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Persyaratan Deklarasi Helsinki dipatuhi, dan pasien memberikan persetujuan untuk semua tindakan bedah prosedur.Informed consent tertulis diperoleh dari pasien untuk publikasi laporan ini dan semua gambar yang menyertainya.Gustavo Maluf, Rogério Jardim Caldas, Eduardo Rodrigues Fregnani, dan Paulo Sérgio da Silva Santos menyatakan bahwa mereka tidak memiliki kepentingan yang bersaing.
Klinik Swasta, Brasilia, DF, BrasilGustavo MalufBrasilia, BrasilGustavo MalufDepartment of Stomatology, Bauru Dental School, USP–University of São Paulo, Bauru, SP, BrazilRogério Jardim CaldasDepartemen Kedokteran Mulut, Rumah Sakit Sírio-Libanês, São Paulo, SP, BrasilEduardo Rodrigues FregnaniDepartment of Stomatology, Bauru Dental School, USP–University of São Paulo, Bauru, SP, BrazilP...
Pakosch D, Papadimas D, Munding J, dkk. Osteonekrosis mandibula karena agen anti-angiogenik, bevacizumab. Oral Maxillofac Surg. 2013;17:303–6.
Corbella S, Taschieri S, Samaranayake L, Tsesis I, dkk. Pilihan perawatan implan setelah pencabutan gigi yang retak vertikal. Sebuah proposal untuk klasifikasi klinis defek tulang berdasarkan tinjauan sistematis literatur. Clin Implan Oral Res. 2014;25:9...
Watters AL, Epstein JB, Agulnik M. Komplikasi oral dari terapi kanker yang ditargetkan: tinjauan literatur naratif. Oral Oncol. 2011;47:441–8.
Herbst RS, O'Neill VJ, Fehrenbacher L, et al. Studi fase II tentang kemanjuran dan keamanan bevacizumab dalam kombinasi dengan kemoterapi atau erlotinib dibandingkan dengan kemoterapi saja untuk pengobatan kanker paru-paru sel kecil yang berulang atau re...
Osteonekrosis rahang terkait Bevacizumab
Tulang meruncing
Tomografi komputer
Osteonekrosis rahang terkait pengobatan
Faktor pertumbuhan endotel vaskular A
Berbagi data tidak berlaku untuk artikel ini karena tidak ada kumpulan data yang dibuat atau dianalisis selama penelitian saat ini.
Lima minggu pascaoperasi, nyeri, drainase sekret purulen, dan tulang terbuka di sekitar implan diamati (Gbr. 4), meskipun tidak ada implan yang menunjukkan mobilitas. Sepuluh sesi terapi ozon yang terkait dengan levofloxacin dilakukan. Setelah 4 minggu terapi dengan minyak ozon (Philozon®, Balneário Cambori, SC, Brasil), tidak ada rasa sakit atau drainase dari sekresi purulen. Namun, sekuestrasi...
Seorang wanita bule berusia 54 tahun mengeluhkan rasa tidak enak dan nyeri di mulut. Riwayat medisnya termasuk kanker payudara dengan metastasis, yang didiagnosis pada tahun 2007. Pasien tidak memiliki penyakit penyerta dan tidak ada riwayat merokok. Telah dilakukan mastektomi radikal dengan diseksi aksila. Pasien tidak memiliki riwayat radioterapi kepala sebelumnya. dan leher atau penggunaan bifo...
Fig. 7. Panoramic radiograph at 7-month follow-up
Fig. 6. Image obtained 7 months postoperatively showing no lesions
Fig. 5. a, b Histological image of the lesion
Fig. 4. Bone exposure surrounding the implants with drainage of purulent secretion
Fig. 3. Panoramic radiograph after dental extractions with subsequent dental implants
Fig. 2. a, b Tomographic findings: lesions, measurements, and bone quality
Fig. 1. Initial clinical image showing oral infection foci
Maluf, G., Caldas, R.J., Fregnani, E.R. et al. A rare case of bevacizumab-related osteonecrosis of the jaw associated with dental implants.
Int J Implant Dent 5, 34 (2019). https://doi.org/10.1186/s40729-019-0188-0
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Received: 01 July 2019
Accepted: 30 August 2019
Published: 01 October 2019
DOI: https://doi.org/10.1186/s40729-019-0188-0
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
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The requirements of the Helsinki Declaration were observed, and the patient gave informed consent for all surgical procedures.
Written informed consent was obtained from the patient for the publication of this report and all accompanying images.
