Bisphosponates and dental implants: a case report and a brief review of literature.

This paper reports a brief review of literature about dental implant in patients taking bisphosphonates (BPs) and a case of a patient taking zoledronate, submitted to postextractive implant surgery. A 54-years-old woman was referred to our observation, at the First Section of Dentistry of Department of Medical-Surgical Specialties, University of Catania. The patient, affected by multiple myeloma, reported being subjected to implant surgery, during the administration of zoledronate. Clinical and radiographic evaluations showed an area of BPs-related osteonecrosis in the only postextraction site where no implant was positioned. From this brief review of literature, we can conclude that the risk of bisphosphonates-related osteonecrosis and of implant failure in patients taking oral bisphosphonates may be low. This is a unique case of implant surgery in patient taking intravenous bisphosphonates. For that, we cannot conclude that implant surgery is safe in patients taking intravenous bisphosphonates or that the immediate implant placement following extraction may prevent the osteonecrosis. According to guidelines of AAOMS, to date any kind of surgical procedure involving alveolar bone in patients treated with itravenous BPs is contraindicated. More studies would be needed to optimize the clinical guidelines for the treatment of patients taking BPs.

Dental extractions in patient treated with intravenous bisphosphonates and risk of osteonecrosis of jaws: presentation of a preventive protocol and case series.

AIM: The exact pathogenesis of bisphosphonates-related osteonecrosis of jaws (BRONJ) is still not clear. Two broad theories have been articulated to explain the pathogenesis of BRONJ. One centres on the bisphosphonate induced osteoclast inhibition and the other explains the process in terms of antiangiogenic mechanisms. Both try to address the predilection for this occurrence in the jaws. In most cases the development of osteonecrosis in those taking bisphosphonates (BPs) has been associated with trauma, predominantly dental extraction. This study reports a case series of patients, treated with Zoledronate, submitted to a preventive protocol of dental extraction, in order to minimize the risk of occurrence of bisphosphonates-related osteonecrosis. METHODS: A total of 34 patients treated with Zoledronate and requiring single or multiple dental extractions were treated, at our Center for research, prevention and care of BRONJ, I Section of Dentistry, Department of Medical Surgical Specialties, University of Catania. The protocol provides an antibiotic prophylaxis and the surgical extraction of interested teeth, accompanied by the removal of the adjacent alveolar bone. RESULTS: A total of 71 extractions in 34 patients were performed with this approach. The follow-up was 12 months. No signs of inflamed tissue or necrotic exposed bone in any patients. CONCLUSION: With limits of present study, the results of our case series are very promising because BRONJ did not develop in any of the patients. In all patients taking Zoledronate and showing untreatable inflammatory dental conditions, the present protocol might be advisable.

Bone substitutes in oral surgery.

Osseous defects pose a clinical challenge the operator can meet with the aid of techniques that promote bone tissue regeneration. The current gold standard is autologous bone harvested from intra- and extraoral donor sites; however, autologous bone grafting requires two surgical sites (donor and recipient), resulting in greater morbidity and prolonged operating times, particularly for extraoral sites, with greater discomfort for the patient. Such disadvantages can be overcome with the use of bone substitute materials. There is a notable variety of so-called intelligent biomaterials that can modulate bone response in regeneration. Based on origin, bone substitute materials are classified as allogenic, heterologous and alloplastic materials. The first refer to bone from same-species donors, the second are obtained through processing of bone from different species, while alloplastic materials are synthetic composites. Besides different resorption rates, they possess different chemical and structural characteristics that influence the stimulation or support of bone regeneration. In daily clinical practice, before selecting from the wide variety of biomaterials, a wise step is to analyze and compare the clinical and histological results obtained with these materials. This article examines the clinical applications and osteoconductive and/or osteoinductive properties of some currently available biomaterials.