendronate - administration & dosage; Alendronate - adverse effects; Anti-Bacterial Agents - therapeutic use; Bisphosphonate-Associated Osteonecrosis of the Jaw - diagnosis; Bisphosphonate-Associated Osteonecrosis of the Jaw - etiology; Bone Density Conservation Agents - administration & dosage; Bone Density Conservation Agents - adverse effects; Cone-Beam Computed Tomography - methods; Debridement; Dental Implants - adverse effects; Dentistry; Diphosphonates - administration & dosage; Diphosphonates - adverse effects; Female; Follow-Up Studies; Humans; Imidazoles - administration & dosage; Imidazoles - adverse effects; Male; Mandible - surgery; Mandibular Neoplasms - diagnosis; Mandibular Neoplasms - secondary; Maxilla - surgery; Medicine; Neoplasms - drug therapy; Original Article; Osteomyelitis - microbiology; Osteoporosis - drug therapy; Risk Factors; Time Factors; Infection; Bisphosphonate-associated osteonecrosis of the jaws (BRONJ); Dental implants; Risk factors; Posterior jaw
• ISSN: 1432-6981; 1436-3771
• DOI: 10.1007/s00784-012-0708-2

Objectives Although there are many reports about risk factors for the development of BP-associated osteonecrosis of the jaws, the role of dental implants as a local risk factor is still discussed, especially in patients with oral BP treatment. Until now, a few case reports and surveys display a possible minor risk in patients with oral BP therapy, whereas the avoidance of implant placement is generally accepted in patients with intravenous BP therapy. Patient and methods In this study, the cases of 14 patients with osteonecrosis of the jaws in association with BP therapy and dental implant placement were analyzed carefully with a detailed literature review. Results Of 14 patients, nine had underlying malignant disease and five patients had osteoporosis. In ten patients, implants were placed either in the posterior mandible or maxilla; the mean interval between implant insertion and disease onset was 20.9 months. Pain ( n 12) and signs of infection ( n 10) were the most common symptoms. Histologically, signs of infection were found in nine of 11 analyzed patients with presence of Actinomyces in six patients. Two patients turned out to have infiltration of underlying malignant disease. Conclusions Posteriorly placed implants seem to be of higher risk of development of osteonecrosis of the jaws. Not only the implant placement but also the inserted implant itself seems to be a continuous risk factor. Clinical relevance The herein elaborated risk factors help dentists plan dental rehabilitation with implants in this high-risk group of patients and indicate careful and regular dental recall.