Abstracts [Allg. med. Risiken_Implantate] 112010

Background: In the past few years, the occurrence of an oral lesion, called osteonecrosis of the jaw (ONJ), has been increasingly reported in patients undergoing treatment with bisphosphonates (BPs); however, few published histological studies of ONJ can be found in the literature. Purpose: The aim of the present case was to report an occurrence of ONJ after implant insertion. Materials and Methods: Multiple myeloma was diagnosed to a 65-year-old female. After 5 years of treatment with intravenous clodronate, two dental implants were inserted in the mandibular molar region. No preexisting bone lesions were present at a preoperative panoramic radiography. Before implant insertion, the patient had suspended the treatment with clodronate for 3 months. Four months after the implant insertion, a breakdown of the oral mucosa covering the implants occurred with a purulent discharge; periapical radiolucency was present around both implants. An en-block resection on the alveolar bone including the two implants was performed. No signs of recurrence of the lesion were observed after a follow-up of 20 months. Results: At the interface of one of the implants, a gap was observed between bone and implant. This bone was nonvital, and many osteocyte lacunae were empty. Moreover, this bone appeared to be partially demineralised. No newly formed bone or osteoblasts were present. Bone trabeculae were observed, on the other hand, within the apical implant threads of the other implant. A close connection was observed between this bone and the implant surface. Discussion: The histological findings showed some areas with osseointegration in patients undergoing BP treatment for malignant disease; however, any invasive procedure can determine the onset of osteonecrosis. Conclusion: In conclusion, there is certainly a temporal association between BP use and development of ONJ, but a correlation does not necessarily mean causation. Moreover, generalizations about this complex relationship cannot be made on the basis of a single case report. In patients undergoing intravenous treatment, clinicians must be aware of the increased risk of implant failure and, probably, implant insertion should be avoided at all until more conclusive data are available. What impact do systemically administrated bisphosphonates have on oral implant therapy? A systematic review. Clin Oral Implants Res. 2009 Sep;20 Suppl 4:87-95. Madrid C, Sanz M. Department of Oral Surgery, Oral medicine and Hospital Dentistry, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland. [email protected] Abstract OBJECTIVES: The aim of this systematic review is to evaluate, analysing the dental literature, whether: * Patients on intravenous (IV) or oral bisphosphonates (BPs) can receive oral implant therapy and what could be the risk of developing bisphosphonate-related osteonecrosis of the jaw (BRONJ)? * Osseointegrated implants could be affected by BP therapy. MATERIAL AND METHODS: A Medline search was conducted and all publications fulfilling the inclusion and exclusion criteria from 1966 until December 2008 were included in the review. Moreover, the Cochrane Data Base of Systematic Reviews, and the Cochrane Central Register of Controlled Trials and EMBASE (from 1980 to December 2008) were searched for English-language articles published between 1966 and 2008. Literature search was completed by a hand research accessing the references cited in all identified publications. RESULTS: The literature search rendered only one prospective and three retrospective studies. The prospective controlled non-randomized clinical study followed patients with and without BP medication up to 36 months after implant therapy. The patients in the experimental group had been on oral BPs before implant therapy for periods ranging between 1 and 4 years. None of the patients developed BRONJ and implant outcome was not affected by the BP medication. The three selected retrospective studies (two casecontrols and one case series) yielded very similar results. All have followed patients on oral BPs after implant therapy, with follow-up ranging between 2 and 4 years. BRONJ was never reported and implant survival rates ranged between 95% and 100%. The literature search on BRONJ including guidelines and recommendations found 59 papers, from which six were retrieved. Among the guidelines, there is a consensus on contraindicating implants in cancer patients under IV-BPs and not contraindicating dental implants in patients under oral-BPs for osteoporosis. CONCLUSIONS: From the analysis of the one prospective and the three