Gustavo Maluf, Rogério Jardim Caldas, Eduardo Rodrigues Fregnani, and Paulo Sérgio da Silva Santos declare that they have no competing interests.
Private Clinic, Brasília, DF, Brazil
Gustavo Maluf
Brasília, Brasil
Gustavo Maluf
Department of Stomatology, Bauru Dental School, USP–University of São Paulo, Bauru, SP, Brazil
Rogério Jardim Caldas
Department of Oral Medicine, Hospital Sírio-Libanês, São Paulo, SP, Brazil
Eduardo Rodrigues Fregnani
Department of Stomatology, Bauru Dental School, USP–University of São Paulo, Ba...
Otto S, Schreyer C, Hafner S, et al. Bisphosphonate-related osteonecrosis of the jaws—characteristics, risk factors, clinical features, localization and impact on oncological treatment. J Craniomaxillofac Surg. 2012;40:303–9.
Agrillo A, Filiaci F, Ramieri V, et al. Bisphosphonate-related osteonecrosis of the jaw (BRONJ): 5 year experience in the treatment of 131 cases with ozone therapy. Eur ...
Pakosch D, Papadimas D, Munding J, et al. Osteonecrosis of the mandible due to anti-angiogenic agent, bevacizumab. Oral Maxillofac Surg. 2013;17:303–6.
Corbella S, Taschieri S, Samaranayake L, Tsesis I, et al. Implant treatment choice after extraction of a vertically fractured tooth. A proposal for a clinical classification of bony defects based on a systematic review of literature. Clin Oral I...
Watters AL, Epstein JB, Agulnik M. Oral complications of targeted cancer therapies: a narrative literature review. Oral Oncol. 2011;47:441–8.
Herbst RS, O’Neill VJ, Fehrenbacher L, et al. Phase II study of efficacy and safety of bevacizumab in combination with chemotherapy or erlotinib compared with chemotherapy alone for treatment of recurrent or refractory none small-cell lung cancer. J Cli...
Bevacizumab-related osteonecrosis of the jaw
Bone level tapered
Computed tomography
Medication-related osteonecrosis of the jaw
Vascular endothelial growth factor A
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
The findings of the present case indicate that insertion of dental implants is a risk factor for osteonecrosis of the jaw in patients exposed to bevacizumab. Therefore, prospective randomized studies should be encouraged to determine a safer bevacizumab regimen that considers both oral surgeries and the risk of dental implants for the management of osteonecrosis in clinical settings.
MRONJ is a side effect of drugs with a predilection for the mandible [24], which can be attributed to the relatively low vascularization of the mandible as compared to the maxilla [13]. Dental infections, surgical interventions, corticosteroid treatment, and chemotherapy have been described as risk factors for osteonecrosis [25]. In this case, the patient presented with stage 2 osteonecrosis with ...
Long-term administration of antiangiogenic agents does not directly indicate a high risk of MRONJ [16], though some authors have established 7-, 14-, and 28-day intervals of bevacizumab suspension for oral surgery [17,18,19]. In this case, the antiangiogenic medication was suspended for 28 days before implant placement; however, this was not enough to prevent MRONJ. The surfaces of Straumann® S...
A meta-analysis showed that the placement of dental implants in patients exposed to bisphosphonates did not reduce the success rate of the dental implant [11], although these patients may experience complications. Based on this analysis, a risk assessment should be performed on a case-by-case basis, since MRONJ is rare but one among serious complication of bisphosphonate therapy [11]. However, a c...
Five weeks postoperatively, pain, drainage of purulent secretion, and bone exposure around the implants were observed (Fig. 4), although none of the implants showed mobility. Ten ozone therapy sessions associated with levofloxacin were performed. After 4 weeks of therapy with ozone oil (Philozon®, Balneário Camboriú, SC, Brazil), no pain or drainage of purulent secretion were present. Bone s...
A 54-year-old Caucasian woman complained of an unpleasant taste and pain in the mouth. Her medical history included breast cancer with metastasis, which was diagnosed in 2007. The patient had no comorbidities and no history of smoking. A radical mastectomy with axillary dissection was performed. The patient had no previous history of radiotherapy of the head and neck or use of bisphosphonates. The...
The treatment of malignancies often involves the use of targeted therapies to control the growth and survival of malignant cells by interfering with specific molecular agents involved in carcinogenesis [1]. Bevacizumab is a recombinant humanized monoclonal antibody designed to selectively bind and inhibit the biological activity of all human vascular endothelial growth factor (VEGF-A) isoforms. It...
Implant
Author Year Reference
Study type
Patients
Primary disease in BP patients (n)
...
