Reducing a patient’s treatment time and simplifying the treatment can increase patient acceptance and reduce the risk of complications. For dental implants, this means moving away from the traditional two-stage surgical approach toward a one-stage procedure. The success of this concept when combined with another complication—that of patients receiving drug therapy for osteoporosis—was studied to determine the best method of treatment in this situation.
The current issue of the Journal of Oral Implantology reports on adult patients, all taking oral biphosphonates for osteoporotic disease, who received fixed full-arch dental prostheses supported by six implants. Immediate loading procedures were performed, installing the implants in a one-stage surgery.
Osteoporosis is a well-known disease that weakens bone and increases the risk of fracture, particularly among postmenopausal women. Biphosphonates, an inhibitor of bone resorption, are widely used as a drug therapy for those with osteoporosis. Prolonged used of biphosphonates, however, can lead to a painful refractory bone exposure in the jaws, known as “biphosphonate-induced osteonecrosis of the jaw” (BONJ).
This condition usually develops after dental treatment, indicating that oral surgery and implants placed into the jaw bone can precipitate BONJ. Although the process is not fully understood, it appears that prolonged use of biphosphonates may suppress the bone’s repair function, interfering with healing after implants.
In the current study, a total of 54 implants were installed for nine osteoporotic patients, 45 to 68 years old, eight of them female. All had been taking oral biphosphonates for less than three years; a significant increase in risk of developing BONJ is associated with more than three years of biphosphonate therapy.
Immediate occlusal loading procedures were used, which require that motion at the bone-implant interface be kept below a certain threshold during healing. This study demonstrated a 100 percent success rate, with all patients rehabilitated with a full-arch prosthesis supported by implants. Two years of follow-up found no adverse events of infection, tissue swelling, or lesions, showing this to be a viable one-stage treatment.
Full text of the article, “Immediate Loading in Mandible Full-Arch: Pilot Study in Patients With Osteoporosis in Biphosphonate Therapy ,” Journal of Oral Implantology, Vol. 38, No. 1, 2012, is available at http://www.joionline.org/