retrospective series (217 patients), the placement of an implant may be considered a safe procedure in patients taking oral BPs for <5 years with regard to the occurrence of BRONJ since in these studies no BRONJ has been reported. Moreover, the intake of oral-BPs did not influence short-term (1-4 years) implant survival rates. "Bis-phossy jaws" high and low risk factors for bisphosphonate-induced osteonecrosis of the jaw. Abu-Id MH, Warnke PH, Gottschalk J, Springer I, Wiltfang J, Acil Y, Russo PA, Kreusch T. J Craniomaxillofac Surg. 2008 Mar;36(2):95-103. Epub 2008 Jan 30. Department of Oral and Maxillofacial Surgery and Plastic Surgery, Asklepios Klinik Nord, Hamburg, Germany. Abstract INTRODUCTION: Bisphosphonates (BPs) have transformed our ability to treat certain malignancies, osteoporosis and hypercalcaemia. This class of drug is assumed to be well tolerated by most. There are some important caveats to this assumption, however, one of the significances being the risk of osteonecrosis of the jaw (ONJ). MATERIAL AND METHODS: This multi-centre retrospective study examined the role of different BPs on the development of ONJ, its clinical presentation and the efficacy of various treatment modalities, comparing these findings with the available literature. RESULTS: A total of 78 patients from 17 centres were identified with ONJ. A majority of patients identified with ONJ had used Pamidronate or Zoledronate (93.6%) intravenously. 94.9% of patients had received BP in the course of treatment for malignancies and a majority had also received prior chemotherapy or exogenous steroids. 82.1% of patients had received BP for more than 1 year. The mean time from the introduction of BP to the development of ONJ in 24 patients from our department was 31.8 months. CONCLUSIONS: The most common intraoral manifestation was exposed necrotic jawbone. Tooth extractions and oral surgical intervention appear to place patients on BP therapy at risk of ONJ, especially after intravenous BP treatments. ONJ proved in this study to be remarkably refractory to treatment, with radical resection being the only curative approach. We recommend that all patients receive necessary dental treatment prior to commencing BP therapy. Influence of chemotherapy on endosteal implant survival and success in oral cancer patients. Kovács AF. Int J Oral Maxillofac Surg. 2001 Apr; 30(2):144-7. Department of Oral, Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe-University Medical School, Frankfurt am Main, Germany. [email protected] Abstract Little is known about the effect of chemotherapy on the osseointegration and survival of endosteal dental implants. In a retrospective study, two groups of patients were compared: one group consisting of 30 oral cancer patients received postsurgical adjuvant chemotherapy with either cisor carboplatin and 5-fluorouracil in three cycles and were treated subsequently with 106 dental implants placed in the mandible; the other group consisting of 17 patents suffering from oral cancer was prescribed with 54 dental implants placed in the mandible after oncological surgery. No patient was treated with radiotherapy. Twenty patients in the first group were successfully provided with a prosthetic superstructure (mean time of function: 35.8 months) compared to 16 patients in the second group (mean time of function: 36.2 months). The observation time was 10 years. A life-table analysis based on defined success parameters demonstrated no significant difference between implant survival in either group. It was concluded that chemotherapy with cisor carboplatin and 5-fluorouracil was not detrimental to the survival and success of dental implants in the mandible. Effects of chemotherapy in patients with dental implants. Steiner M, Windchy A, Gould AR, Kushner GM, Weber R. J Oral Implantol. 1995;21(2):142-7. Department of Surgical/Hospital Dentistry, University of Louisville, School of Dentistry, Kentucky, USA. Abstract Endosseous implant placement is generally considered to be contra-indicated in patients undergoing chemotherapy for the treatment of cancer. A case is presented where a patient was diagnosed with cancer and began chemotherapy four weeks after endosseous implants were placed. The impact of chemotherapeutic agents on endosseous implant acceptance as well as upon oral tissue is examined. Effects of chemotherapy on osseointegration of implants: a case report. McDonald AR, Pogrel MA, Sharma A. J Oral Implantol. 