Topic
Identified (n)
Included (n)
Outcome osteonecrosis risk. ST (bisphosphonate OR denosumab) AND osteonecrosis jaw AND
...
Walter, C., Al-Nawas, B., Wolff, T. et al. Dental implants in patients treated with antiresorptive medication – a systematic literature review. Int J Implant Dent 2, 9 (2016). https://doi.org/10.1186/s40729-016-0041-7
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Received: 26 September 2015
Accepted: 23 March 2016
Published: 04 April 2016
DOI: https://doi.org/10.1186/s40729-016-0041-7
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
The authors Christian Walter, Bilal Al-Nawas, Tim Wolff, Eik Schiegnitz, and Knut A. Grötz declare that they have no competing interests.
All authors designed the review. TW made the primary literature acquisition that was evaluated by the other others. All authors interpreted the data. CW drafted the manuscript that was revised by the other authors. All authors read and approved the final manus...
Department of Oral and Maxillofacial Surgery – Plastic Surgery of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany
Christian Walter, Bilal Al-Nawas & Eik Schiegnitz
Department of Oral and Maxillofacial Surgery of the Dr. Horst Schmidt Clinic, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Germany
Tim Wolff & Knut A. Grötz
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Krimmel M, Ripperger J, Hairass M, Hoefert S, Kluba S, Reinert S. Does dental and oral health influence the development and course of bisphosphonate-related osteonecrosis of the jaws (BRONJ)? Oral Maxillofac Surg. 2014;18(2):213–8. doi:10.1007/s10006-013-0408-3.
Tsao C, Darby I, Ebeling PR, Walsh K, O'Brien-Simpson N, Reynolds E, et al. Oral health risk factors for bisphosphonate-associated jaw...
DeBaz C, Hahn J, Lang L, Palomo L. Dental Implant Supported Restorations Improve Quality of Life in Osteoporotic Women. Int J Dent. 2015;2015:451923. doi:10.1155/2015/451923.
Grötz KA, Al-Nawas B. Persisting alveolar sockets-a radiologic symptom of BP-ONJ? J Oral Maxillofac Surg. 2006;64(10):1571–2. doi:10.1016/j.joms.2006.05.041.
Hutchinson M, O'Ryan F, Chavez V, Lathon PV, Sanchez G, Hatche...
Carmagnola D, Celestino S, Abati S. Dental and periodontal history of oncologic patients on parenteral bisphosphonates with or without osteonecrosis of the jaws: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(6):e10–5. doi:10.1016/j.tripleo.2008.07.011.
Jabbour Z, El-Hakim M, Mesbah-Ardakani P, Henderson JE, Albuquerque Jr R. The outcomes of conservative and surgical ...
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(11):1567–75. doi:10.1016/j.joms.2005.07.010.
Al-Sabbagh M, Robinson FG, Romanos G, Thomas MV. Osteoporosis and bisphosphonate-related osteonecrosis in a dental school implant patient popula...
Javed F, Almas K. Osseointegration of dental implants in patients undergoing bisphosphonate treatment: a literature review. J Periodontol. 2010;81(4):479–84. doi:10.1902/jop.2009.090587.
Bedogni A, Bettini G, Totola A, Saia G, Nocini PF. Oral bisphosphonate-associated osteonecrosis of the jaw after implant surgery: a case report and literature review. J Oral Maxillofac Surg. 2010;68(7):1662–6...
Grötz KA, Piesold JU, Al-Nawas B. Bisphosphonat-assoziierte Kiefernekrose (BP-ONJ) und andere Medikamenten-assoziierte Kiefernekrosen. 2012. AWMF online.
Walter C, Al-Nawas B, Frickhofen N, Gamm H, Beck J, Reinsch L, et al. Prevalence of bisphosphonate associated osteonecrosis of the jaws in multiple myeloma patients. Head Face Med. 2010;6:11. doi:10.1186/1746-160X-6-11.
Walter C, Sagheb K, Bit...
bisphosphonate
bisphosphonate-associated osteonecrosis of the jaws
C-terminal telopeptide of the type I collagen
patients intervention control outcome
preferred reporting items for systematic reviews and meta-analyses protocols
quality of life
search term
temporomandibular joint
Successful implant therapy is feasible in patients receiving antiresorptive therapy. The risk of osteonecrosis development needs to be explained to the patient. An individual risk assessment is essential, taking the primary disease with the medication and further wound-healing-compromising diseases and medications into account. If possible, bone augmentations should be avoided, and a perioperative...
