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Table of Contents   
CASE REPORT  
Year : 2012  |  Volume : 23  |  Issue : 2  |  Page : 298
Early dental implant failure in patient associated with oral bisphosphonates


Department of Prosthodontics, Institute of Dental Studies and Technology, Modinagar, India

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Date of Submission15-Jul-2011
Date of Decision09-Oct-2011
Date of Acceptance21-Dec-2011
Date of Web Publication3-Sep-2012
 

   Abstract 

Oral bisphosphonates are routinely prescribed to post menopausal women. These have shown to increase the risk of osteonecrosis. However, this action may be augmented by local factors. A case report is presented showing an early implant failure in a patient taking oral bisphosphonates. Two implants were placed in left maxillary incisor area. Central incisor was associated with a previous endodontic failure and extraction. Lateral incisor was avulsed 3 years back. After 4 weeks of an implant placement, necrotic bone was evident along with the failing implant in central incisor area. This case report emphasizes on the incidence and an increased risk of implant failure in patients taking oral bisphosphonates.

Keywords: Bisphosphonates, CTX level, implant failure, osteonecrosis

How to cite this article:
Gupta R. Early dental implant failure in patient associated with oral bisphosphonates. Indian J Dent Res 2012;23:298

How to cite this URL:
Gupta R. Early dental implant failure in patient associated with oral bisphosphonates. Indian J Dent Res [serial online] 2012 [cited 2020 Mar 29];23:298. Available from: http://www.ijdr.in/text.asp?2012/23/2/298/100471

   Introduction Top


The success of an implant-supported prosthesis depends upon due evaluation of the risk factors, not just limited to periodontal, endodontic or non-implant prosthetic treatments. Adult post-menopausal women are routinely prescribed oral bisphosphonates (BPs) for the treatment of osteoporosis. BPs reduces the lifespan of osteoclasts and may create an imbalance between normal creation and normal destruction of the bone. [1],[2] Some authors have cited this reason as an increased incidence of bone necrosis of the jaws. However, there may be certain local factors which may act in a synergistic manner in increasing the risk of osteonecrosis. This article reports a case of dental implant failure in a patient taking oral BPs for past two years. Interestingly, an implant failure was associated with a previous endodontic failure.


   Case Report Top


A 54-year-old woman presented at our clinic with missing left central and lateral incisors, aiming at the replacement of teeth with endosseous implants. Left central incisor was extracted 2 weeks ago because of the failed endodontic treatment. The lateral incisor was avulsed 3 years back, and the patient was wearing a removable appliance since then. The right central incisor was endodontically treated. The soft tissue dimensions were adequate for the functional and an esthetic acceptability [Figure 1]. Patient gave a history of postmenopausal osteoporosis and was on oral bisphosphonates (35mg Residronate twice per week) for past 2 years. Investigations showed that serum C terminal cross linked telopeptide of type I collagen (CTX) level was slightly less than 150 pg/ml (132 pg/ml). The patient was informed about the treatment options and possible failure of implants, but patient insisted on implant-supported restorations.
Figure 1: Preoperative view showing missing left central and lateral incisor. Slight food impaction can be seen on the lateral incisor area because of loose removable appliance.

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After induction of local anesthesia, full thickness flap was reflected in relation to maxillary left central and lateral incisors. The sockets were degranulated and 5 wall sockets were obtained [Figure 2]. A pre-fabricated surgical template was used to locate the desired implant position. Two dental implants were placed with an initial insertion torque of 45 Ncm for both the implants. The flap was approximated and sutured with interrupted 3-0 Mersilk. Antibiotic therapy was initiated and maintained for 7 days along with the chlorhexidine rinses. The surgical dressing and sutures were removed on the 10th day, and non-loaded removable partial denture was placed. After 6 weeks, patient reported metallic hue on the palatal aspect of central incisor. After 2 more weeks, an implant and a piece of necrotic bone were exposed from the palatal aspect [Figure 3]. The implant was removed. Other implant was stable in position with no evidence of necrosis/bone loss. Presently, the patient is wearing a removable partial denture and is under a follow-up care on a regular basis.
Figure 2: Intra operative view.

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Figure 3: 4 week post operative view showing metallic hue on the palatal aspect with necrotic bone in the central incisor area.

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   Discussion Top


Various authors have shown an increased risk of osteonecrosis in patients on oral BPs. In the present case, the patient was taking oral BPs for past 2 years. Marx et al has suggested an evaluation of CTX levels in the determination of risk for the osteonecrosis. [1] CTX level is proportional to the osteoclastic activity and shows the healing potential of bone as a marker of bone turnover. [3] Levels above 150 pg/ml pose a minimal or no risk of osteonecrosis. [1] In the present case, an implant placed in central incisor location failed. The area was associated with previous-failed endodontic treatment and perhaps periapical infection. This might have augmented the effect of BPs on risk of osteonecrosis. Whereas, an implant placed in the lateral incisor area was stable at 12 month follow-up and showed acceptable osteo-integration [Figure 4]. During the management of failed implant, conservative and selective removal of the necrotic bone was advised. Some authors have shown that, bone-contouring procedures may produce counterproductive results and could lead to further exposure of bone and worsening of the symptoms. [4],[5]
Figure 4: 12 month post operative radiograph.

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The outcome of the present case suggests that, the patient taking BPs should be warned relating to possible future implant failure and osteonecrosis of the jaw. Perhaps some clinical research is required to make a follow-chart and guidelines for treatment approach during an implant placement in patients receiving oral BPs.


   Acknowledgement Top


The author is grateful to Dr. Vivek Aggarwal, for the great help and guidance in the article.

 
   References Top

1.Marx RE, Cillo JE Jr, Ulloa JJ. Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg 2007;65:2397-410.   Back to cited text no. 1
[PUBMED]    
2.Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: A review of 63 cases. J Oral Maxillofac Surg 2004;62:527-34.   Back to cited text no. 2
[PUBMED]    
3.Rosen HN, Moses AC, Garber J, Iloputaife ID, Ross DS, Lee SL, et al. Serum CTX: A new marker of bone resorption that shows treatment effect more often than other markers because of low coefficient of variability and large changes with bisphosphonate therapy. Calcif Tissue Int 2000;66:100-3.   Back to cited text no. 3
[PUBMED]    
4.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;63:1567-75.  Back to cited text no. 4
[PUBMED]    
5.Kademani D, Koka S, Lacy MQ, Rajkumar SV. Primary surgical therapy for osteonecrosis of the jaw secondary to bisphosphonate therapy. Mayo Clin Proc 2006;81:1100-3.  Back to cited text no. 5
[PUBMED]    

Top
Correspondence Address:
Ridhimaa Gupta
Department of Prosthodontics, Institute of Dental Studies and Technology, Modinagar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.100471

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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    Abstract
   Introduction
   Case Report
   Discussion
   Acknowledgement
    References
    Article Figures

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