Medical Evaluation: Part 4 — The Influence of Osteoporosis and Immunosuppressive Medications (1 CEU)
It’s crucial for clinicians to understand the influence of medications on dental implants, as some patients may be taking prescription medications that have been associated with an increased dental implant morbidity. Medications for the treatment of osteoporosis and autoimmune diseases are commonly prescribed today, especially in older patients. These medications have been directly associated with an increase in infection rates, such as medication-related osteonecrosis of the jaw (MRONJ).
In Part 4, the final article of this series on the medical evaluation of dental implant patients, a reference guide will be provided with common osteoporosis and immunosuppressive medications, with respect to their contribution to infection and increased dental implant morbidity. In addition, recommendations for the modification or discontinuation of medications will be discussed in detail. This straightforward guide is designed to assist clinicians in maximizing treatment success.
For the previous articles in this series, read Part 1 (Chairside® magazine Vol. 16, Iss. 1), which covers the preoperative evaluation of the dental implant patient; Part 2 (Vol. 16, Iss. 2), which describes systemic disease and oral implants; and Part 3 (Vol. 16, Iss. 3), which discusses the influence of systemic medications on dental implant treatment.
1. Bisphosphonates (BP)
Oral Bisphosphonate: Alendronate (Fosamax®), risedronate (Actonel ®) and ibandronate (Boniva®)
IV Bisphosphonate: Zoledronic acid (Zometa®, Reclast®) and pamidronate (Aredia®)
Bisphosphonates are a group of drugs that are widely used for various bone disorders, such as osteoporosis, metastatic bone cancer, and Paget’s disease. Bisphosphonates induce osteoclastic death or apoptosis at the cellular level and kill functionally resorbing osteoclasts not only at the peripheral sites, but also in the bone marrow. Unfortunately, bisphosphonates have been associated with osteonecrosis of the bone, termed medication-related osteonecrosis of the jaw (MRONJ).
Dental Implant Treatment Considerations
When considering dental implants in patients undergoing bisphosphonate therapy, the implant clinician must be conscious of the possibility of infection and/or loss of implants. According to the American Association of Oral and Maxillofacial Surgeons (AAOMS) recommendation,1 patients taking oral BP for less than four years with no comorbidities do not require any modification to the planned implant surgery. For patients with comorbidities or who have taken oral bisphosphonates for more than four years, discontinuation of the bisphosphonate (drug holiday) and/or a CTx blood test should be considered prior to surgery. However, for patients under IV bisphosphonate therapy, elective treatment is contraindicated. See Tables 1 and 2.
Patients today, even those with life-threatening diseases, are more socially active and have a better quality of life than ever before because of advancements in medical care. However, many of the newer, more common medications can be associated with devastating effects on dental implant treatment. Patients being treated with antiresorptive, chemotherapeutic and immunosuppressive medications are at the forefront of possible increased dental implant complications. Therefore, a comprehensive assessment and understanding of the patient’s medical history and current medication usage is crucial for the long-term success of dental implant treatment.
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