The use of bone markers is discussed controversially in the literature, and no clear recommendation can be given at the moment [1, 8]. In these cases, where an implant is planned, a perioperative antimicrobial prophylaxis should be administered, similar to the prophylaxis suggested in other surgical procedures performed in these patients, since this seems to be a tool to decrease BP-ONJ frequency ...
Dental implants can improve the Qol in patients with antiresorptive therapy (bisphosphonate/denosumab) [44] analogous to patients without antiresorptive therapy [48]. A recently performed systematic review on masticatory performance, bite force, nutritional state and patient’s satisfaction showed that implant-supported dentures were associated with high patient satisfaction regarding denture com...
Even latest guidelines and statements dealing with medication associated osteonecrosis of the jaws such as the American [7, 8], Scottish [47], Swiss [6] or German [1] do not address implant therapy in these patients in detail. Due to this lack of data a systematic literature review was performed to fill this gap. Unfortunately the literature dealing with this topic is very sparse and consists main...
No articles could be found regarding the prognosis of the remaining dentition depending on implant therapy, neither for patients with bisphosphonate nor denosumab treatment.
There are no reliable parameters indicating the success of implants in patients with anti-resorptive therapy. The risk of osteonecrosis development has already been described in the chapter referring to the osteonecrosis risk...
The literature dealing with this topic can be separated into two groups:
BP-ONJ case series for which varying amounts are caused by dentures in patients with malignant and benign diseases [2, 33–42] and
studies performed on BP patients with dentures analyzing the frequency of BP-ONJ [15, 43].
Here as well, no imbalance regarding the dignity of the primary disease could be found. Jabbour descr...
Out of 606 articles 556 articles were excluded because they were either duplicates, case reports, narrative reviews, case series with less than 5 cases or were not associated with the topic at all (Table 1 and Fig. 1). Some of the articles analyzed more than one outcome and are referred to several times. Since the available literature is very inhomogeneous with a low level of evidence a statisti...
A table was generated and used to collect the relevant information.
A systematic review was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses protocols (PRISMA-P),
The review was performed using the PICO design.
Patients: For which subclientel of patients with antiresorptive therapy
Intervention: do dental implants have a benefit
Control: compared to forgoing dental implants
Outcome: in regards to oral rehabil...
A similar scenario is well known in patients with radiation of the jaws. Initially, radiation therapy was seen as a contraindication for implant insertion [14] because of osteoradionecrosis. In Germany meanwhile, implants are covered by the health insurance by law in some of these patients (§28 SGB V Sozialgesetzbuch). Due to xerostomia sufficient fixation of a denture is rather complicated, and ...
Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is a well-known side effect in patients receiving bisphosphonates (BP) due to e.g. osteoporosis, multiple myeloma or malignant diseases with metastases to the bone; prevalences range between 0.1% for patients with primary osteoporosis to 1% in patients with secondary osteoporosis and up to about 20% for special high risk subpopulations o...
Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is triggered by inflammatory processes. Typical trigger factors are periodontal disease, denture pressure sores, and surgical interventions such as tooth extractions. Unfortunately there is only little data on how to proceed with implant therapy in patients with bisphosphonate treatment. This topic is not addressed in the German guidelin...
Fig. 6. a Panoramic radiograph 16 months after the sequestrectomy. b Sagittal CT view. c Coronal CT view. d 3D CT view
Fig. 5. tograph 5 months after the sequestrectomy.
Fig. 5. a Extraoral photograph 5 months after the sequestrectomy. b Intraoral photograph 5 months after the sequestrectomy.
Fig. 4. y. c Removal of the dental implant with a specimen of the necrotic bone
Fig. 4. a Preoperative intraoral photograph. b Intraoperative photograph of the sequestrectomy. c Removal of the dental implant with a specimen of the necrotic bone
Fig. 3.
