Patient that has been on oral Bisphosphonates for over 8 years and needs implants....How do you approach the situation?

Sat, 01/30/2010 - 14:53 — Tom House DDS MD

I have a patient that has been on oral Bisphosphonates for 8+ years and needs several implants and a couple areas will need sinus lifts. The literature is very unclear on how to approach. Marx CTX is not proven? Not sure a drug holiday will make a difference?

I am looking for opinions on how people handle these situation in their offices? What is your protocol?

Comments

Tue, 02/09/2010 - 15:26 — bwalline

Drug holiday for 4 months.

Drug holiday for 4 months. Then do the case. I do not get CTX...Bejamin Walline DDS MD

Tue, 02/09/2010 - 21:30 — Ti Doc

4 month rationale? Bisphos have 1/2 life of many years

Why 4 months? The half life of bisphosphonates is many years.

I still don't think we really have a great grasp on this problem.

Wed, 02/10/2010 - 07:00 — N Shumaker DDS MS

4 month drug holiday for Bisphos

The drug holiday protocol comes from the AAOMS position paper on managing Bisphos patients that came out a couple years ago. They have references which suggest this may reduce the likelihood of BRONJ, but I agree it's probably a bit speculative. Definitely read this paper, excellent review.

Overall the risk in an oral bisphos patient with no medical comorbidities is very low, to near none. Especially if the location is other than posterior mandible. CTX test has been shown to be unreliable. I would heavily consent this patient of the risks, then come to a mutual decision of what is the best course of action risk/benefit wise. According to the AAOMS position paper there is NO contraindication to routine dentoalveolar surgery in oral bisphosphonate patients without other medical comorbidities (diabetes, corticosteroid use, etc).

Dr Shu.