Treatment of a Patient With Implant Failure and Jaw Osteonecrosis: Successful Retreatment Using Implants.

C urrently, osteoporosis is on the rise, and is the most common disease of bone metabolism encountered in dental implant patients. Approximately one-third of patients over the age of 60 are affected, with woman incurring events twice as often as men. Alendronate sodium (Fosamax; Merck and Co, Whitehouse Station, NJ) is a secondgeneration nonhormonal bisphosphonate (BP) used in oraldose tablet form for osteopenic conditions. BPs possess a high affinity for bone inhibiting osteoclastic function and decrease bone resorption, preventing further bone loss. A possible complication of patients on bisphosphonates is osteonecrosis. Marx was the first who adopted the terminology to describe spontaneous or surgically induced nonhealing ulcers in the jaws that occur in patients taking bisphosphonates. This is termed bisphosphonate-induced osteonecrosis of the jaw (BONJ). According to the American Association of Oral and Maxillofacial Surgeons (AAOMS), the diagnosis of necrosis of the jaws induced by BP is based on the following criteria: (1) exposed bone greater than 8 weeks in duration; (2) it is induced by BP; and (3) no history of radiation therapy to the jaws. Although the initial effects of bisphosphonate therapy appear to be beneficial, with Merck & Co. reporting a 5.1% (alendronate, 70 mg/wk) mean increase in bone mineral density demonstrated over a 1-year period, the symptoms of BONJ may remain concealed for weeks or months, only to become recognizable by the presence of exposed bone in the oral cavity. Due to the common occurrence of tooth extraction, resulting in exposed bone, there exists a legitimate reason for concern and raises natural questions about alendronate’s effects on dental implant osseointegration. Currently, BONJ is considered long term and irreversible, despite attempts to discontinue medication usage. Little data has been collected on oral bisphosphonate-related osteonecrosis and dental implant failure along with management of these failures. Most of the reported cases were from IVadministered BPs. In the United States, there have been over 200 reported cases of possible bisphosphonate associated osteonecrosis of the jaw in patients taking Fosamax or Actonel (Procter and Gamble, Cincinnati, Ohio). This report discusses a patient taking oral Fosamax for 1 year and having successful implant osseointegration in the maxillary arch while after 5 years on this medication, the patient developed BONJ when implants were placed and loaded in the mandibular arch. The aim of this case study is to present the ongoing management of a patient who prophylactically utilized the bisphosphonate (Fosamax) and developed BONJ and how retreatment with dental implants can be successful following a drug hiatus.