Fig. 3. a Panoramic radiograph showing the sequestrum separation after 5 months of teriparatide therapy (arrows). b Sagittal CT view. c Coronal CT view
molar (arrow). b Sagittal CT view. c Coronal CT view
Fig. 2. a Panoramic radiograph showing marked alveolar bone resorption surrounding the dental implant replacing the right mandibular first molar (arrow). b Sagittal CT view. c Coronal CT view
Fig. 1. al implants associated with mucosal inflammation and a purulent discharge
Fig. 1. a Extraoral photograph showing an extraoral fistula in the right mandibular region. b Intraoral photograph showing an intraoral fistula on the lingual side of the distal dental implants associated with mucosal inflammation and a purulent discharge
Zushi, Y., Takaoka, K., Tamaoka, J. et al. Treatment with teriparatide for advanced bisphosphonate-related osteonecrosis of the jaw around dental implants: a case report. Int J Implant Dent 3, 11 (2017). https://doi.org/10.1186/s40729-017-0074-6
Download citation
Received: 06 December 2016
Accepted: 12 February 2017
Published: 30 March 2017
DOI: https://doi.org/10.1186/s40729-017-0074-6
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
Yusuke Zushi, Kazuki Takaoka, Joji Tamaoka, Miho Ueta, Kazuma Noguchi & Hiromitsu Kishimoto
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You can also search for this author in PubMed Google Scholar
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Stanton DC, Balasanian E. Outcome of surgical management of bisphosphonate-related osteonecrosis of the jaws: review of 33 surgical cases. J Oral Maxillofac Surg. 2009;67:943–50.
Carlson ER, Basile JD. The role of surgical resection in the management of bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2009;67:85–95.
Wilde F, Heufelder M, Winter K, et al. The role of ...
Grant BT, Amenedo C, Freeman K, Kraut RA. Outcomes of placing dental implants in patients taking oral bisphosphonates: a review of 115 cases. J Oral Maxillofac Surg. 2008;66:223–30.
Goss A, Bartold M, Sambrook P, Hawker P. The nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in dental implant patients: a South Australian case series. J Oral Maxillofac Surg. 2010;68:33...
Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003;61:1115–7.
Marx RE, Sawatari J, Fortin M, et al. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws; risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005;63:1567.
Harper RP, Fung E. Resolution of...
We have reported a case of a severely osteoporotic elderly woman with BRONJ around her dental implants, who was treated successfully with teriparatide. Teriparatide therapy appeared to exert beneficial effects in this patient.
It is therefore important that all patients treated with oral BPs must be given a full explanation of the potential risks of implant failure and BRONJ development in the short and long term. Because the potential role of infection in implant failure and BRONJ occurrence is still debated, great attention should be paid to the long-term oral hygiene and plaque control of implant-prosthetic restorati...
We describe a case of a patient with a 6-year history of alendronate therapy, in which BRONJ developed around her dental implants. In this patient, the dental implants achieved successful osseointegration, and BRONJ occurred after the second surgery. Several factors could have played a role in the development of BRONJ in this patient. Glucocorticoid therapy is associated with an increased risk of ...
In November 2011, after a consultation with an osteoporosis expert at the Orthopedic Medicine Clinic of our hospital, alendronate therapy was stopped and subcutaneous teriparatide therapy at a dose of 20 μg per day was started. During the course of the teriparatide therapy, the patient continued to use 0.02% benzalkonium chloride solution for local irrigation.
In April 2012, after 5 months of ...
A 66-year-old woman was referred to the Oral and Maxillofacial Surgery Clinic at Hyogo College of Medicine Hospital, Japan, in September 2011, for an extraoral fistula and refractory pain of the right mandible associated with a purulent discharge and soft tissue swelling. The patient’s osteoporosis was diagnosed in 2005 and treated with 35 mg of alendronate weekly by the family doctor. The pati...
Oral bisphosphonates (BPs) are used to treat osteoporosis, Paget’s disease, and osteogenesis imperfecta. They are most widely used for treatment of osteoporosis. BP-related osteonecrosis of the jaw (BRONJ) was first reported by Marx in 2003 [1]. The risk of BRONJ in osteoporotic patients treated with BPs remains low compared with that of oncology patients [2]. Recent studies have indicated that ...
We report a case of a 66-year-old severely osteoporotic woman with bisphosphonate-related osteonecrosis of the jaw (BRONJ) around her dental implants, who was treated successfully with teriparatide and sequestrectomy of the mandible. After 5 months of teriparatide therapy, the sequestrum separation had progressed and a sequestrectomy was performed under general anesthesia. Five months after the o...
Zushi, Y., Takaoka, K., Tamaoka, J. et al. Treatment with teriparatide for advanced bisphosphonate-related osteonecrosis of the jaw around dental implants: a case report.
Int J Implant Dent 3, 11 (2017). https://doi.org/10.1186/s40729-017-0074-6
Download citation
Received: 06 December 2016
Accepted: 12 February 2017
Published: 30 March 2017
DOI: https://doi.org/10.1186/s4...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
Yusuke Zushi, Kazuki Takaoka, Joji Tamaoka, Miho Ueta, Kazuma Noguchi & Hiromitsu Kishimoto
You can also search for this author in
PubMed Google Scholar
You can also search for this author in
PubMed Google Schola...
