Effect of long-term oral bisphosphonates on implant wound healing: literature review and a case report.
BACKGROUND
Bisphosphonates suppress osteoclast activity, and their intravenous use has been reported in hundreds of cases to be associated with osteonecrosis in the jaw. Little is known of the risks associated with long-term use of oral bisphosphonates despite their use for >10 years by an oral mode of delivery for the treatment of osteopenia, osteoporosis, and Paget's disease of bone. The purpose of this report is to review the literature associated with bisphosphonate use that could impact bone healing and to report a case of bone necrosis in a patient on long-term oral bisphosphonates.


METHODS
A Medline search was carried out to find relevant articles from both medical and dental literature between 1960 and 2006. A patient, who had been taking an oral bisphosphonate for >10 years, developed unexplained clinical signs of bone necrosis after routine dental implant placement. This case was followed, documented, and the treatment of the osteonecrosis described.


RESULTS
A summary of how bisphosphonates may play a role in wound healing is presented. The compromised healing noted in a patient, who was under long-term oral bisphosphonate use, was successfully treated with systemic antibiotics, local microbial mouthrinse, and aggressive defect management (detoxification and mixture of bone graft and tetracycline).


CONCLUSIONS
This case suggests that patients under long-term oral bisphosphonate use should be treated with caution. Well-controlled, prospective clinical trials on the effect of oral bisphosphonates on bone are warranted to determine which patients may be at risk for such complications.
Wang
Hom-Lay
HL
Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078, USA.
Weber
Daniel
D
McCauley
Laurie K
LK
D000284:Administration, Oral; D000368:Aged; D019386:Alendronate / Q000008:administration & dosage / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001861:Bone Regeneration / Q000187:drug effects*; D016025:Bone Transplantation; D000075202:Contraindications; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000628:therapy; D009067:Mouthwashes / Q000627:therapeutic use; D010025:Osteoradionecrosis / Q000139:chemically induced* / Q000628:therapy; D019379:Teriparatide / Q000008:administration & dosage; D014945:Wound Healing / Q000187:drug effects
D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D015921:Dental Implants; D004164:Diphosphonates; D009067:Mouthwashes; D019379:Teriparatide; D019386:Alendronate