Bisphosphonate medications

Conditions using bone-building drugs such as bisphosphonates and anti-RANKL drugs require special attention, because they are associated with a disorder called drug-related osteonecrosis of the jaw. Medications alter bone turnover, which is thought to put people at risk of bone death when undergoing minor oral surgery. At routine doses (eg, those used to treat routine osteoarthritis) the effects of the drugs last for months or years but the risk appears to be very low. Because of this duality, there is uncertainty in the dental community about the best way to manage the risk of osteonecrosis when placing implants. A study conducted in 2009 by the American Association of Oral and Maxillofacial Surgeons found that the risk of caries from low-dose tablet therapy (or slow injection) could be between 0.01 and 0.06 percent for any procedure performed on the jaws (implants, extractions, etc. ). The risk is higher with intravenous bisphosphonate therapy, operations or procedures on the mandible, in people with other medical problems, people taking steroids, and people who have taken a strong bisphosphonate or taken the medication for more than three years. This study recommends that implants not be placed in people who are taking high-dose or intravenous therapy for cancer. Otherwise, the study advises implant placement in general and the use of bisphosphonates may not affect implant survival.[17][18]