Stanton DC, Balasanian E. Outcome of surgical management of bisphosphonate-related osteonecrosis of the jaws: review of 33 surgical cases. J Oral Maxillofac Surg. 2009;67:943–50.Carlson ER, Basile JD. The role of surgical resection in the management of bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2009;67:85–95.Wilde F, Heufelder M, Winter K, et al. The role of surg...
Stanton DC, Balasanian E. Outcome of surgical management of bisphosphonate-related osteonecrosis of the jaws: review of 33 surgical cases. J Oral Maxillofac Surg. 2009;67:943–50.
Carlson ER, Basile JD. The role of surgical resection in the management of bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2009;67:85–95.
Wilde F, Heufelder M, Winter K, et al. The role of ...
Grant BT, Amenedo C, Freeman K, Kraut RA. Outcomes of placing dental implants in patients taking oral bisphosphonates: a review of 115 cases. J Oral Maxillofac Surg. 2008;66:223–30.
Goss A, Bartold M, Sambrook P, Hawker P. The nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in dental implant patients: a South Australian case series. J Oral Maxillofac Surg. 2010;68:33...
Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003;61:1115–7.
Marx RE, Sawatari J, Fortin M, et al. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws; risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005;63:1567.
Harper RP, Fung E. Resolution of...
We have reported a case of a severely osteoporotic elderly woman with BRONJ around her dental implants, who was treated successfully with teriparatide. Teriparatide therapy appeared to exert beneficial effects in this patient.
It is therefore important that all patients treated with oral BPs must be given a full explanation of the potential risks of implant failure and BRONJ development in the short and long term. Because the potential role of infection in implant failure and BRONJ occurrence is still debated, great attention should be paid to the long-term oral hygiene and plaque control of implant-prosthetic restorati...
We describe a case of a patient with a 6-year history of alendronate therapy, in which BRONJ developed around her dental implants. In this patient, the dental implants achieved successful osseointegration, and BRONJ occurred after the second surgery. Several factors could have played a role in the development of BRONJ in this patient. Glucocorticoid therapy is associated with an increased risk of ...
In November 2011, after a consultation with an osteoporosis expert at the Orthopedic Medicine Clinic of our hospital, alendronate therapy was stopped and subcutaneous teriparatide therapy at a dose of 20 μg per day was started. During the course of the teriparatide therapy, the patient continued to use 0.02% benzalkonium chloride solution for local irrigation.
In April 2012, after 5 months of ...
A 66-year-old woman was referred to the Oral and Maxillofacial Surgery Clinic at Hyogo College of Medicine Hospital, Japan, in September 2011, for an extraoral fistula and refractory pain of the right mandible associated with a purulent discharge and soft tissue swelling. The patient’s osteoporosis was diagnosed in 2005 and treated with 35 mg of alendronate weekly by the family doctor. The pati...
Oral bisphosphonates (BPs) are used to treat osteoporosis, Paget’s disease, and osteogenesis imperfecta. They are most widely used for treatment of osteoporosis. BP-related osteonecrosis of the jaw (BRONJ) was first reported by Marx in 2003 [1]. The risk of BRONJ in osteoporotic patients treated with BPs remains low compared with that of oncology patients [2]. Recent studies have indicated that ...
We report a case of a 66-year-old severely osteoporotic woman with bisphosphonate-related osteonecrosis of the jaw (BRONJ) around her dental implants, who was treated successfully with teriparatide and sequestrectomy of the mandible. After 5 months of teriparatide therapy, the sequestrum separation had progressed and a sequestrectomy was performed under general anesthesia. Five months after the o...
Table 1 Comparison of OHIP-14 and its domains in the pre-and postoperative periods
OHIP-14
Preoperative
Postoperative
P value
Median (min-max)
D1
6 (2–8)
0 (0–3)
0.002
D2
5 (1–8)
0 (0–3)
0.002
D3
7.5 (1–8)
0 (0–4)
0.002
D4
7.5 (2–8)
0 (0–1)
0.002
D5
8 (3–8)
0 (0–4)
0.002
D6
2 (0–8)
0 (0–0)
0.003
D7
4 ...