1998;24(1):11-3. University of Pacific School of Dentistry, San Francisco, Calif, USA. Abstract A patient underwent mandibular resection for high-grade osteosarcoma with immediate reconstruction with a microvascular fibula free bone graft and simultaneous placement of osseointegrated implants. Following initial healing, she underwent six cycles of chemotherapy and had further revision surgery prior to implant exposure and construction of a prosthesis. The chemotherapy appears to have had no deleterious effects on implant osseointegration or survival. Artikel frei einsehbar unter: http://www.joionline.org/doi/pdf/10.1563/15481336%281998%29024%3C0011%3AEOCOOO%3E2.3.CO%3B2 Dental endosseous implants in the medically compromised patient. Scully C, Hobkirk J, Dios PD. J Oral Rehabil. 2007 Aug;34(8):590-9. Eastman Dental Institute, University College London, London, UK. [email protected] Abstract The literature contains numerous observations on the significance of systemic disorders as contraindications to dental endosseous implant treatment, but the justification for these statements is often apparently allegorical. Although implants are increasingly used in healthy patients, their appropriateness in medically compromised patients is less equivocal. Perhaps surprisingly, the evidence of their efficacy in these groups of patients is quite sparse. Indeed, there are few if any randomized controlled trials (RCTs) in this field. Furthermore, any health risks from the placement of implants are unclear. We review the current evidence for the risks associated with endosseous implants in a range of systemic disorders. There is clearly a need for prospective systematic trials. The degree of disease-control may be far more important that the nature of the disorder itself, and individualized assessment, including the medical condition, quality of life and life expectancy is indicated. The benefits of implants to many of these patients may outweigh any risks. However, proper informed consent is mandatory. Consensus statements and recommended clinical procedures regarding risk factors in implant therapy. Cochran DL, Schou S, Heitz-Mayfield LJ, Bornstein MM, Salvi GE, Martin WC. Int J Oral Maxillofac Implants. 2009;24 Suppl:86-9. Department of Periodontics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MSC 7894, San Antonio, TX 78229-3900, USA. [email protected] PMID: 19885436 [PubMed indexed for MEDLINE] Artikel frei einsehbar auf der Website des ITI: http://www.iti.org/?a=1&t=0&y=3102&r=0&n=185&i=&c=25&v=list2&o=&s= Systemic conditions and treatments as risks for implant therapy. Bornstein MM, Cionca N, Mombelli A. Int J Oral Maxillofac Implants. 2009;24 Suppl:12-27. Department of Oral Surgery and Stomatology, School of Dental Medicine, Univerity of Bern, Freiburgstrasse 7, CH-3010 Bern, Switzerland. [email protected] Abstract PURPOSE: To evaluate whether systemic diseases with/without systemic medication increase the risk of implant failure and therefore diminish success and survival rates of dental implants. MATERIALS AND METHODS: A MEDLINE search was undertaken to find human studies reporting implant survival in subjects treated with osseointegrated dental implants who were diagnosed with at least one of 12 systemic diseases. RESULTS: For most conditions, no studies comparing patients with and without the condition in a controlled setting were found. For most systemic diseases there are only case reports or case series demonstrating that implant placement, integration, and function are possible in affected patients. For diabetes, heterogeneity of the material and the method of reporting data precluded a formal meta-analysis. No unequivocal tendency for subjects with diabetes to have higher failure rates emerged. The data from papers reporting on osteoporotic patients were also heterogeneous. The evidence for an association between osteoporosis and implant failure was low. Nevertheless, some reports now tend to focus on the medication used in osteoporotic patients, with oral bisphosphonates considered a potential risk factor for osteonecrosis of the jaws, rather than osteoporosis as a risk factor for implant success and survival on its own. CONCLUSIONS: The level of evidence indicative of absolute and relative contraindications for implant therapy due to systemic diseases is low. Studies comparing patients with and without the condition in a controlled setting are sparse. Especially for patients with manifest osteoporosis under an oral regime of bisphosphonates, prospective controlled studies are urgently needed. PMID: 19885432 [PubMed indexed for MEDLINE Artikel frei einsehbar auf der Website des ITI: http://www.iti.org/?a=1&t=0&y=3102&r=0&n=185&i=&c=25&v=list2&o=&s= Medical contraindications to implant therapy: Part II: Relative contraindications.