J Periodontal Implant Sci.  2010 Apr;40(2):90-95. 10.5051/jpis.2010.40.2.90.

Implant failure associated with oral bisphosphonate-related osteonecrosis of the jaw

• Shin EY
• Kwon YH
• Herr Y
• Shin SI
• Chung JH

• KMID: 1783540
• DOI: http://doi.org/10.5051/jpis.2010.40.2.90

Abstract

PURPOSE
The aim of this study is to report a case of oral bisphosphonate-related osteonecrosis of the jaw (BRONJ) resulting in implant failure.
METHODS
A patient suspected of having BRONJ was referred to the Department of Periodontology, Kyung Hee University School of Dentistry for the evaluation and treatment of exposed bone around implants.
RESULTS
The patient, who had been taking oral bisphosphonates (BPs) for about a year, was successfully treated with systemic antibiotics, chlorhexidine mouth rinse, explantation, and surgical debridement of necrotic bone.
CONCLUSIONS
The results of this case suggest that a patient taking BPs orally should be treated cautiously. Appropriate management including cessation of BPs and respective dental treatment may reduce the development of BRONJ.

Keyword

Bisphosphonates; Osteonecrosis; Osteoporosis

MeSH Terms

Anti-Bacterial Agents
Bisphosphonate-Associated Osteonecrosis of the Jaw
Chlorhexidine
Debridement
Dentistry
Diphosphonates
Humans
Mouth
Osteonecrosis
Osteoporosis
Anti-Bacterial Agents
Chlorhexidine
Diphosphonates

Figure

• 

  Figure 1 Pre-operative panoramic radiograph.

• 

  Figure 2 Bone resorption is prominent between #15i and #16i with internal scattered residual bony fragments.

• 

  Figure 3 Necrotic bone is exposed between #14 and #15i.

• 

  Figure 4 Fixture threads are exposed on the buccal and interproximal area.

• 

  Figure 5 After extraction of #14, fenestration is observed on the buccal area.

• 

  Figure 6 Explantation & removal of necrotic bone was performed.

• 

  Figure 7 Suture.

• 

  Figure 8 Post-operative view (1 week later).

• 

  Figure 9 Post-operative view (4 months later).

• 

  Figure 10 Post-operative panoramic radiograph.

Reference

1. Wang HL, Weber D, McCauley LK. Effect of long-term oral bisphosphonates on implant wound healing: literature review and a case report. J Periodontol. 2007. 78:584–594.

2. Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. 2004. 62:527–534.

3. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003. 61:1115–1117.

4. Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2007. 65:369–376.

5. American Dental Association Council on Scientific Affairs. Dental management of patients receiving oral bisphosphonate therapy: expert panel recommendations. J Am Dent Assoc. 2006. 137:1144–1150.

6. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaw: 2009 update. J Oral Maxillofac Surg. 2009. 67:2–12.

7. Badros A, Weikel D, Salama A, Goloubeva O, Schneider A, Rapoport A, et al. Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol. 2006. 24:945–952.

8. Bamias A, Kastritis E, Bamia C, Moulopoulos LA, Melakopoulos I, Bozas G, et al. Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol. 2005. 23:8580–8587.

9. Marx RE, Cillo JE Jr, Ulloa JJ. Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg. 2007. 65:2397–2410.

10. Rosen HN, Moses AC, Garber J, Iloputaife ID, Ross DS, Lee SL, et al. Serum CTX: a new marker of bone resorption that shows treatment effect more often than other markers because of low coefficient of variability and large changes with bisphosphonate therapy. Calcif Tissue Int. 2000. 66:100–103.

11. Migliorati CA, Casiglia J, Epstein J, Jacobsen PL, Siegel MA, Woo SB. Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper. J Am Dent Assoc. 2005. 136:1658–1668.

12. Bone HG, Hosking D, Devogelaer JP, Tucci JR, Emkey RD, Tonino RP, et al. Ten years' experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med. 2004. 350:1189–1199.

13. Bagan JV, Jimenez Y, Murillo J, Hernandez S, Poveda R, Sanchis JM, et al. Jaw osteonecrosis associated with bisphosphonates: multiple exposed areas and its relationship to teeth extractions. Study of 20 cases. Oral Oncol. 2006. 42:327–329.

14. Kademani D, Koka S, Lacy MQ, Rajkumar SV. Primary surgical therapy for osteonecrosis of the jaw secondary to bisphosphonate therapy. Mayo Clin Proc. 2006. 81:1100–1103.

15. Woo SB, Hellstein JW, Kalmar JR. Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med. 2006. 144:753–761.

16. Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005. 63:1567–1575.

17. Jeffcoat MK. Safety of oral bisphosphonates: controlled studies on alveolar bone. Int J Oral Maxillofac Implants. 2006. 21:349–353.

18. Madrid C, Sanz M. What impact do systemically administrated bisphosphonates have on oral implant therapy? A systematic review. Clin Oral Implants Res. 2009. 20:Suppl 4. 87–95.

19. Ripamonti CI, Maniezzo M, Campa T, Fagnoni E, Brunelli C, Saibene G, et al. Decreased occurrence of osteonecrosis of the jaw after implementation of dental preventive measures in solid tumour patients with bone metastases treated with bisphosphonates: the experience of the National Cancer Institute of Milan. Ann Oncol. 2009. 20:137–145.

20. Dimopoulos MA, Kastritis E, Bamia C, Melakopoulos I, Gika D, Roussou M, et al. Reduction of osteonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zoledronic acid. Ann Oncol. 2009. 20:117–120.