IV Bisphosphonates and Dental Implants

[drhobie7]

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I'm curious to hear what the OMS residents (and maybe perio?) are hearing about doing dental implants on Pts with a Hx of IV bisphosphonate Tx. There are a few threads on DT, but not many comments by OMSs. Is this an absolute contraindication? What if Tx was many years prior? If that's acceptable, what's the cutoff in years? Thanks.

 

[OMFS2B]

I'm curious to hear what the OMS residents (and maybe perio?) are hearing about doing dental implants on Pts with a Hx of IV bisphosphonate Tx. There are a few threads on DT, but not many comments by OMSs. Is this an absolute contraindication? What if Tx was many years prior? If that's acceptable, what's the cutoff in years? Thanks.

At our institution we are placing implants on PO bisphosphonates although one OS in town won't. I haven't seen any IV users. Since the half life is not completely known, and may be over ten years, I don't think I would place them unless the patient is well aware of the R/B/I. We did have to I&D an infected bone graft that perio placed on an IV user. Unfortunately I think legal case law will dictate further treatment.

 

[OMFSCardsFan]

At our institution we are placing implants on PO bisphosphonates although one OS in town won't. I haven't seen any IV users. Since the half life is not completely known, and may be over ten years, I don't think I would place them unless the patient is well aware of the R/B/I. We did have to I&D an infected bone graft that perio placed on an IV user. Unfortunately I think legal case law will dictate further treatment.

There is an article in this month's JOMS, by Marx, talking about ON. Check it out. I think it would answer a lot of your questions. It's a good article.

 

[esclavo]

I'm curious to hear what the OMS residents (and maybe perio?) are hearing about doing dental implants on Pts with a Hx of IV bisphosphonate Tx. There are a few threads on DT, but not many comments by OMSs. Is this an absolute contraindication? What if Tx was many years prior? If that's acceptable, what's the cutoff in years? Thanks.

OMFSCardsfan has it right. I was in Denver this last week and talked at some length with Marx about this. He said he wouldn't operate on an IV bisphosphonate user at all. Nothing helps. He said the best model for bisphosphonate use is osteopetrosis of the mandible not ORN. Nothing you can do will help these people except staying 10 feet away. The knife will kill you in these people. Some of the freeflap people are still unconvinced. We'll see if they have some success.

 

[Periogod]

I'm curious to hear what the OMS residents (and maybe perio?) are hearing about doing dental implants on Pts with a Hx of IV bisphosphonate Tx. There are a few threads on DT, but not many comments by OMSs. Is this an absolute contraindication? What if Tx was many years prior? If that's acceptable, what's the cutoff in years? Thanks.

The FDA made Novartis Pharmaceuticals, makers of Aredia or Zometa, issue a drug precaution warning for their IV bisphosphanates because of an increased incidence of osteoradionecrosis found by a 2001-2004 examination of adverse events which discovered 139 cases of ONJ associated with extraction and dental trauma (thats a long sentence). I can tell you I wouldn't want to cause ONJ but I guess that is up to you. Its interesting to note that Marx actually had an article in 2003 in JOMS on this subject calling it a "growing epidemic." I guess it just took people a little while to realize it.

Durie B GM, Katz M, Crowley J, Woo S-B, Hande K, Richardson PG, Maerevoet M, Martin C, Duck L, Tarassoff P, Hei Y-j. Osteonecrosis of the Jaw and Bisphosphonates. N Engl J Med 2005; 353:99-102, July 7.2005

Marx RE. Pamidronate (Aredia) and zoledronate (Zometra) induced avascular necrosis of the jaws: a growing epidemic. J Oral Max Surg. 2003: 61:1115-1117.

 

[mzalendo]

Intresting post, I am actually doing a Howard Hughes Fellowship and one of my projects involves the design of a mouse model detailing the potential events that precipitate osteonecrosis of the jaw. There is a lot of hand waving as to the causes, most information being limited to case reports rather that solid laboratory investigation. My experimental design looks promising, more to come later potentially as a paper.

 

[OMFSdoc]

Intresting post, I am actually doing a Howard Hughes Fellowship and one of my projects involves the design of a mouse model detailing the potential events that precipitate osteonecrosis of the jaw. There is a lot of hand waving as to the causes, most information being limited to case reports rather that solid laboratory investigation. My experimental design looks promising, more to come later potentially as a paper.

Below is the wall street journal article that addressed the issue to the public. The public doesn't read JOMS, I believe this is the one that put a fire in the pants of drug companies.

http://online.wsj.com/public/resources/documents/SB110245057172293526.htm

 

[esclavo]

Intresting post, I am actually doing a Howard Hughes Fellowship and one of my projects involves the design of a mouse model detailing the potential events that precipitate osteonecrosis of the jaw. There is a lot of hand waving as to the causes, most information being limited to case reports rather that solid laboratory investigation. My experimental design looks promising, more to come later potentially as a paper.

Marx thoughts (not always scientific) are that it is due to occlusion of the microvasculature in the bone from the inhibition of the osteoclasts. The osteoblasts/progenitor cells don't have the yang of the osteoclasts. Thus, the microvasculature gets slowly occluded with unchecked bone formation. This lack of blood supply chokes off the cells over time and impedes bone healing, regeneration, and dynamic reaction to infection. I am curious what the science will show. This bone becomes rock hard, brittle, and prone to fracture. That is pathology in a minute according to Dr. Marx.

 

[Dr.Millisevert]

Marx thoughts (not always scientific)

Interesting you should say that. Some of my classmates were inquiring about Marx pathology text. We were recommended not to read/purchase it by some in our faculty for that very reason.

 

[tx oms]

I have the Marx book, Neville and Damm, and the Barnes series. Neville and Damm is plenty--if you know everything in that book you'll get all the pimp and board questions right.

I read the Marx book to get someone else's opinion. Many attendings dis Marx for not being scientific, but how many times have you heard an attendings say, "The literature says x, but I like doing y b/c...(followed by nonscientific evidence)." The fact is experience and operator preference counts for something. Sure, some things are inflexible, but most things have some room for leeway.

The Barnes series is good if you want to read 15 pages about dentigerous cysts and about 70 pages on ameloblastomas.

 

[esclavo]

I have the Marx book, Neville and Damm, and the Barnes series. Neville and Damm is plenty--if you know everything in that book you'll get all the pimp and board questions right.

I read the Marx book to get someone else's opinion. Many attendings dis Marx for not being scientific, but how many times have you heard an attendings say, "The literature says x, but I like doing y b/c...(followed by nonscientific evidence)." The fact is experience and operator preference counts for something. Sure, some things are inflexible, but most things have some room for leeway.

The Barnes series is good if you want to read 15 pages about dentigerous cysts and about 70 pages on ameloblastomas.

My program director did the fellowship under Ord at Maryland. So he is naturally biased against Marx. Whether one agrees with Marx or not, one thing is certain, and that is he is very logical and leaves no stone unturned. He always has great rationale even if he doesn't have the best science to back himself up. I still think he is one of the best minds in the profession. Well thought out and full of novel ideas and opinions. At this level, that is what you need to keep everyones eyes open and minds thinking. I think his book is good. My favorite part is the differential diagnosis section of each entity. Helps you to think about "what else should I be thinking about?" when you are zeroing in on a diagnosis.

 

[iwillkamvariyou]

I like unicorns.

 

[jpollei]

Although the OP asked for OMFS input (of which I am definitely not), there's a reasonable review-type article that touches some on IV bisphosphonate use in the Nov/Dec issue of "General Dentistry." Perhaps applied to implants...