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Oral bisphosphonates and Orthognathic surgery

Discussion in 'Dental Residents and Practicing Dentists' started by IcedOMFS, Feb 22, 2007.

  1. IcedOMFS

    IcedOMFS realultimatepower.net
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    Anyone know of any information on performing orthognathic surgery on patients taking oral bisphosphonates? Risks? I find nothing on it in the literature...

    Anyone besides esclavo with cojones large enough to actually do an osteotomy on such a patient?
     
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  2. north2southOMFS

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    Hell no. Why would you ask for such a headache?
     
  3. scalpel2008

    scalpel2008 beep beep beep...smash
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    hell no. unless they are SEVERE sleep apnea and have failed UPPP+tonsillectomy, CPAP, BiPAP, and absolutely refuse a trach and have only been on po bisphosphonates and sign a consent saying their face may fall off. or if they have bone mets, on IV bisphosphonates, and are going to die anyway and just want to look good and its their last wish to have a harmonious dentofacial relationship.
     
  4. esclavo

    esclavo from frying pan into fire
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    I would consider the procedure on a patient taking ORAL bisphosphonates if they have been taking them for less than 3 years and if their labs showed that they had good osteoclastic function (that little lab thingy that Marx talks about-P100 or something like that). I would make the patient share the risk with me though. I'd show them some nasty cases of osteo and sign and document those pictures that they understood the end risk. The other factor I would consider is how bad is the oral-facial problem. If they had some serious class three problems and were chewing on 3 teeth then I'd be more inclined because the justification for the surgery would be greater than lets say a person with a little VME and a mildly deep class II bite but essentially a functioning occlusion.

    I think a retrospective study would be somewhat easy and interesting. Go back over the last 15 years and take a look at people who had osteotomies while on Bisphosphonates and see what the out come was. You know that there are probably hundreds if not a thousand people who have had osteotomies while on Oral Bisphosphonates..... just to see what kind of incidence there is of problems.....there you have it.... a easy little interesting idea for some young resident-aspiring resident with a lot more time than I.......127 days till June 30 S U C K A S!!!!!!!!! (minus two weeks of vacation, 3 chief days and 1 week operating in Honduras for a grand total of 103 DAYS!!!!!! ... but who's counting :)

    And finally, my cajones have nothing to do with my surgical skill and judgement....they are capable in their own realm (as my 5 cute children can testify by their existence) but their job in surgery is to keep my legs warm....;)
     
  5. aphistis

    Moderator Emeritus 10+ Year Member

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    :eek:

    No wonder you went into OMFS. You must've been desparate for some time off...
     
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  6. Jediwendell

    Jediwendell Senior Member
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    Bad idea. Stephen Milam down here at SA had a rule of thumb of seven years for oral bisphosphonates. He said if a patient has been on them more than seven years don't touch them with a teen foot pole- won't stand up in court. Less than that it would be case by case, but be careful.
     
  7. toofache32

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    Then why do your kids look suspiciously like Bifid?

    As far as bisphosphonates, don't forget that this is elective surgery.
     
  8. OMFSdoc

    OMFSdoc Member
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    I would not do the surgery. Not worth the potential headache. Also, for the VAST MAJORITY of these patients, if they had mets cancer or osteoarthritis, chances are they are old enough that they have been living with their dentofacial deformity for quite a while without "needing" orthognathic surgery. If it's for sleep apnea, I don't know what I would do. This would not be a good idea.
     
  9. esclavo

    esclavo from frying pan into fire
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    Didn't you read?.... I said they were cute! (in the short chubby mexican way, not the big tall hairy greek way ;) ) That is how I know they are mine.... they are like 5 mini me wreaking havoc on society... I should post a picture...

    [GVIDEO]http://video.google.com/videoplay?docid=3197073981776550303&pr=goog-sl[/GVIDEO]
     
  10. GatorDMD

    GatorDMD Suck ChocoSaltyBalls
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    cute kids... except that big one in the back on the couch:D

     
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  11. OP
    OP
    IcedOMFS

    IcedOMFS realultimatepower.net
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    Note that the original post was regarding patients taking ORAL bisphosphonates (as in, for prevention of osteoporosis), not for cancer patients (multiple myeloma, etc) on intravenous bisphosphonates.

    So let's say the patient is 50 years old, has been on oral fosamax for approximately 1 year, has an isolated mandibular deficiency, and is interested in treatment for mostly cosmetic reasons secondary to her desire for orthodontic treatment. Would probably receive a moderate mandibular advancement (6 mm or so)

    How is orthodontics affected by the bisphosphonates? How would one deal with a bad split? Infected hardware afterwards? Relapse?

    Respect to Esclavo on the 3 year deal, ala Marx style. But does that rule hold for more invasive bone surgery of the jaws? Most of the recommendations (AAOMS, ADA, etc) are based on patients needing dentoalveolar surgery (single extractions, implants). And is the 3 year guideline based on any hard evidence, or just Marx's gut feeling based on his own experience?

    I'm sure there are patients out there who have had osteotomies done while on bisphosphonates. But where are the reports in the literature? I have found none...
     
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  12. Doggie

    Doggie Professional Jackass
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    What would you guys do if the patients need elective/non-elective extractions?
     
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  13. UNLV OMS GUNNABE

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    Fosamax < 3 years w/o concomitant steroids = extract
    >3years or w steroids = 3 months off fosamax

    I saw a case last month of BONJ in a patient on fosamax that had RCT on #20
     
  14. north2southOMFS

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    I will repeat. Hell no. Why ask for such a headache.

    I mean you could probably successfully win a litigation battle over it going bad if you had the right consents, buy why, for the money paid doing a jaw surgery, would you risk going through all that hassle. Just take out a day of 3rds and feel more at ease.
     
  15. NUKE

    NUKE Member
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    w/o osteoclasts teeth dont move
     
  16. north2southOMFS

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    They do if i cut off the jawbone surrounding them.
     
  17. esclavo

    esclavo from frying pan into fire
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    ????? this sounds like an intern (extern) statement. Explain yourself....
     
  18. toofache32

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    A #150 forceps can fix that....
     

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