implants - international magazine of oral implantology

overview I useful in particular for patients who have been treatedwithbisphosphonatesoveralongperiodof time before implantation. Reports in literature agree that implant insertion in patients with oral bisphosphonate therapy of less thanthreeyearsconstitutesvirtuallynoriskfactorfor BRONJ.However,implantfollow-upshouldbepartic- ularlyintensiveinthesepatientsaswellsincethearea through which the implant was inserted constitutes anareaatparticularrisk.Thesameappliestopatients who had already received dental implants before a scheduled oral bisphosphonate therapy. _Prospects Although longitudinal prospective studies are be- ingcarriedoutatpresent,mostknowledgeonBRONJ originatesfromtheexperienceoftreatingphysicians, from retrospective studies of patient records and from assumed conclusions of bone physiology and pharmaceutical research. Until long-term prospec- tivestudiesconfirmorcorrectthecurrentprocedures and therapies, we will be on uncertain ground when treating bisphosphonate patients. This problem mightbepresentinparticularregardingoncologypa- tients with intravenous bisphosphonate therapy. _Summary Osteonecrosisofthejawisanundesiredsideeffect ofbisphosphonatetherapyfirstdescribedin2003.Pa- tientswithmultiplemyelomaandskeletalmetastases who are treated with intravenous bisphosphonates run the greatest risk of developing osteonecrosis of the jaw. Osteoporosis patients with oral bisphospho- nate therapy of less than three years are less at risk. Adental-surgicalprocedureprecedestheonsetof thediseaseinmostofthepatients.Alargenumberof associationspublishrecommendationsregardingthe preventionandtherapyofthedisease.Theuseoforal antimicrobial mouthwash solutions combined with oral systemic antibiotic therapy is recommended in early stages. Superficial debridement is indicated as well in some cases. An extended surgical treatment is mainly reserved to patients in more advanced stages. Dentalimplantsarecontraindicatedintumourpa- tientsunderbisphosphonatetherapy.Inosteoporosis patientswithoraladministrationofbisphosphonates (not exceeding three years), however, the risk of de- veloping osteonecrosis is considered to be very low._ Editorialnote:Alistofreferencesisavailablefromthepub- lisher. Fig. 7_Diagram for determining the indication for an implantation in case of bisphosphonate medication (Grötz et al. 2010). I 25implants2_2013 low BP-ONJ risk Prognosis quoad vitam? Indication algorithm Restriction of indication Implant indication persistent sockets? Need for augmentation medium high risk risk no yes Johannes Daniel Bähr Wilhelmstraße 3 79098 Freiburg/Breisgau Germany johannes.d.baehr@web.de _contact implants