Antiresorptive drugs and implantology

Since the first reports of bone necrosis associated with bisphosphonates

more than 10 years ago the understanding of the pathophysiology has

changed a lot. We have learned, that there is no general contraindication

for elective surgery in patients receiving antiresorptive therapy. Dedicated

national and international guidelines elaborate the same analysis: The

underlying disease requiring different dosages of antiresorptive drugs

guides the individual risk for bone necrosis.

Today patients with osteoporosis can be treated with dental implants in

a predictable way, whereas oncologic patients with bone metastases are

still under high risk of developing bone necrosis. it is very important also

for dentists who are not surgically active to understand the mechanism

of tooth extraction, inflammation of the bone and development of

necrosis. Only with this understanding safe patient treatment when under

antiresorptive treatment is possible.

General diseases and implantology

A few years ago many general diseases were rated as contraindications

for implantology. Today we have learned, that especially compromised

patients might have a benefit from a well-planned and cautious implant

therapy. The individual risk has to be differentiated between local risks

for implant healing and general risks for the health of the of the patient.

In many of the typical implant related articles only the implant healing is

focused and risks for the general health, e.g. major bleeding or necrosis are

often underestimated. Anticoagulants and other “bleeding-related” drugs

are typical examples. We have learned from irradiated patients how a riskbenefit

analysis should be planned. Recently the focus of discussion has

shifted more to drugs influencing bone metabolism.

Besides antiresorptive drugs also steroids, NSARs, proton pump inhibitors

and antidepressants are discussed as potential issues for bone healing.

Vitamin D deficiency and also vitamin D substitution is within the focus of

a more emotional discussion. In the viewpoint of these interactions oral

medicine is one of the most challenging fields in modern dentistry. With

these aspects in mind also a very sensitive patient collective may have a

clear benefit from implant therapy resulting in increased quality of life.