Figure 7. Panoramic radiography of the follow-up
Figure 6. Tomographic scan of the follow-up
Figure 5. a Mini-pillar guide. b Installation of the mini-pillars. c Protectors on the mini-pillars. d Relief of the prosthesis on the mini-pillars
Figure 4. Insertion of the implant. a Prototyped surgical guide installed and stabilized. b Long transmaxillary implants are placed on both sides of the maxilla. c Long transmaxillary implant placement with the final insertion using a ratchet or tufted wrench
Figure 3. Surgical guide. a Surgical guide in occlusal view. b Surgical guide in frontal view. c Prototyped model of the atrophic maxilla
Figure 2. Maxillary computed tomography. a Axial view. b Coronal view
Figure 1. Schematic drawing of the transmaxillary implant. Perforation is made using the 2.0 mm lance implant, for giving guidance and stability to the next drill, using the 3.0 mm implant
References
Alzarea BK. Assessment and evaluation of quality of life (OHRQoL) of patients with dental im-plants using the Oral Health Impact Profile (OHIP-14) - a clinical study. J Clin Diagn Res. 2016;10:57–60.
Aparicio C, Manresa C, Francisco K, Ouazzani W, Claros P, Potau JM, Aparicio A. The long-term use of zygomatic implants: a 10-year clinical and radiographic report. Clin Implant D...
Discussion
Considering the particularities of rehabilitation treatments with implants, such as patients with the atrophic edentulous maxilla, and particularly rehabilitation using long implants, this study aimed to assess the impact of using a modified long transmaxillary implant, placed horizontally on the OHRQoL of patients with the atrophic maxilla.
The missing teeth impair mastication ...
Results
The study consisted of 12 individuals, with 10 (83.3%) females and two (16.7%) males. The mean age of the sample was 55.83 ± 2.78 years.
A total of 12 maxillary atrophic patients were rehabilitated, 10 using the transmaxillary implants. Of these, two patients rehabilitated with the transmaxillary implant required postoperative adjustments because the implants were lost. In the first c...
Surgical procedures
External antisepsis was performed on the face using 2% Riorex chlorhexidine digluconate (Rioquímica, São José do Rio Preto, SP, Brazil) and intrabuccal (intraoral) antisepsis was performed using digluconate 0.12% chlorhexidine (Colgate, São Paulo, SP, Brazil). The entire maxilla was anesthetized using 4% articaine and 1:100,000 epinephrine (DFL, Rio de Janeiro, Brazil)...
The transmaxillary implant is more conservative than the zygomatic implant, because it is installed only in the lower third of the maxilla. The zygomatic implant can reach noble regions of the face and can cause serious risks of injury to support structures, including the face, eye socket, and infratemporal fossa. Long transmaxillary implants are positioned horizontally in the maxillary bone, unli...
Materials and methods
Ethical aspects
This retrospective case series was approved by the local Research Ethics Committee (CAAE 98088718.5.0000.0093). Patients were informed of the nature of the study and procedures, according to the Free and Informed Consent Term. Additionally, this study followed the Helsinki guidelines [19].
Study design
Twelve adult patients of both sexes were evaluated. ...
Background
The introduction of osseointegrated implants is considered one of the greatest breakthroughs in dentistry [4]. Dental implants have been used in edentulous jaws to improve the retention and stability of complete dentures. Attachment to implants, in addition to improving stability and functional aspects, increases patient satisfaction [7, 8]. In addition, implant connection improves ...
Long transmaxillary implants improve oral health-related quality of life of patients with atrophic jaws-a case series
Abstract
Background
The advancement of contemporary dentistry is related to the improvement of existing techniques, materials, and technology, consistently for improving people’s oral health, which can ultimately reflect better quality of life. This study aimed to evaluate t...
Abbreviations
BP:
bisphosphonate
BP-ONJ:
bisphosphonate-associated osteonecrosis of the jaws
CTX:
C-terminal telopeptide of the type I collagen
PICO:
patients intervention control outcome
PRISMA-P:
preferred reporting items for systematic reviews and meta-analyses protocols
QoL:
quality of life
ST:
search term
TMJ:
temporomandibular joint
...
Next to this, the patients need to be compliant with an appropriate motivation for oral hygiene and the necessary skills to transfer this. Infectious foci should be treated before implant therapy to further reduce the risk of osteonecrosis development. The surgical sites should be followed up clinically (persisting sharp bone edges without any tendency to remodel) and radiologically (e...
Although there are only very few cases in the literature with augmentation of bone/sinus lift, these procedures are linked to a functioning vascular recipient site with working osteoclastic resorption and osteoblastic bone formation, and this is compromised in patients with antiresorptive therapy. Due to the denudation of the bone at the recipient site the vascular situation might be e...
Discussion
Even latest guidelines and statements dealing with medication associated osteonecrosis of the jaws such as the American, Scottish, Swiss or German do not address implant therapy in these patients in detail. Due to this lack of data a systematic literature review was performed to fill this gap. Unfortunately the literature dealing with this topic is very sparse and consists mainl...
Nibbe analyzed 128 patients with IV BP or denosumab separated into 3 groups. In the first group 5 out of 60 patients with no denture had an osteonecrosis (8%), in the 2nd group 5 out of 34 patients with a fixed partial denture had an osteonecrosis 15%, and in the 3rd group 11 out of 34 patients with a removable denture had an osteonecrosis (32%). Kyrgidis determined that dentures increase the ris...
Results
Out of 606 articles 556 articles were excluded because they were either duplicates, case reports, narrative reviews, case series with less than 5 cases or were not associated with the topic at all (Table 1 and Fig. 1). Some of the articles analyzed more than one outcome and are referred to several times. Since the available literature is very inhomogeneous with a low level of evidence a...
Introduction
Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is a well-known side effect in patients receiving bisphosphonates (BP) due to e.g. osteoporosis, multiple myeloma or malignant diseases with metastases to the bone; prevalences range between 0.1% for patients with primary osteoporosis to 1% in patients with secondary osteoporosis and up to about 20% for special high risk ...
Dental implants in patients treated with antiresorptive medication – a systematic literature review
Abstract
Objective
Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is triggered by inflammatory processes. Typical trigger factors are periodontal disease, denture pressure sores, and surgical interventions such as tooth extractions. Unfortunately there is only little data on how...
The present report showed that short implants may achieve optimal clinical and radiographic outcomes at the 1-year follow-up when used for single restoration or when connected with other implants in substituting for more than one tooth. There was no difference in outcomes between mandibular and maxillary restorations even though a higher quantity of bone volume was required in mandibular restora...
Weton
Sebaran panjang dan diameter implant ditampilkan dalam Tabel 1. Tabel 2 merinkes posisi implant dan ciri prostetik. Rerata tinggi tulang sisa adalah 6.21 ± 1.05 mm di rahang atas dan 10.73 ± 1.63 mm di rahang bawah. Perbedaan di antara 2 rahang itu signifikan (P < 0.05). Tidak ada komplikasi bedah atau pasca bedah yang dilaporkan.
Tabel 2. Posisi implant dan ciri prostetik; implant ante...
Implant length and diameter distribution are shown in Table 1. Table 2 summarizes implant positions and prosthetic characteristics. Mean residual bone height was 6.21 ± 1.05 mm in the upper jaw and 10.73 ± 1.63 mm in the mandible, and it was significantly different between the 2 jaws (P < .05). No surgical or postsurgical complications were reported.
Table 2. Implant positions and prostheti...
In this ad interim report, 1-year data regarding bone resorption were assessed. Implant survival and success rates were evaluated by comparing maxillary and mandibular implants, splinted and single implants, and implants of different lengths. A Student t test was used to compare bone resorption between mandibular and maxillary implants and splinted and single implants. Analysis of variance was u...
Clinical evaluation was performed every 6 months for the first 2 years then yearly. Survival and success rates were evaluated and recorded, following the definitions and parameters described elsewhere. Any surgical, prosthetic, or clinical complication was recorded. Prosthetic success was evaluated as follows: prosthesis in function, without mobility and pain, even if in the face of the loss of o...
Antibiotic prophylaxis with amoxicillin 2 g was administered to all patients 1 hour before surgery in all patients. All implants were placed in healed sites and the bone socket was prepared using a standard atraumatic technique with a sequence of drills of increasing diameter at the decided length. The implant site was always underprepared, taking in consideration the bone density. All implants ...
This prospective single-cohort study was designed and conducted following the principles of the World Medical Association Helsinki Declaration of 1975 for biomedical research involving human subjects, as revised in 2000. Ethical approval for the study was obtained by the review board of the IRCCS Istituto Ortopedico Galeazzi. All patients were informed about the study aims and design and gave w...
Introduction
Implant rehabilitation in the posterior regions of the maxilla and mandible can be complicated in cases of reduced bone volume due to bone resorption after teeth extraction or to particular anatomic conditions. In fact, reduced bone height can prevent long implants (>10 mm long) from being placed because of the risk of involving anatomic structures, such as ...
Short Implants in Maxillary and Mandibular Rehabilitations: Interim Results (6 to 42 Months) of a Prospective Study
J Oral Implantol (2015) 41 (1): 50–55.
https://doi.org/10.1563/AAID-JOI-D-12-00206
The aim of this single-cohort study was to evaluate clinical survival and success of partial rehabilitation supported by reduced-length implants in maxilla and ...